Self Harm

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Selina was 11 years old when she first started cutting. It was her way to cope with the immense trauma she’d already experienced in her young life. Now, as an adult, she wants to know how self harm fits into the world of addiction. Nzinga and Selina have an intimate, one-on-one conversation about trauma, recovery, and Selina’s own words of wisdom to others in her position. Please note, In Recovery contains mature themes and may not be appropriate for all listeners. 

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Other resources mentioned in the show: 

  • Celebrate Recovery is the faith based group support Selina mentioned
  • SMART is a non faith based support group
  • Crisis Text line: Text “Hello” to 741-741
  • National Suicide Prevention Hotline: 1-800-273-8255
  • The Trevor Project: Text “Start” to 678-678

To follow along with a transcript and/or take notes for friends and family, go to shortly after the air date.

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[00:27] Dr. Nzinga Harrison: Hello, everybody. This is Nzinga, and you are listening to In Recovery. This week, we’re going to be talking about self-harm. So let me start just upfront with a trigger warning: we have some pretty heavy, pretty painful content in this week’s episode. We’ll be talking about sexual assault and self-harm. So I wanted to just drop some resources up front and we’ll put these in the show notes, of course. If you or anyone you know is working through self-harm, you can call a crisis hotline. The goal is that when you get that trigger to self-harm that you call the crisis hotline before you self-harm so that we can hopefully prevent it. So the first one is the Crisis Text Line. So you literally just text the word HELLO to 741741, and somebody will get on with you immediately. The second one is the National Suicide Prevention Hotline. So that’s one 1-800-273-8255. It’s also 24/7, and somebody will hop on the phone with you. And then the last one I’m gonna give you is actually the Trevor Project. So the Trevor Project is specifically for LGBTQIA+ kids and teens to be able to reach out during a crisis. That number is 678678, and you just text the word START. 


[02:03] Dr. Nzinga Harrison: So with that, let me give you my regular introduction. I’m Dr. Nzinga Harrison. I’m a psychiatrist, a physician and addiction expert, co-founder and chief medical officer of Eleanor Health, where we take care of people who are affected by addiction. So if you’re in New Jersey or North Carolina, you call us up, we want to be in your community taking care of you. In Recovery is a show about all things addiction. So we talk about drugs. But, like today, we talk about other things: self-harm, sex, work, you name it. We are shining a bright light on all of the things that we usually push into the dark. And it’s question and answer, so I need you to send in your questions. You can call us, leave us a voicemail. That’s 833-4LEMONADA. Or for those of you like me who need the numbers: 833-453-6662. Or you can fill out our contact form. With that, Claire, should we jump in to the show?

[03:14] Claire Jones: Yeah. Let’s jump in. So we got a voicemail a little while ago with a pretty incredible story. I’m not really going to say anything. I just want to play a little bit of the voicemail. 


[03:28] Selina: Hi, my name is Selina. I’m 33, I’m from Idaho. I am wondering about cutting. So I have struggled with self-harm as well as opioid and meth use for decades. And I am in recovery from all of them at the moment. I just got over 30 days clean and sober, as well as having over 30 days off of self-harm. But my specific question is, is cutting, picking and hair pulling, is that considered an addiction in itself? Because to me, they feel like addiction. They feel the same as when I’m using drugs because they cover up the pain. I don’t know. I’ve never really asked a professional that. So I’m just curious about what your thoughts are. So, yeah. Thank you so much for hosting your show and have a great one. 


[04:30] Claire Jones: We wanted to call Selina back to ask her a little bit more about her story and to talk a lot more in-depth about self-harm, because like she said on her voicemail, this is something that she’s never asked a professional. And I think that that really goes to show how some mental health treatment is pretty isolated. So let’s hop into our conversation with Selina. 


[04:52] Dr. Nzinga Harrison: So, Selina, thank you so much for coming on with me. Nice to meet you. 


[04:57] Selina: Nice to meet you, too.


