Self harm or self care?

(Please note: This is about self harm and suicidal urges, self-destructive thoughts, and specific ways I try to harm myself (including with food).)

I’ve been struggling recently with basic self care. Anything that I know is good for me or that will help me is hard for me to do.

I used to self harm myself in one specific way. I told my DBT therapist over the summer about it, and I’ve been tracking it on my diary card and using skills like distraction, “riding the wave,” etc. to not engage in the behavior. And, I’ve been successful! I haven’t done that behavior in over three months. Yay!

But… the urges to hurt myself or kill myself haven’t gone away. I have the urges as much as I did when I was still using the behavior. Sometimes I’m successful in using distraction or some sort of positive coping mechanism to manage and resist the urge. However, if the urge is very strong, or I’ve been feeling it constantly for several hours and nothing seems to be helping, or I’m too hopeless to believe skills will work… then I bargain with myself.

I say, “Okay, fine, I won’t kill myself. But, as a compromise, I won’t eat dinner. I know that eating dinner is something that will help me and make me feel better, and that is exactly why I won’t do it.”

I’ll say to my emotion mind, “I know you have the urge to hurt yourself. You can’t do that because it’ll mean you have to stop trauma work. But you still feel intense shame and anger at yourself and want to harm yourself. So, here’s something. I know you feel tired and want to go to sleep. How about you just don’t go to sleep?” And then I stay up until 2 am and don’t get enough sleep and feel more angry and guilty the next day and even more tired.

I’m still harming myself, just in less obvious ways. Not eating enough. Not sleeping enough. Not brushing my teeth. Avoiding friends because I know they’ll make me feel better. Avoiding using skills because I know they’ll make me feel better. Not submitting applications because I’m mad at myself and don’t think I deserve it. Eating chocolate late at night because I know it’ll keep me awake, and I want to prevent myself from taking care of myself and sleeping.

It’s almost easier to self harm in these ways because it’s a smaller decision to make. It often doesn’t require action, just intentional inaction.

Writing this out is helping me realize that self harm is still an issue for me, even if it doesn’t leave visible scars. I’m losing weight, even if it’s not noticeable. I’m hungry all the time. I sometimes have an erratic sleep schedule. My teeth hurt often. My eyesight is getting worse because I refuse to look up from my phone or computer when I start to get a headache. I feel as though I need to feel the pain of the headache because I deserve it.

So, it’s not good. There are negative consequences to doing these things. My “cured” self harm has really just been transformed into different behaviors because I was replacing the behavior, not acting opposite to it.

To be fair to myself, I do sometimes just distract and not do anything harmful. I sometimes reach out to friends or my therapist. I sometimes eat meals because I know it’ll make me feel better. There are just some times that I don’t…

I think the solution is opposite action. Instead of acting on the urge to harm myself, I want to acknowledge that it’s an urge, use the self talk that my therapist and I came up with, and act opposite to the urge.

The self talk is along the lines of,

• “This is emotion mind talking. It’s strong, but it’s emotion mind.
• Using skills has helped in the past.
• Sometimes skills take a while to work.
• Skills “working” is relative.
• Distress tolerance is supposed to help get you through the moment, not make you feel better. If you feel better, that’s an added bonus.
• When you are feeling better, you like feeling better.
• In the times that you’re not feeling like this, you would want to take care of yourself and help yourself feel better.”

Opposite action to the urge to hurt myself and to the emotions of shame and guilt is to be kind to myself. Some options are: putting lotion on my skin instead of hurting my skin, eating food, hanging out with friends, wearing pretty clothes, watching or reading something funny, etc.

Opposite action to self harm is self care. It’s hard to do because it’s the very thing that the self harm urges are telling me not to do. That’s where the self talk comes in. I have to believe it’ll work and have enough perspective to remember that there’s more than this moment and that self care or skills have helped in the past.

If I’m not thinking clearly enough to do the above, then distraction, calling my therapist, or other skills (if I’m willing to use them) are helpful.

In conclusion… self harm is still a problem for me, and I, Wise Mind Me, want to use the techniques listed above to take care of myself as opposite action to the emotions and urges I sometimes feel. I do deserve to feel better.

Things I’ve learned about myself

I’ve done three weeks of my treatment program now. I have at least one more week in the program, maybe more, depending on what I decide to do. I have learned a lot of new skills and ways of behaving, but I have also learned a lot about myself!

