October 15, 2010
Self-injury is a problem all too common for trauma survivors with dissociative identity disorder (DID / MPD) or borderline personality disorder (BPD). For that matter, self-injury (SI) is an issue for other populations of people as well. This discussion will focus more on the effects of trauma and abuse and how self-injury can be addressed effectively. However, because self-injury is actually a very complicated topic, this particular blog article will reach only a few of those layers.
In my years of working as a trauma therapist, I have noticed that many DID survivors self-injure when they are in emotional pain. They are hurting, their heart feels broken, they feel betrayed or abandoned, or they feel incredibly sad (but can’t cry). Turning to various forms of self-injury and self-harm sometimes helps to temporarily relieve their emotional pain. (Trauma survivors also self-injure when they believe they need to be punished, or when they are extremely anxious, or when they are feeling strong compulsions or hearing internal instructions, etc.)
One of the reasons self-injury works is because the brain cannot distinguish between a self-caused physical injury and any other type of physical injury and upon recognizing a body injury, the brain releases all the necessarily chemicals and hormones. Dopamine, serotonin, and neural structures are significant in this process. I’ll refer all the complicated medical explanations to others more qualified, but the point being is that the act of self-harm creates a reaction in the brain that allows the hurting person to feel a little more calm and numb.
In other words, when self-injuring, survivors are trying to feel better. They know they are in emotional distress, they recognize the emotional pain, and they know they are hurting. And they want to feel better, or at least to feel differently.
Self-injury can be a quick fix for these intense feelings. In that sense, self-injury is not a lot different from having a few shots of whiskey, or a shot of heroine, or a plateful of doughnuts, or a pound of chocolate. Many addictive behaviors are centered around finding a way to feel better when hurting.
Typically speaking, this has been a life-long issue. From even their youngest days, most dissociative trauma survivors were neglected or ignored when they were hurting. They were not comforted, and their pain was not acknowledged. Even as very young children, they were left alone with their pain and injuries. All too often, they were not properly tended to, they were not cared for, they were not hugged, they were not given medical aid. They were hurt – physically and emotionally – and they were left on their own to manage.
In my opinion, this lack of comfort and the years of neglect are some of the biggest crimes committed against young children. Neglect is as significant in causing harmful life-long effects as any direct trauma.
So, when working with trauma survivors who experienced significant pain and next-to-no comfort, a critical and crucial part of their healing process is to teach how to accept and create healthy and positive comfort.
Children who are injured in healthier environments are very much comforted by their mothers or fathers or other caregivers. Their hurts are recognized and acknowledged appropriately. These children are given hugs and gentle affectionate kisses. They get band-aids — sometimes they get the fancy special band-aids with Snoopy or Spiderman or pretty flowers on them! They are checked on repeatedly, they are allowed to sit close to their caregiver, they are given other little treats (such as stickers, or the chance to watch their favorite cartoon), etc. These injured children learn that positive forms of comfort can help them feel better.
Since traumatized dissociative survivors were typically not taught these ways of receiving comfort, this becomes an important treatment goal in their healing process. They need to know their wounds can be tended, that their hurts matter, that someone hears them, and that they can be treated gently during times of pain.
Tending to the hurts and the wounds often has to be modeled to dissociative trauma survivors. In many situations, this will be completely new experience for them, and the process of having their hurts be important, can be a profound experience.
As trauma survivors start to experience genuine comfort and caring from others (this may start first in the therapeutic office setting), these survivors will eventually learn to copy these same kinds of behaviors and apply them towards themselves and their other insiders.
Emotional pain is no different, and in some ways, addressing and comforting emotional hurts is even more important.
Teaching trauma survivors to sit with their emotions and to increase their ability to endure intense emotions is an essential part of the healing process. In early stages of therapy, most DID survivors can barely touch their feelings. In the later stages of the healing process, DID survivors can sit with their feelings, no matter how intense they feel them, and not turn to anything destructive or harmful.