[04:59] Dr. Nzinga Harrison: So why don’t we start with you just telling our listeners a little bit about what you told me, and then we’ll get into your questions, but just help us get to know you. 


[05:11] Selina: So I’m in recovery from a lot of different things. So my primary things were meth and heroin. I’m clean and sober off of everything over 30 days. Coming up on 60, actually. I’ve also struggled with self-harm, primarily cutting for the most part. But sometimes trichotillomania and dermatillomania. 


[05:37] Dr. Nzinga Harrison: Go ahead and define those big words for the listeners. 


[05:42] Selina: So trichotillomania is pulling out the hair and dermatillomania is picking at the skin. And I am a survivor of sexual abuse. I was trafficked from five to seven by my nanny and her boyfriend, and then I was also being molested by my mom until I was 12, and my uncle at 13. And I started cutting myself at 11 just to kind of ease that emotional pain that I was going through. And so I guess that’s that’s pretty much like a lot of my story. I’ve also been in the military, lost a son and just been in survival mode pretty much most of my life. 


[06:28] Dr. Nzinga Harrison: So, man, survivor is absolutely right of so many things. It always hurts my heart to hear my young kiddos going through these kinds of experiences like you have. Talk to me about your magic formula that has gotten you almost to 60 days. Kudos, shout-out to you, by the way. 


[06:49] Selina: Thank you. So I actually go to AA and Celebrate Recovery, which is a faith-based version of Alcoholics Anonymous. And that’s where I found my first piece of support and my first home group and my first set of people that really understood me. Because what I get out of it is I get that family that I never had. That’s my first family. I have people nowadays that I can call at 1 a.m. if something goes down and I’m not OK. And then AA is pretty much along the same lines. I get a lot out of that because there are tons of meetings all over the place. And so I’m able to go to that more and build up more relationships and supplement my recovery through them. I worked the 12 steps. This is the first time I’ve ever been clean and sober and not been self-harming or struggling with eating disorders all at the same time. Like, I’ve been completely off of everything, which is pretty amazing for me. 


[08:00] Dr. Nzinga Harrison: Incredibly amazing. Do you feel like at 60 days then, is it getting easier? Is it still kind of takes all of your, you know, a lot of your energy each day?


[08:12] Selina: It does depend on the day. There are some days where it’s a lot easier and some days where it takes a lot of my energy. It really just depends on the day. 


[08:24] Dr. Nzinga Harrison: Yeah. Can you tell what it is about like one day where it feels a little bit autopilot and then another day where it gets very difficult?

[08:32] Selina: If my meds aren’t right. If I’m hungry, angry, lonely or tired, my HALTs are messed up. Or if I’m PMSing, like, it’s just dependent on what’s happening at that moment in that time. I’m also bipolar, and so if my medications — we just sit a medication adjustment — and I’m also on Suboxone for the heroin. So it has saved my life, literally. I’ve got actually longer than 60 days off of heroin, I’ve got nine months total off of heroin. I only count 60 days because that’s what I have off of meth and everything else. And that’s the longest I’ve ever had in my life. And that’s from being on Suboxone. And it not only helps with the cravings, because I was having such bad cravings that I was like foaming at the mouth. And it helps with the cravings for the heroin. But it also has been helping with the cravings for the meth. They increased my dose a little bit and it’s been helping with just cravings and general cravings to use meth or heroin or anything. And it kind of takes the edge off. And then the other thing it does is I have chronic pain from injuries that I’ve suffered. And so it also helps with my chronic pain without having to take any kind of other opiates or anything like that, just the Suboxone itself helps with the chronic pain, too. 


[10:14] Dr. Nzinga Harrison: Totally. So, you know I always talk about the magic formula being biological, psychological, social, spiritual, cultural. And you’re like hitting all of these. You’ve got your meds, your Suboxone, your meds for bipolar disorder, which is biological. But then on the other side, like, I love that you mentioned PMS, because we don’t think about kind of the internal chemical hormonal things that also make for a day where you have to really pour a lot of energy into using your coping skills. 


