Self harm blog (Editted)

For an interesting blog on self harm have a look at Sarah's Blog

She was kind enough to answer some questions I had and came up with some interesting material that provides more insight into this area.

I have made some comments about it but I will not post them until she has given approval. So this maybe editted later.

Case study 4.

Stone (2009) states, “I started to deliberately injure myself when I was in my mid teens.... When it came to my last year of Uni it really reared it’s ugly head as an addiction, one that came with an almost unbearable amount of emotion. I was so stressed out because of the pressure of my studies that I was thinking up ways to harm myself, but I couldn’t face the thought of someone else finding out that I had actually done this to myself.” (Paragraphs 11 - 12)

A follow up interview of the individual which was placed on the internet. “T” is myself and “S” is part of the response from the interviewee

Stone (2010) states, “T = Can you describe the type of self harming that you did , was there a ritual involved and so forth?

S = No there wasn’t a ritual that I followed, they were all separate events with sometimes weeks or a couple of months in between them as the stress built up. I felt in a very particular kind of mind set each time though and one which I came to recognise over the years. I didn’t self harm in the stereotypical way that one hears about these days, as I’ve said in my original post I’d never heard of the term or knew that anyone else did anything at all similar. I certainly considered hurting myself with blades etc but always wussed out! Now that I think about it punching or inflicting pain with a blunt tool such as a hair brush or edge or a piece of furniture was by far my preference. This created bruising rather than cuts as I felt it easier to do to myself. Twice I created a scene that appeared as though I’d passed out and made sure that I was found by someone. This had a similarly good feeling as it caused people to be really concerned for myself and give me some attention. Other times I created bruising and lied about how I had got them, pretending that I’d been beaten up or similar.

T = How the actual relief came. Was it before, during or after the actual act of self harming? And was their thinking about the self harming going on in your head at that time of self harming and if so what was it?

S = When I was inflicting the bruising at first it hurt but after a few minutes it almost became easy as I guess I became used to the pain and managed to block it out. This allowed me to continue inflicting this injury on myself long after I otherwise could have beared I think. It felt good to actually hurt myself like that, in doing it I felt some form of relief, but with it came a huge chunk of guilt knowing that what I was doing wasn’t good, but the ‘need’ to do it was far stronger than any feelings that tried to make me feel bad about doing it. Having created the injury I then liked telling people about it, lying all the time obviously, but their compassion made me feel good so the more people I told the better I felt about it. I certainly don’t go by ‘the end justifies the means’ ideas at all on the whole but in this case that went out the window! It was a completely cold calculated decision that I made each time. I didn’t consider the long term effects of what all the deception was doing to me or others, or whether this was a long term solution, it just went round and round my own head as I didn’t let anyone in on any of it.” (Paragraphs 10 - 13)

“T = I assume you don’t self harm now, so what changed?

.....So I have no need to hurt myself any more. When I’m stressed about something I talk it through with my husband, Mum, sister or close friend before it becomes a big issue. I look at the issue as objectively as I can, ask their opinions about it, weigh them up, ask God for His opinion on it and act from there. If it’s something that needs resolving that can be then I act in the way that I consider best, but if it’s just one of those things that you’ve got to just grin and bear it knowing that there’s an end in sight then I just get on with it. If I find that I’m still getting stressed I talk more about it, eat some chocolate, have a long bath, do some exercise – in fact anything rather than just sit and stew about it!” (Paragraphs 15 & 17)

This case study has some interesting clinical features. The most common methods of self harm tend to be cutting, burning and perhaps wound interference. In this instance we have an example of hitting self such that one bruises. As with other types of self harm there is an addictive quality reported thus indicating that her Child ego state is obtaining a significant psychological benefit from the activity. She reports the benefit as a sense of relief and she is using the self harm mainly as a means of tension relief.

Excluded Child ego state

Also reported is a particular kind of mind set prior to the punching and bruising. From a counseling point of view this is important as it indicates the build up period prior to self harm and one would enquire as to what that mind set was. Once defined one can then use it as an alarm system such that the individual can develop a Plan B to be used at that time with the hope of avoiding the self harm. Plan B being alternative ways to relieve tension and stress. Also from a counseling point of view she reports being able to block out the pain which means that she is capable of significant exclusion of the Child ego state as is shown in diagram 2. Treatment would need to include at some point an opening up of the Chile ego state feelings again. However they have been repressed for some time and for some good psychological reason if she agrees to open up the feelings again then she may come across some feelings which may be quite painful.

This case study also demonstrates how the different motives for self harming are not mutually exclusive. As indicated she self harmed as a means to reduce tension and she also mentions that she self harms as a way of obtaining attention from others. In addition to this we see that she self harms as a means to get nurturing in this instance from others. She reports liking the concern and compassion shown by others and reports regularly seeking these responses from others.

This shows the possible initial development of a condition like Munchausen Syndrome. By self harming she can adopt the sick or injured role with others then giving her nurturing and compassion. In this instance, as she matured she subsequently developed other means of seeking compassion and nurturing from others. If that had not happened then she may have developed fully fledged Munchausen Syndrome symptoms. In her last paragraph she explains how she now deals with stress and distress in ways other than self harming. She seeks out family and friends to talk to and get support from which is the psychologically healthy way to deal with stress and thus any Munchausen Syndrome symptoms have no need to develop.

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