Reposted from https://kirstenlindsmith.wordpress.com/2016/02/05/the-dark-side-of-the-stim-self-injury-and-destructive-habits/
The Dark Side of the Stim: Self-injury and Destructive Habits
In my previous article, Stimming 101, I wrote about autistic stimming as a normal and healthy aspect of autistic identity. While this is most often the case, I want to follow up with a slightly different article, because not all stims are created equal.
Sometimes stimming is unhealthy or even dangerous.
Parents, caregivers, and autistic people all need tools to deal with these types of stims. We in the autistic advocacy community often paint all stimming as wonderful and healthy, leaving high and dry those who need help. So, let's talk about the dark side of the stim.
The Dark Side
One of the most frequent questions I get from readers is what to do about unhealthy stimming. These requests come from both non-autistic caregivers and autistic people. A few typical examples include children who bang their heads against walls, teenagers who bite their fingers and nails until they bleed, or adults addicted to self-harming behaviors like cutting or burning.
As I discussed in Stimming 101, stimming serves a variety of purposes.
Many people require various forms of sensory input to regulate their systems. For example, people with ADHD benefit from mild background music while working to keep up their dopamine levels and maintain focus.
Stimming can also be an outlet for overload—sensory or emotional—and provide a feeling of relief and reset from overwhelming feelings. Examples of this can even be seen in overexcited neurotypicals.
Related to the latter but slightly more extreme: stimming can provide a safe haven from full overload and meltdown. Regular, strong stimulation provides a focus point for the body and mind, helping to shut out painful stimuli.
The stronger the overload, the stronger the stim has to be to provide the needed relief.
This last purpose is a primary source of unhealthy stimming, for this very reason.
Everything Louder than Everything Else
How do we respond to discomfort? To fear?
Let's look first to film and literary clichés for examples…
We grit our teeth and bear it. We ball our fists and dig our nails into our palms. We bite our tongues to keep from screaming. We pinch ourselves. We slap hysterical people to knock them out of it.
What do all these methods have in common? They all involve the distraction of pain as a coping mechanism.
Have you ever been so upset that you instinctively retreated to the distraction of overwhelming stimulation, even in a mild way? Perhaps you relished the burn of a pure shot of vodka, squeezed your hands together a bit too tightly, or jumped into a too hot shower.
There's a reason pain is the universal distractor. Pain is the only form of stimulation that our nervous systems will not acclimate to.
All other sensory receptors, when continually stimulated, eventually stop firing.
If you walk into a house with too many cats you may cringe at the strong scent of kitty litter, but if you stay and hang around you'll stop noticing the smell. This isn't about attention, this is a physiological reaction. You really do stop smelling the cat pee.
But if you're in pain, you won't acclimate to it. As long as the reason for the pain is still present, your nervous system will keep on sending you those signals. Not only that, but it will prioritize that sensation above others.
Pain is perhaps the strongest bodily sensation we have. It covers and blocks out all other sensations. This is what makes it so useful—it tells us when something is wrong. It keeps us safe when we are injured and need to tend to our wounds. But this is also what makes it so dangerous for those prone to sensory overload.
Most people have never felt sensory or emotional discomfort so strong they would injure themselves to cover it. But to a person with a sensory or emotional processing difference that threshold can be much easier to reach.
Types of Unhealthy Stimming
I'm going to focus here on the most common types of unhealthy stimming that readers bring to me. There are always going to be exceptions that don't fall into a neat label, but in an effort to be as practical as possible, I'll divide unhealthy stims into two major categories: Overload, and Bad Habits.
These are the stims drown out everything else. Including:
- Hitting the head (against a hard surface or with objects)
- Biting or scratching the hands, arms, or other parts of the self
- Hitting oneself or throwing the self against hard surfaces
- Tearing or pulling at the hair
- Other extreme injurious behaviors that come on suddenly and forcefully
2) Bad Habits
These stims, while still unhealthy, are done in a more slow and controlled way. They may come on gradually and escalate, or may occur at low levels continually. Including:
- Biting, picking, or scraping at the finger or toe nails to the point of injury
- Dermatillomania and trichotillomania (skin picking and hair plucking, respectively)
- Self-harm behaviors such as cutting, burning, stabbing, etc.