[14:13] Dr. Nzinga Harrison: So, Selina, your question, could self harm be considered an addiction? Yes, yes, yes, self-harm, we can absolutely approach it like an addiction. So, you know, on In Recovery, we define addiction as anything as humans that we keep doing, even though there are negative consequences. But very importantly, as humans, we don’t keep doing anything that only has negative consequences. And so we always have to be looking for what’s the benefit of that behavior so we can try to get the benefit of that behavior from something else that’s not going to cause us the negative consequences. Over the last like almost 20 years, I’ve taken care of a lot of people that have self-harm behaviors. And this is what they’ve told me over and over: the physical pain actually makes the emotional pain more bearable. Over these last 30 days, then, what have you found that is helping you cope with the emotional pain in a way that is not self-harm? Because our goal is we’re trying to find something that can give us the benefits of that behavior, because you need to cope with the emotional pain, but without the hair pulling, the skin, picking, the burning, the cutting. And so how are you doing that? So our listeners maybe can learn from you and try something themselves.


[15:40] Selina: So I’ve got a couple different tools in my belt. One of the best ones is writing. I’m a writer and I’m an artist. And so if I’m not writing, then I’m painting it out. That’s a good way to express where my emotions are at. And then if I’m not writing poetry or painting, then there’s some physical tools, because it’s a physical, sometimes a physical craving. So like holding ice in my hand or snapping rubber band on my wrist I’ve found. And those were suggested to me by other people. And I’ve actually used them a couple times. And the ice is really good because you get that burning sensation. Just don’t hold your hand until you actually do self-harm because that would defeat the purpose. Calling people.


[16:31] Dr. Nzinga Harrison: Yes, yes, yes, yes. We are pack animals. And when we’re hurting is when we need our pack the most. Calling people, calling people. Everything you’ve named is what we call grounding. When we think about addiction, we have the deep brain, and the deep brain is where our dopamine pathway is. And the dopamine signal in your brain basically tells you, like, you need this to live. But it also communicates very closely with the part of your brain that says that is dangerous and do whatever you have to do to stay away from that danger. When you were little, so many dangerous things were going on for you from being trafficked to being molested by your mom to being molested by your uncle. And if all of those things were going on, I can only imagine the other ways that you were not being protected as a child. And so your brain tries to protect you. And what it does — and tell me if you’ve had this experience, Selina, it kind of like checks out. Dissociates. Out of body. Because the emotional pain, and probably at times the physical pain is too great. And your brain says, I am going to protect you from this. And you get this checked out, out of body kind of experience. And so then what you’re doing when you put that ice in your hand is putting your feet back on the ground. We call it grounding. It’s bringing that danger signal down to a range where your brain can actually grab ahold of it and make a plan for it, as opposed to when it’s just too much in your brain just has to check out. Does that kind of feel like some experience you’ve had? 


[18:28] Selina: Oh, yeah, definitely. I’ve been diagnosed with a dissociative disorder, MLS, and PTSD. And I’ve definitely had times, even after trauma has passed, where like being a combat military veteran also, as well as everything else that I’ve been through, fireworks, for example, this past Fourth of July was my first Fourth of July sober since I’d come back from overseas. And I was ducking down and having physical reactions to the fireworks that brought me back.


[19:12] Dr. Nzinga Harrison: Totally. That was the danger part of your brain saying our life is in danger. And then this is where the addiction part comes in. So what you’ve been doing for the last 60 days is training your brain out of the knee-jerk reaction, because your knee-jerk reaction will be, I know what resolves this kind of danger: cutting, hair pulling, skin picking, heroin, methamphetamine. That’s the addiction pathway. That’s the dopamine pathway. Because those things did resolve danger and anxiety and fear and trauma before they became their own problem. The brain is now like, oh, I know exactly what will resolve this danger, and that’s when it gives you the cravings for those self-harm behaviors, for the amphetamine, for the opioids. And those are the days where it’s hard work. 


