Self Injury; Research, Bill of Rights and Worksheets

[historyteach]

This sticky is dedicated to the issue of Self Harm. It is a little known, and little understood issue. Hopefully, the information found here, and the sharing that results, will lead to a better understanding for all of us.

The following link will lead you to important information and research about Self Harm, or "cutting." It was on the anxiety forum a few years ago. Feel free to discuss any issues found on it here....
http://www.soberrecovery.com/forums/...lf-injury.html (Self-Injury)

My gratitude to MG for this information.

Shalom!

[daisygirl1217]

I was a cutter...I know from my own experience its all a matter of just not feeling the emotional torture...it sways away from that pain and brings on a whole other that in itself is relieving...Im grateful i only did it for a short period of time and that I grew from it knowing that cutting myself was really going to end up being yet another addiction to my list and maybe even one far worse then others....eventually i did end up trying to take my life and it was a stepping stone to that......I am thankful to be here today and feel for those that where once in my place years ago.....Just know in the end the healing from within will not take place from cutting on the outside......

[historyteach]

The following is from our own Miss Done-With-It.
I am sincerely grateful for her contributions to my understanding of this issue, and for all her sharings.

IMPULSE CONTROL LOG

The impulse control log is taken from S.A.F.E and is geared specifically for self-injury but can be used for many types of compulsions.
With the impulse control log it is required that you log down every thought or feeling associated with a particular urge to self injure, whether or not you actually go through with the act or not. In the beginning the goal is that the writing will become a diversion from the act itself. The long-term goal is to understand the connection between your thoughts, feelings, and behaviors.

Self-injury itself is a thought, not a feeling. Once you can fully grasp and understand that internally, you can begin to understand that self-injury is a behavior and behaviors can be changed.

Self-injury keeps us from dealing with uncomfortable feelings. Feelings or thoughts we find unacceptable are disguised through self-harming in some way although only a temporary relief is felt. If you feel the need to self-harm there is a feeling behind that, something you need to express.

Using the impulse control log is a good way to make you slow down, think before you act and remind you that you are in control.

Below is a generic example

IMPULSE CONTROL LOG

1.SELF-INJURY THOUGHTS: Burning, Cutting

2.TIME AND DATE: 3/9/07

3.LOCATION: My Room

4.SITUATION: A Friend and I aren't speaking, my boyfriend and I got into a fight, a relative is sick, and I lost my wallet.

5.FEELING: Angry, Upset, Lonely, Frustrated, Alone, And Disappointed

6.WHAT WOULD BE THE RESULT OF SELF-INJURY? If I cut/burn, Then I don’t have to get angry, then I don’t have to cry, then I don’t have to care,
then it won’t matter what they say or do, I can act and appear like I don't care.

7. WHAT WOULD I BE TRYING TO COMMUNICATE WITH MY SELF-INJURY?
That I do have feelings, that I think no ones cares, that I think I don't matter, that it hurts less if I cut/burn myself, that I'm scared.


8.ACTION TAKEN: Ended up running, doing some artwork, and writing in my journal.

9.COMMENTS: My desire to cut or act out is still w/me but I’m challenging the thoughts. Tonight I plan on going to the gym and then to a friends house.

__________________

Feel free to print out this ICL to log your own impulses.
Share whatever you feel appropriate with us as you wish.
__________________

IMPULSE CONTROL LOG

1.SELF-INJURY THOUGHTS:



2.TIME AND DATE:



3.LOCATION:



4.SITUATION:



5.FEELING:



6.WHAT WOULD BE THE RESULT OF SELF-INJURY?



7. WHAT WOULD I BE TRYING TO COMMUNICATE WITH MY SELF-INJURY?




8.ACTION TAKEN:



9.COMMENTS:


This is some powerful stuff!
I hope you find it helpful...

L'Chaim!
(To Life!)

