self injury, dissociation and amnesia

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Self-injury in all its forms, including accident-proneness or a tendency to be victimised again in abusive relationships, may actually constitute screen memories of abuse or symbolic memories that a person is using to keep explicit abuse memories out of consciousness. Repeatedly hurting oneself is a way of not having to remember the original hurt. Self-wounding may also be an unconscious repetition of past abuse in an attempt to make sense of a dim but haunting memory. The person is trying to knit the implicit remnant of the trauma memory into fabric of a continuous mental narrative.

The amnesia that many self-injurers have for their destructive behaviour may be related to the return of memories from which they have disconnected. Since the emotional pain of returning memories is overwhelming, the person enters a trancelike state in an effort to keep them blocked. Self-injurers with dissociative disorders often say that they “find themselves” with injuries on their bodies in the same way that they in strange places without knowing how they got there. Self-injuring can be a form of reality testing for abuse that the person, on some level, knows happened but has split off from consciousness. Injuring oneself can bring “forgotten” memories of abuse into the awareness in several ways. The wounds themselves can reinforce the reality of past abuse, long disavowed by dissociation and the persistent denials of family members who maintain that the abuse never happened or was an expression of love. The pain of self-injury can test reality by restoring the feeling of being alive. Self-injury can also re-enact past abusive events symbolically, recalling them behaviourally, and reinforce the persons conviction that he/she was abused as a child. The fear of remembering what one was forbidden to remember may make amnesia a survival tactic once again.

How common is self-harm?

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As with many emotional and mental health issues, where so many keep their suffering a secret, it can be very hard to gain accurate figures.  Another important consideration is that often even the friends and family of the person will be unaware of the self-harm, to such a degree is this secrecy.. What we do know though is that in the UK alone self-harm is responsible for over 150000 admissions to A&E a year, and this is only counting those who admit to their wounds being self inflicted. Research conducted anomalously through charities and support groups also indicate that only about 15% of people who self-harm will seek medical attention for their wounds, so this 150000 really can only be seen as the tip of the ice-berg.

People of all ages and from all backgrounds may at some time engage in self-harm, though it is most commonly seen among adolescents.  The NICE report into self harm indicates that the average age changes of adolescence have been removed, but for many the issue will continue into adulthood. Self harm seems to be more common in females than in males overall, though in fact more boys than girls under the age of 10 are admitted to hospital due to self-harm. In adolescence, girls may be around two or four times likely than boys harm in different ways and may be more likely to cover it up as the result of an accident or a fight. Self harm also occurs in adults, and there is some evidence that adults who self harm are at greater risk of serious consequences such as suicide attempts or hospital admission.

One group of adults who seem particularly vulnerable to self harm are prisoners, over half of female prisoners on remand say that they have self-harmed at some point in their lives. This may be because some of the common triggers of self-harm are more common in those who are vulnerable to committing crimes than in the general population, the actual prison environment may also serve to cause self-harm as prisoners are likely to know others who self-harm, may be discouraged from openly expressing emotion, and are often unlikely to gain access to support for mental health issues.

What is self-harm?

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Self-harm is generally defined as acting to deliberately injure yourself physically. The exact form of harm varies, some forms being invisible or don’t leave a wound, whereas others are visible, damaging the skin or other outer area. These visible forms (especially cutting) are seen as a more common form, but due to the secrecy held by many self-harmers regarding the activity and their reluctance to seek medical attention make it difficult to judge the real scale of self-harm.

Some people always harm using the same method, others use different methods based on what is available at the time or what will be easiest to hide. Some people who engage in self-harm do so only on specific parts of the body, others will vary in what area they harm, though many do say that they favour one area, failing to get the same degree of relief/comfort/pain/etc from other areas.

One very important thing to remember when discussing self-harm is the difference between acts with the intention of causing harm to the body and acts with the intention of ending ones life. In some ways these two actions could be seen as opposite to one another, with suicidal actions aiming to escape from life by ending it, whereas self-harm is an attempt to cope with life with the aim of continuing it. However, it is important to be aware that self-harm is often very closely linked to suicidal thoughts and attempts. Statistically those who self harm are many times more likely to attempt suicide than those who do not. Even those who are not suicidal may risk their life unintentionally if their harming becomes serious. Most teenagers say they harm in an attempt to express distress and escape difficult situations, but every year some lose their lives, even though this was not their aim.