I have learned:

• Dissociation: I dissociate a lot. I know I am beginning to dissociate when I lose track of what is going on, ask “what?”, feel like my legs are disappearing, feel confused, have trouble moving, and have trouble focusing my eyes on things.
• Minimizing: I minimize my problems a lot. I say, “Eh, I’m just having a bad day, but it’s okay,” when really I am experiencing intense fear, shame, sadness, and anger and have very strong urges to engage in my target behaviors (self harm, suicidal ideation, etc.). This interferes with asking for help because I think my problems are “not bad enough” to deserve help. But they are.
• Self-validation: It is hard for me to validate myself. I tell myself that I “shouldn’t” be feeling emotions, and I try to block them out. It is hard to be understanding and kind to myself and to acknowledge that there are very valid reasons I feel the way I do. I may be overreacting to a situation, but I am overreacting for reasons that make sense, given my life.
  • Before my therapist left for her vacation, I told her to be safe on her trip and that I was scared that she was going to die. It was hard to say that, and especially hard to say it without prefacing it with, “This is weird, but…” After some talking, I was eventually able to validate myself by saying, “It makes sense that I am scared of this because it has happened before.” My family and I nearly died on a trip once. That doesn’t at all mean that my therapist is going to die when she goes on this trip, but it is valid for me to feel that way.
  • All emotions are valid! The specific emotion, intensity, and duration may not fit the situation, but it is still valid to feel that way.
  • Maybe I look to therapists, friends, and the internet for validation so often because it is hard for me to give myself validation, yet I still need it.
  • Purposefully reminding myself of my trauma (looking at my scars, going through old papers, finding triggering things), even though it upsets me, also serves the function of validating that something bad did happen to me and that it was real.
• Judgements: I judge my feelings and thoughts a lot. Now that I think about it, this could be the reason I minimize and invalidate myself. I say out loud or in my head, “This is stupid,” “This is weird,” “I’m so weird,” “Shut up,” “It doesn’t matter,” “It’s nothing,” “It’s weird; don’t say it,” etc. I am working on being more nonjudgemental and only stating the facts, not my judgements of them. For example, “I notice that I am feeling scared. I notice that I am having an urge to run away. I notice that I feel my heart pounding.”
• Abnormal behavior: I am learning what is normal and not normal behavior for a teenager.
  • Making plans to run away from home is not normal.
  • Staying up to 1 am and sleeping in to 9, or 11 or 12, is normal for a teenager.
  • Staying in bed or in my room for five hours after a nightmare is not normal.
  • Being afraid of going to sleep and as a result doing everything I can to put off going to sleep for hours is not normal.
  • Having feelings of wanting to die every day is not normal.
  • Having panic attacks every day is not normal.
• Avoidance: I avoid a lot of reminders of my trauma, and I have many methods of avoiding them. I have a list of triggers with over 50 items. I avoid looking at said list. I refuse to share it with my current therapist. I don’t look at pictures we have in our house that remind me of the trauma. I tune out of conversations that only indirectly remind me of it. I limit the places I go. I barely watch movies or read books because I’ve been upset so many times by them. I limit the classes I take in school to avoid topics where memories might be brought up. I clamp down on thoughts of the trauma, when I have them, and I very, very rarely talk about what actually happened (even just the basics).
  • I also avoid thinking about how I am feeling. In DBT, I have to fill out a “diary card” every day with my symptoms, emotions, target behaviors, etc. When I show it to my therapist, I flip it over, push it to the side, and try not to talk about it. It is hard for me to think back and explain what was happening when x on my diary card occurred because I bury it so deep.
  • This isn’t something I’ve learned about myself but something I’ve learned in general. Avoidance is okay in the short term but a problem in the long term. Avoidance is okay when it prevents me from engaging in target behaviors. In exposure, I will gradually stop avoiding, but it will be done in safe ways. 
• Relationships: I am scared of pushing people away and losing relationships. I genuinely don’t understand why certain people don’t hate me by now.
  • I had several close friendships end abruptly in my childhood. This could be why I feel like this.
• Self-hatred: I have feelings of self-hatred and worthlessness, and think I don’t deserve kindness, compliments, or good friends.
• Wanting to be a therapist: It is common for people who struggle with mental health issues to want to study psychology and become therapists. I am not weird for secretly wanting to be a therapist or to take psychology courses, even though I’m currently studying a totally different field. It’s okay for my interests to change.
• Diagnoses: I don’t actually know what diagnoses I have, and I’m not sure if I want to ask. I know for sure that I have Post-Traumatic Stress Disorder and that I have had (but maybe don’t at the moment? not sure) Major Depressive Disorder. Other illnesses I think I have or have had at some point (but I could very well be wrong because I am definitely not qualified to diagnose myself) are Social Anxiety Disorder, Obsessive Compulsive Disorder, Hypochondria (health anxiety), Generalized Anxiety Disorder, Seasonal Affective Disorder, Pre-Mentrual Dysphoric Disorder, Borderline Personality Disorder, and Panic Disorder.

I am learning so much! It makes me sad to realize how badly I’m actually doing, but I think that that’s necessary in order to actually address my problems and recover.

What is something you know about yourself?

(here is Things I’ve learned about myself, part 2)