In order to sit with those feelings, survivors need to learn what to do during those moments. They need to know and understand that they matter and that bringing more harm and pain to their selves and their bodies is not the answer. Learning how to comfort themselves – how to self-soothe, instead of self-injure – is a significant process in their healing.
Self-soothing means that the person is doing something that brings comfort in a helpful, positive way. Feeling better can become about comfort instead of numbing. Survivors can learn that they are worth being comforted, instead of being feeling unvalued and ignored.
Each time trauma survivors are comforted in their pain, instead of ignored or injured more because of their pain, they are experiencing a corrective emotional experience. Correcting the neglect by experiencing proper comfort, including self-soothing comforts, is incredibly significant in the healing process.
Comfort actually works much better than numbing, especially in the long run. Comfort allows for pain to heal. Numbing (or self-injury) means that the pain is just postponed until it comes back again.
Ways to Self-Soothe Include:
Self-soothing is unique to each person, just as any other preference is unique to each person. There are dozens and dozens of healthy options — explore a variety of different options to see what works best for you. Some ideas to try include:
- Listening to music that matches your mood – if you are feeling sad, listen to music that will help you express that sadness.
- Sing to yourself (even if this means making up your own songs, or singing sounds), or play musical instruments as a way of expressing your feelings.
- Wrap yourself up in your favorite comfy clothes or in a warm blanket and snuggle up somewhere safe, quiet, and protected.
- Hold or hug a pet, a stuffie, or a pillow.
- Sit close to someone safe. Lean against their shoulder, or find some way to have physical contact that is in no way sexualized or dangerous.
- Sip on your favorite tea, or any other gentle beverage, and treat yourself to a few simple snacks that are not heavy, but are tasty and nutritious.
- Rock in a rocking chair, or sit in a swing, and let the movement relax and calm you.
- Walk slowly or sit quietly in areas of nature that are beautiful and inspirational.
- Make your room, or your home feel particularly cozy – have nice smelling candles, or soft lighting, or bring out your favorite treasures to look at, sit by a calming fireplace (not for injury purposes! But yes, sitting by a warm fireplace can be very beautiful and calming). If you need to clean up an area first, that is ok, because it is important to be in an area that you can feel calm and quieted.
- Take a warm shower or a warm bath, using very nice smelling soaps and body washes. Dry off with your favorite most soft towels. The more you can make this a “spa-like” experience, the better.
- Bring in fresh flowers, or fresh greenery, or pretty leaves. Looking at something beautiful from nature, even while you are indoors, can be calming and soothing.
- Allow yourself to cry, uninterrupted, when the feelings come. Crying really is allowed, it really is ok, and it is a natural expression for pain. Use soft tissues, and don’t punish yourself for having real human emotions. Give yourself permission to feel, permission to heal, and permission to respond naturally to your pain. The more you can express your emotions in natural ways, the healthier you are.
Trauma survivors — you really can help yourself to feel better without bringing more pain and injury to yourself. The key is to surround yourself with lots of nice, positive moments that help you feel better through the course of the day. Practice self-soothing every single day, especially on painful days. It will get easier, even when if it doesn’t feel easy or natural to you at first. You can learn this, and when you do, it will make a huge difference in your life.
Kathy Broady LCSW
Copyright © 2008-2010 Kathy Broady LCSW and Discussing Dissociation
May 10, 2009
This blog article is a tribute to the mothers out there in the world that have spent huge chunks of their lives fighting for the safety / healing of their children. These women are incredible spirits and are an inspiration to us all.
I know mothers who have absolutely gone the distance for their children. These women don’t get thanked often, but I do want to let them know that they are appreciated, recognized and deeply valued.
These mothers do a lot of things right.
- They listen attentively to their children, even if hearing the horror stories of abuse breaks their heart. They want to know what happened, and no matter how hard it is to hear, they listen to every single word.