Myths and facts of self-harm.

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Self-harm is usually a failed suicide attempt.

This myth persists despite a wealth of studies showing that, although people who self-injure may be at a higher risk of suicide than others, they distinguish betwen acts of self-harm and attempted suicide. Many, if not most, self-injuring people who make a suicide attempt use means that are completely different to their preferred methods of self-inflicted violence.

People who self-injure are crazy and should be locked up.

Tracy Alderman, Ph.D., author of The Scarred Soul, addressed this:

“Fear can lead to dangerous overreactions. In dealing with clients who hurt themselves, you will probably feel fear. . . . Hospitalizing clients for self-inflicted violence is one such form of overreaction. Many therapists, because they do not possess an adequate understanding of SIV, will use extreme measures to assure (they think) their clients’ best interests. However, few people who self-injure need to be hospitalized or institutionalized. The vast majority of self-inflicted wounds are neither life threatening nor require medical treatment. Hospitalizing a client involuntarily for these issues can be damaging in several ways. Because SIV is closely related to feelings of lack of control and overwhelming emotional states, placing someone in a setting that by its nature evokes these feelings is very likely to make matters worse, and may lead to an incident of SIV. In addition, involuntary hospitalization often affects the therapeutic relationship in negative ways, eroding trust, communication, rapport, and honesty. Caution should be used when assessing a client’s level of threat to self or others. In most cases, SIV is not life threatening. . . . Because SIV is so misunderstood, clinicians often overreact and provide treatment that is contraindicated.

People who self-harm are just trying to get attention.

A wise friend once emailed me a list of attention-seeking behaviors: wearing nice clothing, smiling at people, saying “hi”, going to the check-out counter at a store, and so on. We all seek attention all the time; wanting attention is not bad or sick. If someone is in so much distress and feel so ignored that the only way they can think of to express their pain is by hurting his/her body, something is definitely wrong in their life and this isn’t the time to be making moral judgments about their behavior.
That said, most poeple who self-injure go to great lengths to hide their wounds and scars. Many consider their self-harm to be a deeply shameful secret and dread the consequences of discovery.

Self-inflicted violence is just an attempt to manipulate others.

Some people use self-inflicted injuries as an attempt to cause others to behave in certain ways, it’s true. Most don’t, though. If you feel as though someone is trying to manipulate you with SI, it may be more important to focus on what it is they want and how you can communicate about it while maintaining appropriate boundaries. Look for the deeper issues and work on those.

Only people with Borderline Personality Disorder self-harm.

Self-harm is a criterion for diagnosing BPD, but there are 8 other equally-important criteria. Not everyone with BPD self-harms, and not all people who self-harm have BPD (regardless of practitioners who automatically diagnose anyone who self-injures with BPD).

If the wounds aren’t “bad enough,” self-harm isn’t serious.

The severity of the self-inflicted wounds has very little to do with the level of emotional distress present. Different people have different methods of SI and different pain tolerances. The only way to figure out how much distress someone is in is to ask. Never assume; check it oput with the person.

Alternatives to self-harm (focused on cutting)

Self-harm is when someone deliberately hurts or injures him or herself. This can take a number of forms including:

* cutting

* taking overdoses of tablets or medicines

* punching oneself

* throwing their bodies against something

* pulling out hair or eyelashes

* scratching, picking or tearing at one’s skin causing sores and scarring

* burning

* inhaling or sniffing harmful substances

Somepeople self-harm on a regular basis while others do it just once or afew times. For some people it is part of coping with a specific problemand they stop once the problem is resolved. Other people self-harm foryears whenever certain kinds of pressures or feelings arise.

Afew people who self-harm may go on to commit suicide – generally thesisnot what they intend to do. In fact, self-harm can be seen as the’opposite’ of suicide as it is often a way of coping with life ratherthan of giving up.

There are many methods that are meant to helpwhen the urge to SI overcomes you, some work, some don’t. One way toincrease the chances of a distraction/substitution helping calm theurge to harm is to match what you do to how you are feeling at themoment.

First, take a few moments and look behind the urge. What are you feeling? Are you angry? Frustrated? Restless? Sad? Craving the feeling of SI? Depersonalized and unreal or numb? Unfocused?