[nandm]

Thank you daisy for you insight. My oldest daughter went through a period of time when she cut. It was frightening to watch her go through it. I have learned that I have similar tendencies although I have not taken them to a cutting extreme yet. Hopefully I never will. Counseling and treatment for my fear of emotion is something I hope will teach me enough about the disease and my own feelings that I am better able to help myself and others.

[historyteach]

The following Bill of Rights was made into law by the person who wrote it. (I'm not sure what state, but, I think it may be California.)

Bill of Rights for People Who Self-Harm

Preamble

An estimated one percent of Americans use physical self-harm as a way of coping with stress; the rate of self-injury in other industrial nations is probably similar. Still, self-injury remains a taboo subject, a behavior that is considered freakish or outlandish and is highly stigmatized by medical professionals and the lay public alike. Self-harm, also called self-injury, self-inflicted violence, or self-mutilation, can be defined as self-inflicted physical harm severe enough to cause tissue damage or leave visible marks that do not fade within a few hours. Acts done for purposes of suicide or for ritual, sexual, or ornamentation purposes are not considered self-injury. This document refers to what is commonly known as moderate or superficial self-injury, particularly repetitive SI; these guidelines do not hold for cases of major self-mutilation (i.e., castration, eye enucleation, or amputation).

Because of the stigma and lack of readily available information about self-harm, people who resort to this method of coping often receive treatment from physicians (particularly in emergency rooms) and mental-health professionals that can actually make their lives worse instead of better. Based on hundreds of negative experiences reported by people who self-harm, the following Bill of Rights is an attempt to provide information to medical and mental-health personnel. The goal of this project is to enable them to more clearly understand the emotions that underlie self-injury and to respond to self-injurious behavior in a way that protects the patient as well as the practitioner.

The Bill of Rights for Those who Self-Harm

1. The right to caring, humane medical treatment.
Self-injurers should receive the same level and quality of care that a person presenting with an identical but accidental injury would receive. Procedures should be done as gently as they would be for others. If stitches are required, local anesthesia should be used. Treatment of accidental injury and self-inflicted injury should be identical.

2. The right to participate fully in decisions about emergency psychiatric treatment (so long as no one's life is in immediate danger).
When a person presents at the emergency room with a self-inflicted injury, his or her opinion about the need for a psychological assessment should be considered. If the person is not in obvious distress and is not suicidal, he or she should not be subjected to an arduous psych evaluation. Doctors should be trained to assess suicidality/homicidality and should realize that although referral for outpatient follow-up may be advisable, hospitalization for self-injurious behavior alone is rarely warranted.

3. The right to body privacy.
Visual examinations to determine the extent and frequency of self-inflicted injury should be performed only when absolutely necessary and done in a way that maintains the patient's dignity. Many who SI have been abused; the humiliation of a strip-search is likely to increase the amount and intensity of future self-injury while making the person subject to the searches look for better ways to hide the marks.

4. The right to have the feelings behind the SI validated.
Self-injury doesn't occur in a vacuum. The person who self-injures usually does so in response to distressing feelings, and those feelings should be recognized and validated. Although the care provider might not understand why a particular situation is extremely upsetting, she or he can at least understand that it *is* distressing and respect the self-injurer's right to be upset about it.

5. The right to disclose to whom they choose only what they choose.
No care provider should disclose to others that injuries are self-inflicted without obtaining the permission of the person involved. Exceptions can be made in the case of team-based hospital treatment or other medical care providers when the information that the injuries were self-inflicted is essential knowledge for proper medical care. Patients should be notified when others are told about their SI and as always, gossiping about any patient is unprofessional.

6. The right to choose what coping mechanisms they will use.
No person should be forced to choose between self-injury and treatment. Outpatient therapists should never demand that clients sign a no-harm contract; instead, client and provider should develop a plan for dealing with self-injurious impulses and acts during the treatment. No client should feel they must lie about SI or be kicked out of outpatient therapy. Exceptions to this may be made in hospital or ER treatment, when a contract may be required by hospital legal policies.