- These mothers have clearly done a good job building communication with their children even before this point. Children have to know that it is ok to tell – “telling the secret” is often one of the biggest barriers in children getting help from their abuse. The children have to have someone safe to tell, someone they trust, someone that they can rely on to help them. If the mother hasn’t already built that kind of relationship with her children, she has drastically lowered the chances that her children will ever tell her their deepest secrets of abuse. Mothers that are approachable will
- These inspirational mothers do what it takes to protect their children from abusers, including leaving the perpetrator in whatever way is necessary – divorce, moving to another area of the country, going into a shelter, etc.
- They take assertive strong legal action against the perpetrator such as filing a report with child protective services, filing protective orders, pressing charges against the offender.
- They withstand the pressure from other friends and family members who may, for whatever reasons, oppose taking a strong stance against the perpetrator. These mothers know that protecting their children is more important than the approval of family members who want to hide embarrassing issues in the closet.
- These mothers are dedicated to finding helpful resources for their children’s therapy and treatment for sexual abuse. This is not always an easy task, and it might require a great deal of persistence, but these mothers will persist, for as long as it takes.
- These mothers sit with their children as they cry, they comfort their children after nightmares, they let their children cling to them when “being away from mommy” feels too scary. These mothers recognize that their children have been crime victims, that they have PTSD from their abuse, and that their neediness has skyrocketed. Good mothers let it be ok that their children need this extra time and attention to rebuild their emotional security again.
- These mothers are strong for their children, even when their heart is breaking. They get their own personal support system to help with their intense emotions (believe me, being the mother of an abused child is a highly emotional situation), and they find a way, place, and time to talk about their own grief and anger so that they can be present and available for their children.
- These mothers are brave enough to honestly assess the situation, and to look closely at how their children got tangled in an abusive situation. They learn from whatever mistakes were made, and correct them. They think back to see if there were any warning signs or high-risk factors that they missed, and learn how to handle things differently now that they are aware of the abuse. They figure out what to do in the future to keep their children safe from being abused in that particular way ever again.
- These mothers spend hours and hours of time with their children, even if they are acting-out and emotionally distraught from the abuse they suffered. The mothers temper their discipline with deep understanding that their children are acting out of their hurt, fear, pain, anger, etc. These moms realize that their children’s behavioral issues are not about the children being “bad”.
- These mothers provide new and positive activities for their children to help boost their tattered self-esteem and body image. They find recreational activities, or artistic activities, etc that give their children healthy feelings of acceptance, accomplishment, mastery, positive self-worth, creativity, growth, etc.
- Protective mothers will do everything in their power to help their children overcome the long-term negative effects of childhood sexual abuse. They are determined to not leave their children to suffer in silence and isolation. These mothers actively attend their needs, provide comfort, and help their children move forward as healthy, productive members of society.
Helping children recover from sexual abuse can be a long, difficult process, but if non-offending mothers are not willing to be protective and helpful for their children, the negative affects of the abuse can multiply and worsen through the years. Untreated sexual abuse issues lead to all kinds of additional complicating factors such as addictions, promiscuity, self harm, depression, anxiety, mental health issues, repeated involvement in destructive relationships, angry behavior, destructive behavior, sexual acting out, hospitalizations, additional abuse, dissociative disorders, etc. The cost of untreated sexual abuse truly multiplies exponentially over time.
Mothers that are willing to help and protect their children as close to the injury-point as possible are helping their children in the here-and-now, and creating a permanent and positive effect on their children’s lives. These mothers are also making a positive difference that can have a positive influence on society for years to come.
For those mothers that are willing to protect their children, here are my very best wishes that today is the most wonderful Mother’s Day for you. Thank you, thank you, thank you for helping your children. You truly deserve a good day today!
Kathy Broady LCSW
April 25, 2009
Long-term, chronic, and severe child abuse causes a variety of medical and emotional issues for the survivors of such extensive abuse. Dissociative identity disorder (DID/MPD) is one long-term issue, but medical complications are extremely common as well.
In addition to addiction issues and mental health issues, most survivors find that they have numerous medical issues as either a direct or indirect result of their severe childhood sexual abuse.