[20:06] Selina: Yeah, very much so. 


[20:09] Dr. Nzinga Harrison: And so what we have to do — it’s kind of like I gave this metaphor about race car drivers being able to drive 200 plus miles an hour in a circle. None of the rest of us can do that because we haven’t practiced, practiced, practiced, practiced. And so they do it so often that their brain can do it on autopilot. And so that’s what you’re doing right now in AA and Celebrate Recovery and with your therapist and your meds on board, is that you’re training your brain over and over and over when those scary moments come — because unfortunately, we can’t aim for zero scary moments in life. It’s just not the way life works. And so what we have to do instead is when we’re not in scary moments, practice, practice, practice, practice. Grounding, grounding, grounding, grounding. 12 steps, 12 steps, 12 steps, 12 steps. Call someone, call someone, call someone, call someone. Celebrate recovery, celebrate recovery, celebrate recovery. So that, like that race car driver, when you get in the race and your car clips the edge of the wall and you’re in a scary situation, your brain can go on autopilot to your coping skills instead of autopilot to the addiction. But it has to be trained. 


[21:30] Selina: That makes total sense because if you don’t practice when the sea is calm, then you’re not going to be able to know what to do when the sea is stormy. 


[21:39] Dr. Nzinga Harrison: There it is, because your brain is gonna to protect you from that danger. Your brain is gonna be like, I’m out. Like, we’re checking out. We’re dissociating. But when you have that autopilot that knows what to do. It’s kind of like the mom that lifts the car off the baby. We can’t do that under normal circumstances, but the brain will try to protect us.


[22:00] Dr. Nzinga Harrison: Life can be hard and awful. And there are childhoods that are awful, like Selina’s childhood. There is no other way you can call it except for just awful and nothing we would ever want for a child in our lives. But Selina is working her magic formula. Be like Selina, take the risk and figure out what’s biologically going on and figure out what’s psychologically going on. And sometimes that means going back to some very scary things. Figure out who your pack is. So Selina’s pack is AA and Celebrate Recovery and the other people she has wrapping around her. Find your life meaning and your joy. So Selina’s life meaning and joy is painting and writing poetry. And in Selina’s words, you have to practice, practice, practice when the seas are calm so that when the storm comes, you have those tools in your tool box to grab on to. 


[23:05] Dr. Nzinga Harrison: So, Selina, thank you so much for coming on. I know we’re getting close to the end of our time together, but I did want to ask you one more question, which is if you could say something to someone who is in your same position before you got help, what would you tell them? 


[23:22] Selina: I would say love yourself enough to ask for help. And that’s the hardest thing in the world when you’re an addict like us, coming from places we’ve been through is so love yourself. But just do it. Love yourself enough to ask for help. 


[23:43] Dr. Nzinga Harrison: Beautiful. Selina, I’m so glad you called us. 


[23:47] Selina: Thank you.


[27:05] Dr. Nzinga Harrison: So, Claire, I always get, like, a little emotional when our listeners come on and share with us so freely about such painful things. And then I also just feel so deeply like the triumph in her story. I prescribe Suboxone for a ton of people and literally over and over and over what I have heard: It’s saved my life. It’s saved my life. It saved my life. And it does. The risk of a heroin overdose is there every single time a person uses heroin, you literally could die right now in this moment, every single time. And so every person that I help get on Suboxone and that I help stay on Suboxone, that goes nine months without using heroin, the typical heroin use pattern is several times per day. It makes the brain call out. The withdrawal symptoms start about four hours after the last use. And so typically three to four times per day or more are people using heroin. Every single one of those, I’m terrified that this is the last time. And so when I hear Selina say — oh, I got choked up — when I hear Selina say nine months. Nine months, four times a day. This is when high school math becomes useful. That is a big number of times that Selina’s loved ones didn’t have to worry about getting that phone call. It is like a big deal. Suboxone saves lives. And so this is my life’s work, right? Like, stop hating on Suboxone because there’s a lot of hate on Suboxone. That is a lot of times that her family didn’t have to worry about getting that call. 


