BPD and Self Harm Syndrome

Working in a prison, the inmates wear short sleeves at all times (they do have coats they can wear outside and thermals for underneath their shirts at times), and due to my specialty with BPD I find myself often looking down at inmate arms for scars.  I haven't taken any kind of survey, but easily a quarter of the clients, whom are not necessarily mental health clients have scars.  They are quick to tell me the last time they cut, "it's been 2 years," "this was before I was locked up," mostly because they can be sent to segregation for these "dangerous" behaviors and suicidal actions (per the prison).  There is a huge rate of self-harm in those with Borderline Personality Disorder, as well as those with other mental health diagnosis.  There has been a push to create a diagnosis for those whom self-harm called Self Harm Syndrome. 

Favazza and Rosenthal, in a 1993 article in Hospital and Community Psychiatry, suggest defining self-injury as a disease and not merely a symptom. They created a diagnostic category called Repetitive Self-Harm Syndrome.The diagnostic criteria for Repetitive Self-Harm Syndrome include:

• preoccupation with physically harming oneself

• repeated failure to resist impulses to destroy or alter one's body tissue

• increasing tension right before, and a sense of relief after, self-harm

• no association between suicidal intent and the act of self-harm

• not a response to mental retardation, delusion, hallucination

Miller (1994) suggests that many self-harmers suffer from what she calls Trauma Reenactment Syndrome.As described in Women Who Hurt Themselves, TRS sufferers have four common characteristics:

• a sense of being at war with their bodies ("my body, my enemy")

• excessive secrecy as a guiding principle of life

• inability to self-protect (often seen in a specific kind of fragmentation of self

• relationships dominated by a struggle for control.

Miller proposes that women who've been traumatized suffer a sort of internal split of consciousness; when they go into a self-harming episode, their conscious and subconscious minds take on three roles:

• the abuser (the one who harms)

• the victim

• the non-protecting bystander

Favazza, Alderman, Herman (1992) and Miller suggest that, contrary to popular therapeutic opinion, there is hope for those who self-injure. Whether self-injury occurs in tandem with another disorder or alone, there are effective ways of treating those who harm themselves and helping them find more productive ways of coping. source

(Trigger Warning) It's the scars I don't see that worry me the most, the inmates whom have admitted they cut around their genitals as "punishment" for past experiences, which was not their fault.   Those that admit that even a man cat-calling them will give them trauma echo and their first thought it to hurt themselves, as they see themselves as to blame for the situation.  In my experience stopping someone from cutting is a lot harder than taking away the tool.  I meet with a 17 year old while working at a crisis center, whose mom told me he has not cut for a year, since she removed the knives and locked them away.  The young man then raised his shirt and told his mom that he had "found another way," showing her dozens of scars,  Without a new coping skill it is hard to leave an old stand by.  For that matter those who cut state "it works," it distracts from the pain they are feeling and provides temporary relief.  So rather than work on counting days without cutting, here is a list of DBT/CBT skills to do instead of self-harm.  I put my favorite in bold.

99 Coping Skills

• Exercise (running, walking, etc.)
• Put on fake tattoos.
• Write (poetry, stories, journal, etc.)
• Scribbling on sheets an sheets of paper
• Be with other people.
• Watch a favorite TV show.
• Posting on web boards, and answering others' posts.
• Go see a movie.
• Watch a movie from your childhood.
• Do schoolwork.
• Play a musical instrument.
• Paint your nails.
• Sing.
• Look up at the sky. (Night is especially beautiful.)
• Punch a punching bag (with gloves on.)
• Cover yourself with Band-Aids where you want to cut.
• Let yourself cry.
• Sleep (only if you are tired.)
• Take a hot shower or relaxing bath.
• Play with a pet.
• Re-organize your room.
• Clean.
• Knit or sew.
• Read a good book.
• Listen to music.
• Watch a candle burn (no playing with the flames!)
• Meditate.
• Go somewhere very public.
• Bake cookies.
• Alphabetize your CD's.
• Paint or draw.
• Ripping paper into itty-bitty pieces
• Hug someone.
• Write letters or email.
• Talk to yourself (or if that feels weird, buy a small tape recorder.)
• Hug a pillow or stuffed animal.
• Hyperfocus on something like a rock, hand, etc.
• Dance.
• Make hot chocolate.
• Play with modeling clay or Play-Dough.
• Build a pillow fort.
• Go for a nice, long drive.
• Complete something you've been putting off.
• Draw on yourself in red marker.
• Take up a new hobby.
• Cook a meal.
• Look at pretty things, like flowers or art.
• Create something.
• Pray.
• Make a list of blessings in your life.
• Read the Bible.
• Go to a friend's house.
• Jump on a trampoline.
• Watch an old, happy movie.
• Call a hotline or your therapist.
• Talk to someone close to you that knows [how you’re suffering.]
• Ride a bicycle.
• Feed the ducks, birds, or squirrels, etc.
• Color with Crayons.
• Memorize a novel, play, or song.
• Stretch.
• Search for ridiculous things on the internet.
• Hunt for stuff on Ebay or Amazon (you can find ANYTHING there).
• Color-coordinate your wardrobe.
• Watch fish.
• Make a tape of your favorite songs.
• Play the “15 minute game.” (You can't cut for 15 minutes, and when the time is up, start again.)
• Plan your wedding / prom / other event.
• Alphabetize your books.
• Hunt for your perfect home in the paper.
• Try to make as many words out of your full name as possible (then do your friends’ names.)
• Sort all your photographs.
• Plan a dinner party.
• Play with a slinky.
• Find yourself some toys and play.
• Start collecting something.
• Play video/computer games.
• Clean up trash at your local park.
• Go out and perform a random act of kindness for someone.
• Call up an old friend.
• Write yourself an "I love you because…" letter.
• Try to build something.
• Rearrange your house.
• Go through all your old stuff.
• Smile at least five people.
• Play with little kids.
• Go for a walk (with or without a friend.)
• Go to the mall.
• Clean your room /closet.
• Try to do handstands.
• Try to do cartwheels, bridges, backbends, and such.
• Teach your pet a new trick.
• Write a note to a very useful inanimate object thanking it for how useful it’s been.
• Move EVERYTHING in your room to a new spot.
• Get together with friends and play Frisbee, soccer or basketball.
• Randomly go up and hug a friend.
• Randomly search MySpace music for new music. Or use Pandora.com.
• Play the "If inanimate objects talked, what would they say?" game.
• Face paint.

My favorite skills I have utilized with clients is to freeze ice cubes (use red food coloring) and when you feel the urge grab an ice cube and melt it in your hands (over the sink or shower) and watch the red color drip down where you would want to cut. I try not to use foul language, but couldn't resist posting this gem.