INCREASED MEDICAL COMPLICATIONS
- Numerous medical complications or physical ailments from the years of internalized stress, anger, bodily harm, etc.
- Increased risk of stress related diseases, including depression, bipolar, PTSD, anxiety, etc
- Colitis, high blood pressure, heart disease, gastrointestinal problems, fibromyalgia, etc.
- Frequent headaches and migraines
- Numerous dental issues, including harm to the teeth, especially if the survivor experienced a lot of drugging
- A history of shaken baby syndrome, whiplash, broken bones, head injuries, etc.
- Bizarre illnesses or medical conditions that are difficult to explain or diagnose
- Inability to thrive – failure to grow
- Physical or mental impairment due to early childhood injuries
- Brain development affected – people who are severely sexually abused in childhood have permanent changes in their brains, specifically in the left hemisphere. These changes cause increased difficulties in the way they think, react, feel, and behave.
Long-term, severe, chronic child abuse causes long-term, severe, chronic medical issues, with both physical health and mental health.
Who pays for that?
One of the most frustrating negative effects of childhood sexual abuse is that the survivors as adults, on their own and struggling through each day, are left to manage the costs of their medical and mental health treatment by themselves, with minimal financial assistance from the people that actually caused the harm.
Going the legal route in terms of suing for damages is typically unrealistic. Besides, dissociative survivors often need long-term therapy and treatment prior to being ‘emotionally together enough’ to even consider a lawsuit. Either the survivors have not yet sorted out their trauma history / information in order to be able to present an organized, sequential legal suit, or they have too much internal conflict going on about what to tell, who to tell, etc. And, of course, being angry at the perpetrators is such a frightening thought that taking their perpetrators to court can be completely impossible.
So by the time dissociative survivors are able to deal with the legal world, they have already had to find a way to get years of therapy in the first place.
It’s so very frustrating to see the perpetrators walk away, comfortably well off after demolishing and destroying the lives of the survivors. Just like the pimps on the streets are comfortably rich in comparison to the beaten up, drug-addicted, stressed-out girls they sold on the corners, organized perpetrator groups are wealthy in comparison to the girls they’ve sold, abused, and used up.
Sometimes, perpetrator fathers will pay for therapy costs / medical bills as a quiet “under the table” compromise to their children. The “I’ll pay for your medical bills in exchange for your ongoing silence and not taking this to the public arena” exchange does happen, but it does not come without its own complications. Perpetrator fathers are very good at guilt-tripping their daughters, and having an ongoing connection to their perpetrator creates a constant tension and conflict in their healing process.
Insurance companies and disability policies are providing less and less coverage.
No one wants to pay for the crimes done by sex offenders, yet these offenders have created horrible life-long wounds for children all over the world.
One of the costs of long-term, severe child abuse for survivors is dealing with the complications of getting proper healing in the first place.
POOR MEDICAL AND THERAPEUTIC ASSISTANCE
- Excessive monies spent on medical bills, treatments, therapies, etc.
- Years of misdiagnosis, poor medical treatment, inappropriate therapies
- Hospitalization after hospitalization after hospitalization – It’s not at all uncommon for survivors with DID to have over psychiatric 30 hospitalizations in their lives.
- Costs to insurance, government medical funds, unpaid medical facilities, etc.
- Finding appropriate therapeutic help is extremely difficult, and too often non-existent, leaving the victims to suffer even longer
- Maintaining appropriate therapeutic help for the years it takes to overcome the depth of the damage is complicated and expensive. The treatment is heart wrenching and grueling work. And yet, intense therapy is required to improve a survivor’s devastated quality of life
- Expensive medications are often needed for years to assist with stability
- Psychiatric medications, though helpful in many ways, have many disturbing side effects that are also difficult to live with
- Psychiatric medications are not prescribed in an exact science type of way. Survivors will go through years of trial and error to find what works for them and when. Different doctors prescribe medications differently.
So who pays for all of this?