7. The right to have care providers who do not allow their feelings about SI to distort the therapy.
Those who work with clients who self-injure should keep their own fear, revulsion, anger, and anxiety out of the therapeutic setting. This is crucial for basic medical care of self-inflicted wounds but holds for therapists as well. A person who is struggling with self-injury has enough baggage without taking on the prejudices and biases of their care providers.

8. The right to have the role SI has played as a coping mechanism validated.
No one should be shamed, admonished, or chastised for having self-injured. Self-injury works as a coping mechanism, sometimes for people who have no other way to cope. They may use SI as a last-ditch effort to avoid suicide. The self-injurer should be taught to honor the positive things that self-injury has done for him/her as well as to recognize that the negatives of SI far outweigh those positives and that it is possible to learn methods of coping that aren't as destructive and life-interfering.

9. The right not to be automatically considered a dangerous person simply because of self-inflicted injury.
No one should be put in restraints or locked in a treatment room in an emergency room solely because his or her injuries are self-inflicted. No one should ever be involuntarily committed simply because of SI; physicians should make the decision to commit based on the presence of psychosis, suicidality, or homicidality.

10. The right to have self-injury regarded as an attempt to communicate, not manipulate.
Most people who hurt themselves are trying to express things they can say in no other way. Although sometimes these attempts to communicate seem manipulative, treating them as manipulation only makes the situation worse. Providers should respect the communicative function of SI and assume it is not manipulative behavior until there is clear evidence to the contrary.

© 1998-2010 Deb Martinson.

Once more, I'd like to give credit to Miss Done for her contributions to our understandings about the serious issues involved in self harm. Thank you, Done!!!

This is an excellent model for other states to follow. If your state doesn't have a Bill of Rights similar to this, for people who self harm, feel free to copy this and take it to your state representative, or senator. All states needs to deal with these issues in a fair, humane manner.

L'Chaim!

[daisygirl1217]

hi Nandm

No problem on the story, i feel as though im really not ashamed of who and what i am, nor what ive been through....but i am learning to be more careful about whom i tell (like dates!) I cant even imagine the thought of seeing my child do something as torturous as this to themselves.....But I was alone and no one ever saw me, and no one ever saw the cuts either..Its a very personal problem that most dont want to share, so I am glad you knew about it and where able to help her.....Our emotions can be our biggest battles, least for me it is, and when you feel hopeless, useless and unloved (or so you think) it makes it very easy for oneself to hurt themselves.....Today is my first day on this site, and already i see myself coming out of the gloom i was in and ready to possibly start quitting my current addictions....before i used to tell myself that it takes one day at a time...now i know its more like one minute at a time....

[historyteach]

Originally Posted by daisygirl1217

I was a cutter...I know from my own experience its all a matter of just not feeling the emotional torture...it sways away from that pain and brings on a whole other that in itself is relieving...Im grateful i only did it for a short period of time and that I grew from it knowing that cutting myself was really going to end up being yet another addiction to my list and maybe even one far worse then others....eventually i did end up trying to take my life and it was a stepping stone to that......I am thankful to be here today and feel for those that where once in my place years ago.....Just know in the end the healing from within will not take place from cutting on the outside......

Thank you, daisygirl, for sharing.

I was quite surprised to see that scratching was one form of SI. I once did that as a child. I was almost in a trance, and didn't even know I was doing it, until I "woke up" and found a big cut on my wrist from scratching it over and over. It was the only time I did it, but, I still, to this day, remember it.
I don't know if that fits the profile or not. It just makes me think. And yes, there was an awful lot of emotional turmoil in my childhood.
Come to think of it...there is still now, in my adulthood! LOL!

How did you find your healing, if I may ask?

Shalom!

[historyteach]

Nan,
That fear of emotion you speak of is interesting to me. We wern't allowed to express any negative emotions as children. "Don't cry or I'll give you something to cry about" was a common statement from mom. Dad just gave a back hand to us. Children were to be seen and NOT heard! To this day, I have a very difficult time expressing myself appropriately. I either stuff it, (to quote Archie Bunker), or I rage. I'm learning to control the rage much better now, but, still can't get to the appropriate expression of emotions. Anger makes me cry most often now.
Hopefully, some day, I will learn. Better be soon. I'm well past middle age now!

