"Are you cutting yourself"? How to talk to loved ones about self-harm

3. “What makes you want to hurt yourself?”

After a loved one has made it clear that they are ready to talk, it is worth asking a few more questions to understand their feelings, explains Zendegi. “Try to find out what emotional triggers precede self-harm, what consequences it causes. You need to identify the feelings surrounding the action, but not judge the action itself,” Freeman adds.

According to Kantor, questions such as “Have you noted what feelings make you want to harm yourself?” and “How do you feel afterwards?” are quite appropriate. and “How long does the feeling of relief last?” Not only will this lead to greater awareness of the person's experiences, but it may also give them the opportunity to speak out in a way they have never done before.

4. “I will do my best for you, but I cannot help you alone. Maybe we should ask for help?

According to NAMI, self-harm is a complex problem that is often accompanied by other behavioral and mental health disorders, such as substance abuse and depression. Stopping this behavior and learning new coping mechanisms requires the help of a mental health professional, so the first step is to convince the person to see a doctor.

But a friend or relative may refuse therapy, in which case you can mention acquaintances who have gone through this experience (if these people do not mind talking about it).

Some people are intimidated by the idea that psychotherapy is for life, in which case you can try a tactic that Zendegi calls “foot in the doorway” and invite the person to call someone and see what they have to offer, or try to go to the primary consultation. Only once, not for life.

5. “It’s okay if you don’t want to talk about it right now. I’m always there if anything happens.”

Perhaps a loved one is not ready for a long conversation or does not agree to immediately rush to a specialist. Experts advise in any case to respect his decisions and desires and promise to listen at any time when he needs help. Yes, this may take a lot of time, but no matter how you force it, you absolutely cannot.

Megan says she appreciated her friend's offer to return to the conversation on another day. “I don’t think we talked about it anymore,” she recalls. “But I felt relieved that I told someone about it.” The recognition did me good.”

The only exception in the case of advice to leave a loved one alone for a while is the fear that self-harm may indicate an intention to commit suicide. According to the US National Library of Medicine, self-harm is usually not a suicide attempt, but the habit does significantly increase the risk of suicidal thoughts in a person who does not get help on time. You can contact specialists, a crisis center, take the person to the hospital, or call his family, depending on the situation.

Phrases that should never be said under any circumstances:

1. “Let me see!”

Excessive curiosity is inappropriate here, Freeman warns. No matter how interesting it may be, it has nothing to do with helping, and there is a risk of not containing a negative reaction, which in turn can cause a feeling of shame in the person.

Megan found herself in a similar situation when a friend of hers, after finding out what was happening, asked to see her wounds. She was shocked by what she saw: “I don’t blame her for this reaction, but it certainly hurt me. I was already ashamed, and I condemned myself.”

2. “It’s not that bad.”

You should not try to convince a person that his feelings are not justified or that his behavior is not rational. Optimism is not appropriate here. Devaluing a person’s intense personal pain will minimize the significance of his experiences, which will make him feel even worse, warns Zenteghi.

3. “If you don’t stop, I won’t communicate with you anymore.”

Ultimatums are prohibited. Stopping self-harming takes more than just willpower, explain experts at NAMI. And putting forward conditions and ultimatums can only worsen the situation. The fear of losing friendships and connections will only increase a person's feelings of loneliness, hopelessness, misunderstanding and powerlessness.

You must always remember that your possibilities are not limitless.

Despite all the efforts made, a person may refuse to listen and also refuse help, reminds Dr. Kantor. Yes, this may create a feeling of failure and hopelessness, but this does not mean that the words did not have the desired effect. “Don't expect your friend or loved one's behavior to change immediately, but you've already planted the seeds in the ground,” he explains.

For example, Megan admits that she continued to self-harm for six months after talking to her friend. She eventually stopped doing this thanks to the help of her mother and a psychotherapist. But that conversation with her friend was, in her words, “a tiny step on the road to recovery.”