[29:03] Dr. Nzinga Harrison: So I’m gonna quote Selina again, because she gave me my whole entire life during that conversation, which is like, just take the first step, take the first step. Find somebody you can trust. Get some help if you use, just go back and get some help again. If we’re gonna do a little recap on the time that we just spent with Selina, then I wanted to touch on just like a few big themes that I think a lot of people experience. One: the relationship between childhood trauma and addiction is 100 percent hard-core established. So if you have gone through horrible, awful, painful, traumatic things as a child, then absolutely your risk for developing addiction of some sort is higher. 


[30:03] Dr. Nzinga Harrison: And so I hope what you hear in Selina’s story is the ability to really put an eye with support on those very scary things that may have even stolen your ability to develop healthy coping skills as you were growing up. Because we’re not born with coping skills. We learn coping skills by the people who are around us. And so if you had a childhood that was not protected and not nourishing and where you were not learning healthy coping skills, then this is how these other kind of riskier, health-damaging coping skills can develop. And I always say to my people, your childhood is not your fault, period, point blank. But now, as an adult, you do have the ability to grab onto some of that stuff and reduce the pain that is causing you. So Claire can guess what I’m about to say next, which is therapist. Therapist. Therapist. It is absolutely remarkable the scary things we can bring out of the dark with compassionate, professional support. So that’s number one. Number two: cumulative trauma. So as if Selina hadn’t already been through enough, then she went to war. And the trauma of combat laid on top of all of the biological and psychological changes that her brain and body had gone through, kind of to survive that childhood trauma. And so that was like another step. And what we know is that people who have been exposed to childhood trauma actually are at greater risk for being traumatized later in life. And so, again, so that we can try to interrupt this cumulative trauma cycle, is getting some help, getting some help. Three: you heard me just like layering on the praise and high-fives and backflips for Selina’s magic formula. And what I really want to point out is that she is working it. She was so honest with us. Like, listen, every day is not a cake walk. There are like some days where life is going to bring us something — and this is what’s so tricky about the brain is we don’t always know what those triggers are. The brain puts a lot of things together unconsciously that we don’t necessarily consciously put together. And so a lot of times the way we recognize that is like, oh, I’m anxious. Oh, I’m depressed. Oh, I feel lonely. 


[32:50] Dr. Nzinga Harrison: Oh, I feel afraid. And we don’t necessarily know what has triggered the brain to those feelings, but all of those feelings represent danger to our brain. And then that triggers the cravings for whatever coping skill the brain has access to. And then this the last thing I’ll say: support system, joy, life meaning. I cannot emphasize enough. We are pack animals and we need joy and we need meaning and we need purpose even in the midst of the most difficult times. And so a huge part of your support system’s role for you — and I do this for people when I’m taking care of them in the context of our treatment relationship — is when things are too scary, and you don’t know where to access your hope, and you don’t know where to access your life meaning, and you don’t know where joy is that you have a support system wrapped around you so that we can access those things for you. We can hold your hope for you and help you get your feet on the ground where you can find your own hope. 


[33:57] Claire Jones: So as we sort of talked about Selina story, there’s a lot that has gone on in her childhood and throughout her life. And so is treatment and recovery different when you’re experiencing co-occurring issues? Especially because it seems like she’s very aware of the other types of addictions that she has. But this was the first time that she’s ever talked about self-harm. So what does that look like for the treatment and recovery side of things? 