- Biting or scratching the self at a continuous, low-grade level (e.g., chewing on the hands)
- Pica (eating non-food items, such as paper or tinfoil)
- Other dangerous or injurious behaviors that are done relatively calmly, either continuously, in all or most contexts, or under stress
Addressing Overload Behaviors
There are two primary ways to interrupt dangerous overload stimming. The first is to remove the problem stimulus that's causing the overload. The second is to redirect the behavior while still addressing the need for stimulation. Usually, some combination of the two methods will be most effective.
Removing the problem
This first method is most effective as preemptive intervention, or during the initial, ramp-up stages of meltdown.
Preemptive intervention requires the problem stimulus to be specific, predictable, and controllable.
For example, my mother once worked with an autistic little girl who had several triggers along these lines. If she heard a studio audience applauding on TV, or saw her sister's bellybutton, it would set off an intense self-injurious meltdown. These meltdowns could be averted preemptively, by turning off the kids' favorite show before it panned to the audience, and by bathing and dressing the girls separately.
Removing a problem stimulus can also be effective if you catch the meltdown during the early stages. I once worked with a little boy who would start pulling at his hair in the build up to a meltdown. If the build up continued, he would progress to hitting himself in the head with his fists. Hair pulling was the warning sign I watched for.
If you are the caregiver
Intervene with this method if you know a trigger is coming, see the problem behavior beginning, or notice warning signs that it is about to start.
If you are the autistic
If you struggle with dangerous overload behaviors, tracking your own meltdowns is similarly important. If possible, it's helpful to have a second person who can keep track of your meltdown patterns for you. If you don't have that luxury, then journaling during mild to moderate overload is one alternative (journaling during full meltdown is usually impossible).
One way to begin the process of tracking your warning signs is to use an app that will remind you at intervals to record how you feel. I recommend either default reminder apps (setting reminders at hourly intervals), or something like iMoodJournal for iOS.
Focus on physical sensations: How does your stomach feel? How do the muscles in your face feel? Do you feel hot or cold? And if so, where? Do you feel numb or tingly anywhere? Keep track of what your body is doing at continuous intervals. Then, if you have a meltdown, you can later look back over your journal entries and check out how you were feeling in the hours leading up to it. Similarly, just setting continual reminders to check in with yourself can help you avoid meltdowns entirely. I'll write a future post on how to develop these types of meltdown coping skills.
The important element is learning to identify the signs that a meltdown is coming, and to interrupt it before it reaches the point of no return. Whether that means leaving a party, turning off the music, or moving to a quiet, dark room, this method is about removing a problem.
This method is NOT helpful if the problem is an emotional one. For anyone who struggles with emotional overload, I recommend seeking Dialectical Behavior Therapy (DBT) or Cognitive Behavioral Therapy (CBT) from a qualified provider with experience working with your particular diagnosis. If you don't know where to start, I recommend browsing the Psychology Today directories.
Redirecting the behavior
This method is the most practical, and the one you will probably need to make use of the most often.
What if the problem stimulus is schoolwork? Wearing clothes? A perceived slight from a stranger? An argument with a significant other? Puberty?
What if the stimulus can't be identified, can't be removed practically, or is too abstract to remove? Or what if the meltdown is already so intense that removing the stimulus doesn't help?
In situations like these, the dangerous stimming needs to be redirected, and replaced with a safe stim that serves the same purpose.
If you are the caregiver
It is your job to find a way to provide intense, unignorable stimulation that will drown out the world and provide a focal point for the person having the meltdown. The type of input depends on the person.
For example, that little boy prone to hair-pulling and head-hitting I mentioned earlier favored auditory and vestibular input. Playing a favorite song very loud, while picking him up and swinging him around, was the best way to help him through his meltdowns.