“You should think through and talk about what you are going to say in advance,” advises Zendegi. “You should be ready to use non-verbal methods of communication: look into your friend’s eyes, “mirror” his body language - facial expressions, postures, movements, in order to feel his state.”

What it is?

Most are of the opinion that only teenagers of recent decades cause physical harm to themselves. The reason for this is said to be the huge amount of violence and information overload. However, how to cut oneself has been known since ancient times. Religious fanatics resorted to various methods of self-torture, believing that the suffering of the body purifies the soul. Physical pain can really temporarily drown out mental pain. But why do teenagers and adults actually cut themselves, and what provokes such desires?

Self-harm is the infliction of intentional damage to one’s body for internal reasons without suicidal intentions. Considered a symptom of some mental disorders. Among them are borderline personality disorder, post-traumatic stress disorder, schizophrenia, bulimia, anorexia, bipolar disorder and others. But people can cut themselves without a clinical diagnosis, but it is often associated with depression, anxiety and other mental health problems.

Common types of self-harm:

Cuts on palms, wrists and thighs.
Scratching the skin until it bleeds.
Burns.
Throwing the body onto hard surfaces, hitting the head against walls.
Self-suffocation, head squeezing.
Interfering with the healing of wounds and scratches, their constant opening.
Swallowing inedible objects.
Piercing the skin with sharp and piercing objects.

Don't correct an alcoholic's mistakes

A typical situation: the son drinks, gets behind the wheel and gets into an accident. Parents immediately go to resolve the conflict with the police, pay fines and compensation, and restore their rights. This should not be done for several reasons.

Firstly, by taking care of your adult relative, you encourage him to take a childish position. A person will not learn to take responsibility for his own actions if problems are constantly solved for him. Gratitude will very soon be replaced by the feeling that the consequences of mistakes are not his concern.

Secondly, you provoke a new relapse. For example, if your loved one has already driven drunk once, nothing will stop him from doing it again. Often such indulgences lead to death - more than half of the crimes are committed while intoxicated.

How to deal with an alcoholic in the family: let them deal with the consequences of their decisions and actions on their own. This will help you quickly realize that a bad habit can ruin your life if you don’t start treatment.

Causes

This behavior is explained by two theories related to physiology:

Serotonin theory. A lack of serotonin in some people causes them to cope poorly with stress and begin to cut themselves. Painful sensations cause a surge of serotonin and improve a person’s well-being.
Opiate theory. The brain's anti-pain system is activated during bruises and wounds. Opiates are natural pain relievers, which dull pain and cause euphoria. People who regularly physically harm themselves can become accustomed to such effects.

The causes of self-harm can be both internal and external. Most often, such behavior hides a person's attempts to cope with emotional discomfort. The motive for starting to cut yourself can be any stressful situation. For example, the reasons could be:

Intrafamily problems: abuse, divorce proceedings, tyranny of wife or husband, neglect, excessive severity of parents.
Own powerlessness, resentment.
Experienced sexual violence.

Stage one. Shock and/or denial

Having received a confirmed diagnosis of a serious illness, the first hours or even days a person experiences a state of shock. He lives and acts “automatically” and may look completely calm and healthy.

Following the shock comes panic, the person begins to rush about literally and figuratively. To protect itself, the psyche develops a “denial reflex”: the patient does not believe in his diagnosis and often tries to lead a normal life, avoiding any reminders of the disease. Such a short-term state of denial is a natural defensive reaction, but if a person remains in this state for too long, then, firstly, he experiences extreme stress, and secondly, he puts his life at great risk, since he does not see a doctor and does not take care about your health. At the same time, relatives may be completely in the dark: often the diagnosis is either hidden from them, or they do not know the whole truth. Therefore, at this stage a person may feel very lonely, even isolated from the world, alone with his fear.

How to cope. Engage in self-education, collecting complete information about your illness. From getting to know the disease, you should gradually move on to getting to know the sick - that is, people suffering from the same disease. As the observations of doctors at the Moscow Center for Multiple Sclerosis show, even ordinary friendly communication between patients increases the effectiveness of treatment and quality of life.

