 | Scott E. Spradlin, M.A.
is a counselor who specializes in dialectical behavior therapy (DBT), a treatment for borderline personality disorder (BPD), self-injury and other disorders of emotional control. He also provides counseling for couples, depression, and anxiety. Scott has provided workshops to area mental health professionals, educators and clergy on the topics of suicide awareness and interventions, and self-injury. In addition to his counseling work he is also the author of the recently published book, Don't Let Your Emotions Run Your Life: How Dialectical Behavior Therapy Can Put You in Control, from New Harbinger Publications, he serves as the Pastor of Student Ministries at Grace Presbyterian Church in East Wichita, and is a part-time instructor at Wichita State University's Department of Counseling and Education. Contact Scott at (316) 651-7073, or e-mail: scott@ksdbt.com |
Family Counseling
2003-03-01 12:24:00
Self-mutilation
: After my 21-year-old daughter attempted suicide several months ago as a result of a young romance gone badly, a member of the hospital staff asked us, "Has your daughter tried to harm herself in the past by self-mutilation?" She has suffered unexplained cuts and bruises, but denies that they were self-inflicted. What does all this mean?
ANSWER: This is a very good question. It's always shocking to family members when one of their family tries to attempt suicide and may be engaging in self-harm behaviors. So first of all let me say, that it's normal to feel disoriented by all of this. And your daughter is indeed harming herself, it's understandable that she wouldn't admit that this is the case since she is most likely aware that most people don't consider this normal behavior, and so she might cover this up to avoid shame or being stigmatized by others.As for the unexplained bruises and cuts, they well could be the result of self-harm, or what mental health practitioners refer to as parasuicidal behaviors. There is a small number of people in the US population who engage in these behaviors, and women or girls are more likely to engage in this kind of behavior than are their male counterparts. And It's common to see self-harm behaviors among those who attempt suicide, and vice-versa, not always but quite frequently.Self-harm is frequently associated with Borderline Personality Disorder (BPD), but your daughter's behaviors, if it is self-harm, do necessarily mean that she meets the full diagnostic criteria for this disorder. To find out would require a professional evaluation in order to make any diagnosis. Self-harm is sometimes seen in people who fall in the broad category of Impulse Control Disorders. Some researchers are arguing for a new diagnosis for people who self-injure, repetitive self-injury, but who otherwise don't show enough symptoms of BPD or another disorder.There's a number of ways that people who self-harm do self-harm. Some people pull their own hair, others hit themselves with their own fists or objects such as walls, while others might self-injure by burning or cutting themselves. And now for the why? People who engage in self-harm usually do this as a way to control or regulate overpowering emotions, especially negative emotion states such as distress, sadness, anger or anxiety. There is a function within the dysfunction, so to speak. Self-harm behaviors are usually effective for them to distract themselves from their overpowering emotions, to reorient their attention to a single point, where the pain is, and there is usually a following sense of relief or calm immediately following self-harm. This sense of relief and calm serves as a reinforcer that will strengthen the likelihood that behavior will happen again, unless the self-harming person learns alternate skills that give the same effect of emotional control. You might want to talk to your daughter about seeking professional help for this problem. Try to approach her with as much understanding as you can muster. Be sensitive to the embarrassment she might feel in talking about it at all. Explain to her that you are concerned, that you don't understand what's going on for her, and that you think getting an expert involved is the best thing for her and the whole family. In fact, you will want to consider being part of the treatment process so that you can learn how to be supportive of her attempts to learn coping skills in a manner that is more informed and truly helpful to her in overcoming this problem. On this note, I recommend that you seek out a therapist who is trained in cognitive behavioral therapy, and be sure to ask your prospective therapist if they have treated this problem, and ask what kind of training they have in treating this particular problem. Even if she is not willing to seek help at this time, counseling and education for the rest of the family may still prove effective as you can learn how to cope as a family and perhaps over time she will see these efforts to genuinely understand her and warm up to the prospect of beginning treatment
