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
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