[34:25] Dr. Nzinga Harrison: Yeah. This is part of why I always ask people to get a comprehensive psychiatric or comprehensive mental health evaluation, because when I do psychiatric evaluation — and this is like standard of care — self-harm evaluation is part of that, because we know so many people, unfortunately, are having these childhood and young adult experiences that increase the risk for self-harm behaviors. That said, it’s not uncommon for people to have kind of this serial experience where it’s like, oh, we just started Suboxone from opioid use disorder and no evaluation was done for depression. Oh, and then you’re depressed and maybe your primary care doctor recognizes the depression, but evaluation wasn’t done for trauma. So then you start having nightmares and you go to a therapist and they say, oh, this looks like PTSD, but an evaluation wasn’t done. Like, our health system is so disjointed that that is a very common experience that people have, which is why we’re trying to arm them on this show.


[35:38] Claire Jones: Aside from a comprehensive exam, what else are some other things that would make recovery or treatment look different for people who have sort of co-occurring issues? 


[35:48] Dr. Nzinga Harrison: I mean, it actually looks different for every single human being because one of the most important parts of getting in recovery from any chronic illness that has a risk of relapse is figuring out what your triggers are. So that’s whether we’re talking about diabetes, high blood pressure, self-harm, opioids, methamphetamine. Like what are the triggers that make your brain send up that smoke signal that says “drugs will resolve this danger.” What are those dangers? That’s going to be unique for each person. The other side of that that’s going to be unique for each person is what brings you joy and life meaning? You put me and Selina in the same treatment recovery program and they’re like, today we’re going to do painting to resolve your stress. You just increased my stress. Painting is stressful for Nzinga! And so Selina over there having an amazing recovery experience and Nzinga’s over here getting triggered. 


[36:58] Dr. Nzinga Harrison: So the life meaning and the joy and the triggers are all extremely individual. And so while I collect these into big buckets, like I say, childhood trauma — what that trauma was, is different. How that child responded to that trauma is different. Cumulative trauma on top of that is different. Anxiety is different. Person to person to person to person to person. And so group therapy is a mainstay of addiction treatment. Some people can’t tolerate group. And so I can’t force you in a group because I’m actually destabilizing you. The pieces of the magic formula, there will be biological pieces, psychological pieces, social, joy, meaning support system, connectedness. The pieces are always going to fall in those big buckets. But it should be an individual puzzle for every single person that walks in. There’s no cookie cutter. It should look different. And it should look different depending on what’s going on right now. Selina told us that. So what her magic formula looks like today may not be what her magic formula looks like a year from now, because life is different. 


[38:21] Dr. Nzinga Harrison: I’m going to pin my words of wisdom at the end of this week’s episode for anybody who’s listening, who heard yourself in any aspect of Selina’s story. But what I hope Selina’s story will do for you is, one, help you recognize that you’re not on an island. And two, I’m always careful when I use the word “courage.” The courage that I’m asking you for is not the courage to not use. It’s not the courage to not cut. It’s just the courage to ask for help. If you are in pain, if you are suffering, there are people like us all around that want to be here to help you figure out how to not be in pain and how to not be suffering. And so when I’m saying “courage,” because there are scary things, it’s just the courage to trust another human being to ask for help. Even if you didn’t see yourself in Selina’s story, or if you did, and you’re in a position or a place in your life where you can maybe be the person to just ask another person if they need help, then I want you, even in this mind your own business culture that we live in, I don’t want you to mind your own business. I want to say I think I see you hurting. If you need help, I just want you to know that I’m here. So that’s how I would like to end this episode. Take the risk to ask for help if you need it. Take the risk to offer help if you have help to give.


[40:12] Dr. Nzinga Harrison: In Recovery is a Lemonada Media original. The show is produced by Claire Jones and edited by Ivan Kuraev. Music is by Dan Molad. Jessica Cordova Kramer and Stephanie Wittels Wachs are our executive producers. Rate and review us and say nice things. And follow us @LemonadaMedia across all social platforms, or find me on Twitter @naharrisonmd. If you’ve learned from us, share the show with your others. Let’s help destigmatize addiction together. 


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