Myth #3: Attracting attention to yourself

People who hurt themselves need love, attention and good treatment from others and loved ones, but this does not mean that they are trying to attract attention to themselves by self-torture. People who find themselves in such a situation try to stand out with their appearance and behavior: they either dress brightly or have excellent manners and politeness. The consequences of self-harm are never revealed, but are hidden and hushed up by wearing long sleeves or inflicting injuries in hidden places.

Stage five. Acceptance and revaluation

Acceptance and reconciliation are not the same thing. Acceptance means that a person has come to understand that he can live with his illness, that the patient has developed clear positive goals and aspirations, the implementation of which even illness cannot prevent. At this stage, it is time to re-evaluate your life, your plans and goals. Often, only after making a serious diagnosis do people understand what is really important and valuable to them, what is worth spending time and energy on, they focus on what is most important for themselves and give up what is unnecessary.

Chasing pain

Teenagers in Europe and the CIS began to drink less

According to statistics cited by the Spanish publication El Mundo, from 70 to 97% of people involved in self-injury are prone to “carving on the body” - legs, arms, stomach. From 21 to 44% - they fight. From 15 to 35% are burned. And, despite such a craving for self-mutilation, none of them even thinks about killing themselves with this. They would rather peel potatoes in the kitchen with a knife than cut their veins. But the risk of suicide through such actions, objectively speaking, increases.

A textbook example is a girl observed in the psychiatry department of the Sant Pau Hospital who introduced herself as Anna.

Anna “made her debut” in self-injury when she was only 14 years old. The cause was excess weight and bulimia, the fight against which resulted in anorexia and nervous breakdowns due to the ineffectiveness of treatment for these diseases. Today she is 16, and she is still not deregistered: a couple of weeks ago she cut her hands again.

When she was fat, she was constantly teased at school. Good-naturedly at first. Gradually this intensified, negative emotions began to prevail over positive ones - teasing turned into bullying. She set out to lose weight on her own after reading advice on the Internet. Among the most radical methods were recommendations for bloodletting and self-injury.

devices

Photo: Global Look Press/Jürgen Wiesler

“At home they began to hide from me all the objects that could cut oneself: knives, forks and even pencil sharpeners, which I learned to disassemble better and more professionally than a watchmaker unwinds clocks,” Anna shares her “professional” skills. “Then I learned to create sharp objects from everything that came to hand. Could have broken off a piece from the frame of the mobile phone. Or break the glasses you find. Or “accidentally” dropping a plate. If I walked past the tables set out on the street by some restaurant, I could easily pretend that I urgently needed to tie my shoelaces. She sat down near the table where there were wine glasses or glasses, and left with one of them. Sharp debris was always with me.”

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Methods of psychological assistance

Psychologists help determine the cause of the problem if the patient cannot do this on his own. In most cases, the latter cannot explain why they specifically harm themselves. Depth psychoanalysis helps to determine the preconditions for such behavior.

The treatment method is selected individually and may include the use of drug therapy. Taking medications is strictly controlled by a doctor. Cognitive behavioral therapy can achieve the maximum effect in the fight against self-torture. Psychotherapists advise patients to replace the habit of cutting veins or cauterizing themselves with any other actions not related to trauma. For example, you can start tearing paper.

Replacing them with your favorite activity or hobby will help you take your mind off obsessive thoughts. If harm is caused with the aim of obtaining certain emotions, then a cold shower, which intensifies the sensations, can help.

Types of damage

The described damage can be divided into the following types:

Impulsive. A person (often a teenager) causes harm to himself under a strong influx of emotions. This happens without intention or desire, unexpectedly, thoughtlessly and automatically.
Stereotypical. People with a stereotypical type of self-harm in most cases inflict bruises on themselves. Typically for people with autism or developmental delays.
Compulsive or moderate. Obsessive thoughts force a person to cause physical harm to himself. May be present in persons of any age.