Self-destructive behaviours like self-harm, disordered eating and substance misuse naturally spark concern in loved ones and care providers. 

The risks and consequences of such behaviours can be far reaching.  It makes sense then that motivation most often lies in ‘fixing’ the behaviour and eliminating the risks.

Frequently, the question posed is ‘Why the behaviour?’. However, as suggested by Dr Gabor Mate, perhaps the more pressing question is ‘Why the pain?’  (2018).

Self-destructive behaviour is an often misunderstood issue that profoundly impacts both the individual and those close to them.  Where current standard treatment approaches focus on thought and behaviour patterns in the ‘here and now’, there is growing evidence to support therapeutic interventions which explore the root causes of the behaviours.

Renowned trauma specialist, Dr Janina Fisher explains that each incident of destructive behaviour results in short term relief from psychological pain, followed by a ‘rebound effect’ which may include negative social consequences, traumatic exposure or reinforcing experiences.  This increases the likelihood that the same destructive behaviours will be stimulated again (2024).

Consultant Psychiatrist, Dr Frank Corrigan explains that destructive behaviours are an attempt to regulate a dysregulated nervous system (2010).  A cycle of re-traumatising self-destructive responses is set in motion and since the individual likely develops a tolerance to the addictive behaviour, increased or more intense attempts to self-regulate are needed to achieve some relief. 

Dr Janina Fisher explains that, despite the best efforts of health professionals, successful treatment of destructive coping behaviours is extremely challenging because the fear of their underlying pain is much greater than the fear of the risks involved in their behaviours (2024).

Self-destructive behaviours are self-protective strategies offering a sense of safety and a way to cope and regulate through deep, often unconscious pain. 

Although challenging thought and behaviour patterns is one aspect of successful therapy, it is not enough. 

I believe that much of the work is possible only as a stable therapeutic relationship begins to be established.  It is important to find a counsellor who feels like a ‘good fit’ for you.  Who can sit with you in your pain and honour the protections that have helped you survive whilst offering safety, compassion and care.  In this way, you can work together to uncover the underlying thread of pain, processing and establishing a new level of safety within and finding new, safer ways to regulate your system. 

References

Corrigan, F. F. J. N. D. (2010). Autonomic dysregulation and the Window of Tolerance model of the effects of complex emotional trauma. Journal of Psychopharmacology, 0(0), pp. 1-9.

Fisher, D. J. (2024). Understanding Self Destruction. s.l.:Dr Janina Fisher Ph.D. for Instagram and Facebook.

Mate, G. (2018). In the Realm of Hungry Ghosts. London: Vermillion.

The Window of Tolerance illustrates the state in which we best tolerate life’s every day demands and stresses. 

When we are within our own window of tolerance, we are present and alert.  We can engage with others and respond in a calm and considered manner, with skills to self soothe and regulate our emotional state.

However, when we are dysregulated, we are pushed out of our window of tolerance into either hyper-arousal or hypo-arousal.

Hyper-arousal is a state of excessive energy.  You are likely to feel a heightened sense of anxiety, which may make you highly sensitive and reactive.  The fight or flight responses are activated and you may experience symptoms such as:

anxiety, panic, fear, hypervigilance, angry outbursts, sleep problems and difficulty concentrating.

Hypo-arousal, in contrast, is a state of very low energy as a result of the freeze response.  You may experience:

numbness, lack of energy, inability to think or respond, reduced physical movement, low appetite, excessive tiredness and difficulty processing thoughts and emotions.

For people who have experienced trauma or cumulative toxic stresses, their window of tolerance can become very narrow.  Consequently, they will often find themselves in either hyper-arousal (fight or flight) or hypo-arousal (freeze) state.

As dysregulation feels incredibly uncomfortable, we unconsciously develop protective defences to bring us back within our Window of Tolerance.  Unfortunately, they can become very problematic when, later in life they end up causing us harm.

For example, as it is intolerable for a child to believe their caregivers are ‘bad’, they internalise the ‘badness’ and develop the belief that they are ‘bad’.  When this decision has been made early in life and reinforced through cumulative experiences, it is likely that they will carry this belief and defence into adult life.  Although it helped them survive childhood, it no longer serves in the same way in adulthood.

Counselling which focuses on processing trauma and painful memories without being flooded or overwhelmed helps to widen the window of tolerance; the client sees that those defences they created are parts of them created to survive but are not helpful or necessary now.  

Anxiety is hugely prevalent in society today. Over the last couple of years, with all the uncertainty of COVID, lockdowns and associated issues, more people of all ages have been seeking help to deal with anxiety.

The nervous system is a bit like a smoke alarm.  It is supposed to be there in case of emergencies, it is part of us, and when it’s doing its job properly, it’s good and it’s healthy.

The problem arises when our nervous system becomes over-sensitive and perceives threat and danger everywhere. When this happens, our alarm system goes off, flooding our bodies with stress hormones, and causing all the horrible physical feelings associated with anxiety.

In her book, ‘Atlas of the Heart’, Brene Brown explains that, unlike fear, which is a response to current threat, anxiety is linked to the future.  Research has revealed that there is a link between intolerance to uncertainty and anxiety.  It is common and natural to want to have control over what may happen.  However, unfortunately we never really have control over the future and this striving often exacerbates symptoms. 

Once the cycle of anxious thoughts, feelings and physical symptoms has started, it’s impossible to stop it using “mind over matter”.  You cannot think your way out of anxiety once it is there.  It is in our bodies and that’s where we must start to break its cycle.

Through counselling, we can learn techniques to put our bodies back into a calmer state and feel safer again.  We can influence our brains, slow them down and reduce anxious, overthinking thought patterns.

For many people, living with a chronic illness such as chronic fatigue syndrome (CFS) can be an anxious and frustrating experience. Fatigue, widespread pain, digestive problems, and disordered sleep are just some of the more common symptoms.  Dealing with these daily can be very isolating, and for some sufferers, this may lead to low mood, depression and/or anxiety.  Unfortunately, this is often a vicious cycle, with each component exacerbating the other.

 In his book ‘The Body Says No’, Dr Gabor Mate writes about the mind-body connection:

“The body will always find a way to communicate its needs. Whether we pay attention or not.”

Talking about your worries and frustrations and exploring new ways to cope with the limitations the condition brings, can help make it more manageable.

CBT, a type of therapy which works by interrupting the negative cycle of thoughts, physical feelings emotions and actions, and breaking down overwhelming problems into smaller, more manageable chunks, can be particularly effective.

 Mindfulness, a practice which helps reduce stress and anxiety by focusing on being in the present moment, can also be very useful as it helps the body to be in a naturally more healing state.