Next, match the activity to the feeling.

A few examples:

Angry, frustrated, restless

Try something physical and violent, something not directed at a living thing:

– Slash an empty plastic soda bottle or a piece of heavy cardboard or an old shirt or sock.

– Make a soft cloth doll to represent the things you are angry at. Cut and tear it instead of yourself.

– Flatten aluminium cans for recycling, seeing how fast you can go.

– Hit a punching bag.

– Use a pillow to hit a wall, pillow-fight style.

– Rip up an old newspaper or phone book.

– On a sketch or photo of yourself, mark in red ink what you want to do. Cut and tear the picture.

– Make Play-Doh or Sculpey or other clay models and cut or smash them.

– Throw ice into the bathtub or against a brick wall hard enough to shatter it.

– Break sticks.

– Yell at what you are breaking and tell it why you are angry, hurt, upset, etc.

– Crank up the music and dance.

– Clean your room, or your whole house.

– Go for a walk/jog/run.

– Stomp around in heavy shoes.

– Play handball or tennis.

– Scratch/draw a picture on a thick piece of wood or use a screwdriver and stab at a piece of wood.

-Take the item that you are self-injuring with and use it againstsomething else. For example, if you are using a razor blade rip itacross a towel or plastic pop bottle. Sometimes seeing what “can” bedone to an object can make a person think twice about using it onthemselves. Can also give the feeling of “doing it”.

Sad, soft, melancholy, depressed, unhappy

Do something slow and soothing:

– Take a hot bath with bath oil or bubbles.

– Curl up under a comforter with hot cocoa and a good book.

– Babying yourself somehow.

– Do whatever makes you feel taken care of and comforted.

– Light sweet smelling incense.

– Listen to soothing music.

– Smooth nice body lotion into the parts of yourself you want to hurt.

– Call a friend and just talk about things that you like.

– Make a tray of special treats and tuck yourself into bed with it and watch TV or read.

– Visit a friend.

-Instead of harming yourself, try massaging the area you want to harmwith massage oils or creams, reminding yourself that you are specialand you deserve to treat yourself and your body with love and respect.

Craving sensation, feeling depersonalized, dissociating, feeling unreal

Do something that creates sharp physical sensation:

-Squeeze ice hard (this really hurts). (Note: Putting ice on a spot youwant to burn gives you a strong painful sensation and leaves a red markafterward, kind of like burning would).

– Put a finger into a frozen food (like ice cream) for a minute.

– Bite into a hot pepper or chew a piece of ginger root.

-Focus on what is real and around you right then. Start lists of thingsaround you in detail i.e. colour, texture, smell, shape, etc.

– Slap a table hard.

– Snap your wrist with a rubber band.

– Take a cold bath.

– Stomp your feet on the ground.

– Focus on how it feels to breathe. Notice the way your chest and stomach move with each breath.

Wanting focus

-Do a task (a computer game like Tetris, or minesweeper, writing acomputer program, needlework, etc.) that is exacting and requires focusand concentration.

– Choose an object in the room. Examine itcarefully and then write as detailed a description of it as you can.Include everything: size, weight, texture, shape, colour, possibleuses, feel, etc.

– Choose a random object, like a paper clip, and try to list 30 different uses, and try to list 30 different uses for it.

– Pick a subject and research it on the web.

Wanting to see blood

– Draw on yourself with a red felt-tip pen.

-Take a small bottle of liquid red food colouring and warm it slightlyby dropping it into a cup of hot water for a few minutes. Uncap thebottle and press its’ tip against the place you want to cut. Draw thebottle in a cutting motion while squeezing it slightly to let the foodcolour trickle out.

– Draw on the areas you want to cut using icethat you’ve made by dropping six or seven drops of red food colour intoeach of the ice-cube trays.

– Paint yourself with red tempera paint.

Wanting to see scars or pick scabs

-Get a henna tattoo kit. You put the henna on as a paste and leave itovernight; the next day you can pick it off as you would a scab and itleaves an orange-red mark behind.

– Another thing that helpssometimes is the fifteen-minute game. Tell yourself that if you stillwant to harm yourself in 15 minutes, you can. When the time is up, seeif you can go another 15.

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