Coping with Self-Harm and Dissociation
Self-harm and dissociation, separately, can be scary things. Together, they can be a frightening and isolating experience, to say the least. Let's talk a little about what that's like, and how to cope.
What Is Dissociation?
Dissociation, simply put, is a sense of detachment from reality. Some people experience a mild, generally harmless version of it from time to time in the form of daydreams. The same can be said when you "lose" yourself in an engrossing book, game, or movie.
Depersonalization and derealization are two much more serious examples of this that some people may or may not experience in conjunction with self-harm. As the Mayo Clinic's overview of these disorders explains,1 depersonalization occurs when you feel disconnected from yourself and who you are—you may feel as if you are not you or as if you do not really exist. Derealization, on the other hand, is when you feel disconnected from your surroundings—it's the world around you, rather than you, that feels unreal.
I've personally experienced derealization only a handful of times. It's surreal, to say the least, to look around your own backyard—the one in which you grew up and constantly played—and think, "Where am I? Why doesn't this place look familiar to me?"
Some people may only ever experience dissociation and not engage in self-harm; others who self-harm may never experience dissociation. But for a "lucky" few of us, self-harm and dissociation appear to be connected.
How Are Dissociation and Self-Harm Connected?
I'm not a therapist, and I won't pretend to have all the answers as to why some people experience dissociation and self-harm simultaneously. But I think a lot of it has to do with our emotional survival instincts. Our brains are hard-wired to protect us from overwhelm at any cost. Dissociation can be a way of distancing ourselves, psychologically, from thoughts, feelings, or situations we may feel unable to cope with.
I've never been diagnosed with an anxiety disorder, but I've struggled on and off with anxiety for some time now, and I've experienced several of what I am reasonably sure were panic attacks. It was these attacks that sometimes brought on an episode of derealization. While dissociated, everything—including my fear—seemed far away and inconsequential. It was like my brain needed a breather before it could parse everything I was trying to cope with.
Similarly, some people self-harm to vent difficult emotions and find relief from overwhelming distress. From this angle, I think it's pretty clear why those same people might also experience dissociation. Both are attempts to cope; unfortunately, neither seem to serve us well in the long run.
Coping with Self-Harm and Dissociation
At the moment when you're experiencing dissociation, it can be difficult to focus. In my experience, the most helpful thing at these times is to have someone nearby who can help you through it. This should be someone who not only knows about your situation but is aware (ahead of time) of how you want them to handle it. If this varies from one episode to the next, simply ask this person to be quiet and listen for what you need.
In my case, I usually ask for two things: peanut butter and talk. Because of its consistency, sticking a small spoonful of PB in my mouth forces me to slow down, to focus on a tactile experience. In that slowness, I can sometimes find a sense of calm. Asking my boyfriend to distract me by talking, meanwhile, gives me something to listen to, something to do besides spiral deeper into my dissociation. His voice is a comforting lifeline I can follow out of the fog and back into the real world.
Sometimes, however, I just need a quiet space to breathe. In my experience, simple breathing exercises are the most reliable coping methods for dealing with short episodes of dissociation—they're easy to remember, even when dissociating, and can be done anywhere, anytime. I'll say it again: slowing down and focusing on one single thing can be powerfully grounding.
Equally important, however, is what you do outside of an episode of self-harm and dissociation. Practicing good self-care—physical, mental, and emotional—is critical to diminishing and potentially preventing these episodes. Getting enough sleep, reducing stress, and eating a balanced diet all increase your resilience, decrease your distress, and make you less prone to self-harm urges and dissociation.
Above all, be sure to seek help if you need it. I strongly recommend finding a therapist or other mental health professional who can help you dig down to the root causes of your distress and help you find your best path forward. Other important sources of support include trusted family and friends, support groups, hotlines, and educational resources.
It's not easy coping with self-harm and dissociation, but it can be done. If you know of any other helpful tips or tricks for managing these that I've not mentioned here, please share them in the comments. Your suggestions might help more people than you know.
- Mayo Clinic, Depersonalization-Derealization Disorder. May 2017.
Kim Berkley (2022, January 13). Coping with Self-Harm and Dissociation, HealthyPlace. Retrieved on 2022, December 7 from https://www.healthyplace.com/blogs/speakingoutaboutselfinjury/2022/1/coping-with-self-harm-and-dissociation