Shalom!

PS, I also use humor.

[daisygirl1217]

My healing...gosh......it took me almost dying to find my way...to be at the brink of death to see that what i was doing was sooo very foolish......but in a way i felt like i had to go that distance...i grew up very suicidal and always wanting to die....well after many attempts this was my very worst and closest one.....never mind traumatic! I went to a mental hospital and was around so many beautiful wonderful people that have and where going through much worse torture than i could ever in my life imagine..and for the first time i saw the light..the light that said "what the hell are you doing, your life's problems are nothing in comparison" ...so i guess you could say i learned my lesson the hard way...like i always do.....but now I still struggle but never in my life will i cut or try and kill myself again......There are days, like today, where i find myself in dark places and struggle still to be happy...but i dont give up..i keep looking...and thats how i ended up here today

[daisygirl1217]

I do the same thing.....sucks!

[historyteach]

The humor isn't too bad; the crying sucks!

Thanks for your sharing, again.
It's true, I've found too, that there are many others with many worse problems than mine. Hard to imagine when I'm stuck inside my head. But, giving to others, like here on SR, for example, is one way to help me get *out* of that place.
*most of the time*

Shalom!

[October]

I had better ask permission to post here.....I am a lifelong major damage cutter.....my words are true....and extreme. Please let me know if you can accept me here.

[Done-With-It]

Originally Posted by unscarred

I had better ask permission to post here.....I am a lifelong major damage cutter.....my words are true....and extreme. Please let me know if you can accept me here.

Hi,

Of course we can accept you here.
I'm not sure what your asking permission to post, I personally just try and make sure my posts aren't or won't trigger anyone when it comes to self harm, etc.
But there are also mods on here to help out with that.

There's not a whole lot of SI'ers on here, but a few of us around.

Welcome!

[October]

Exactly the reason i asked......promise to always label my posts as "trigg" if it is pertinent. I am burned outTHE mod from psychforum's self harm forum....the one who burned out. Formerly "hardcore" also known as "deadseason". I am a cutter. I have been dead and bled three times from my problem......locked in the ward so many times i lost count. Quitting suboxone is the hardest thing i have ever done....i was a severe opiate addict...(oxycontin, heroin, those drugs.) for 12 years to the tune of 2000 dollars a week. On the program for six years......blew it due to a deadly benzo overdose last month....was homeless, schizzing out, and lost with no memory for 3 weeks......also as dpd....DISSASCOTIATIVE PERSONALITY DISORDER. I have more Dx's than ripley would believe. The last time i cut.........i almost cut my arm off. Do you still want me here? If so......tears of gratitude.....being welcome is something i am NOT used to. I am extreme......but, i care.....so much it hurts.....i love....others tear my heart out and i would do anything to help ANYONE with this problem.....just say the word.

[historyteach]

(((unscarred)))

Yes, you *are* welcome on the MH forum of SR!!!
Always...

Just know, we can help only as much as you are willing to help yourself.
Said with total love.
Cuz your dx is more than my experience can share...though I can share some.

Shalom!

[October]

Thank you Hteach.......on my knees tonight. SHALOM.

[October]

Where would you stay if she promised you heaven? Would you even try.

[historyteach]

No one can promise you heaven.
It's all up to you by your actions now on this earth.
Perception matters.

Shalom!

[October]

I chose to dance across the stages of the world.

Everyone said i'd never learn.

I waited all my life for you.

Sometimes even i am allowed to fall.

She said come down here.

Sweet Girl.

[historyteach]

I'm sorry, but, I don't understand your criptic style.

Do you need help?
Please call 911 if so, and say you are in trouble. They can assist you.

Otherwise, what are you saying with those ... I don't know... lyrics?

Please let us know. Cuz, we care.

Shalom!