Unfortunately, for the most part, survivors have to pay for their own healing by themselves, which means more sacrifices made by people who have lost quite enough in their lives already.
Is that fair? Is that right?
No, that is not fair. No, it is not right. Not at all.
But it is typically the only way for survivors to get the healing they need.
Is your healing worth this for you?
Kathy Broady LCSW
March 21, 2009
The healing process for Dissociative Identity Disorder (DID/MPD) is very long, involved and complex. The article, 50 Treatment Issues for Dissociative Identity Disorder, lists out many of the steps involved in trauma therapy. While that list is comprehensive, it still only covers the surface steps. What tasks do you need to tackle next?
It takes years of time to work through all the issues and complications created from severe trauma and dissociative splitting, and while that length of time may feel discouraging in the beginning, let me assure you that progress truly is possible. You really can heal from your hurt and traumas and lead productive happy, healthy lives.
Therapy is somewhat like the progression through years of school. Therapy work builds upon itself through time to involve a lot of additional steps – the basics needing to be accomplished and mastered first. If the basics are neglected or not learned well, then therapy will get stuck — and if someone goes to school and gets stuck in the fifth grade for three years, they are going to feel very frustrated, especially if the goal is to graduate from high school.
So what keeps a person stuck and unable to progress further in their healing? What blocks their therapy from moving forward?
Sometimes people get comfortable addressing only the surface layers of their trauma. Sometimes they get too afraid to address the deeper layers of their system. Therapeutic resistance can be normal for various periods of time. But will avoiding those areas of your healing bring you the peace of mind that you want?
What if you have been in therapy for years already and are still struggling desperately? Blocks and stalemates in the therapy process usually lead to increased depression, ongoing anxiety, more self-injury, not to mention the added frustration and wasted time and resources. While it is important to tackle the healing process at your own pace, it is also good to make significant treatment gains at every step of the way.
What is missing in your therapy process?
What is interfering with your therapy process?
Where are you resistant to change?
Here are some of the common reasons that people get stuck in their healing process:
- A fear of seeing the abuse – wanting to keep those dissociative walls in place
- A lack of resources, and financial constraints to being able to get sufficient help
- A refusal to accept that loving family members were also abusive monsters
- An adamant refusal to look at who the abusers were
- Anger – wanting a “safe target” to fight with instead of a therapist for assistance and guidance
- Being too busy testing everyone over and over instead of getting to the actual therapy work
- Clinging to denial, clinging to denial, clinging to denial
- Comfort Clingers – wanting to stay hurting, even on purpose, to get comforting responses from other people
- Creating distractions from therapy work
- Current-day abusers actively sabotaging the progress you are making in therapy
- Current-day control by external abusers reinforcing the fear of telling
- External life issues become too overwhelming, ie: kids, school, work, finances,
- Fatigue, frustration, and just being tired of trauma issues being the center of your life
- Fear of learning more, of future consequences, of any number of things.
- Fear of other loved ones being hurt or abused if certain secrets are exposed
- Finger-pointing blame at others instead of being self-responsible for movement and changes
- Genuinely incompetent therapy or working with an uninformed therapist
- Interference of addictions – any form of drug abuse, alcohol abuse, sex addition, etc
- Internal programming is running interference and not being removed or addressed
- Laziness – thinking that healing happens magically without having to put in the hard work required
- Not really and truly wanting to do the therapy work – simply going through the motions instead
- Outgrowing the therapeutic knowledge and assistance that your current therapist can offer
- Putting more effort into helping / rescuing others than addressing personal issues
- Refusal to speak with the others in your system
- Refusing to acknowledge, admit, or address your own negative behavior
- Sabotage – of self, of relationships, of therapy
- Self-injury, self-destructive behaviors, suicidal behavior
- The front host refusing to speak with the inside system
- The Ostrich Syndrome — denial or blindness to seeing the reality of the problem
- Threats of ongoing abuse if certain secrets are exposed
What is blocking your therapy and healing?
Kathy Broady LCSW