A few examples of safe, intense stimulation to provide are:
- deep pressure (squeezing up and down the arms, pinching the finger tips, a strong bear hug, or lying on top of the person)
- vibration in the chest area or around the mouth (a massager on the chin and mouth area, or rhythmicly pounding on their back with your hand)
- loud music (playing a rhythmic, sensory oriented song, or singing right in their ear)
- strong vestibular input (spinning or pushing them in a swing, or, if size and strength allow, picking them up and spinning them around)
If you're not sure what kind of stimulation your charge likes best, pay attention to what they're seeking through their behavior.
- Is she hitting or biting herself? She needs deep pressure. Focus first on the areas she's hitting.
- Is he screaming? He needs auditory input. Play some loud music. Using your phone is best, since you can move it around. For added input, move the speaker back and forth, from one ear to the next, or move it forward and back, close to the ear and away again.
- Is she throwing objects, trashing the room, or throwing herself on the floor? She needs vestibular input. Put her in a swing, on a bouncer or trampoline, or pick her up and spin her around.
If you are the autistic
Start by compiling a list while you're calm of ideas for intense sensory input. Keep multiple copies scattered around, such as on your phone, on your computer, and posted up on your fridge. You need a bank of sensory options that you can keep adding to over time. Ideally, what you're looking for are different types of intense stimulation that can provide a sensory buffer or sensory reset to give you the input you need without resorting to hurting yourself.
A few of my favorites are:
- Hold ice cubes
- Have another person sit on you, or invest in a weighted blanket
- Keep a playlist of intense, sensory oriented music you can blare in headphones (feel free to contact me for recommendations)
- Squeeze your wrists, hands, and finger tips (push down on the nail) instead of biting or scratching
- Take a cold shower or bath
Again, the goal is to keep adding to the list every time you think of or find a new idea.
Addressing Bad Habits
Bad habits are often more difficult to deal with than dangerous meltdowns. Where meltdowns come and go like hurricanes, bad habits are ever-present. But similar guidelines apply for handling these. You can try to remove the trigger, redirect the behavior, or both.
Removing the trigger
This one isn't always possible with bad habits, sadly. But for some habits, it can be. For example, If your child eats glue, and you've tried and failed to redirect this, your next step is to lock up the glue.
One of the bad habits I have is biting my lips. For whatever reason, my lips chap very easily. This mean I nearly always have little tears and flakes of skin on my lips. If and when I inevitably feel them (either with a finger or by rubbing my lips together), I compulsively bite at the flaps of skin and peel my lips to pieces. The more I bite, the more flaps and flakes appear. It's a self-propagating cycle. The only way I've found to interrupt this behavior in myself is to always have lip balm available. If I can smooth down the flaps and flakes with balm, I won't feel them as much, and then I can avoid the trigger (feeling the rough texture) that causes the behavior.
I was able to quit biting my nails much the same way. But because this process was more involved than simply applying lip balm preemptively, I'll include it under redirection.
*EDIT: A Note About Root Causes
I recently received a message that reminded me of something I forgot to address here. Many "bad habits" or self-destructive stims can come from root causes that need to be addressed. For example, the message I got was a story about a root cause I've heard happen to more than one person: An autistic teen suddenly developed a new, very violent stim of banging his head against the wall. He was brought to doctor after doctor, and no one could figure out the problem. One professional even went so far as to dismiss the issue, telling the boy's parents that this was "just something autistic people do," and they would have to get used to it. Eventually, they noticed something. His wisdom teeth were coming in impacted, pressing into a nerve! He was in horrible pain, and banging his head against the wall was his only coping mechanism.
Often if there's some underlying medical issue it may go unchecked because an autistic person can't speak to effectively explain the problem. These issues may also go overlooked in more verbal autistics, if due to alexithymia, they either don't understand the problem themselves, or can't articulate it well.
Some examples of common medical issues that can cause self-injurious behavior are:
- Inflammation (allergies, autoimmune disorders, food intolerances, bad drug reactions)
- Dental issues (cavities, new teeth budding, broken teeth, mouth injuries)
- Gut issues (IBS, celiac, injuries, menstrual cramps or PMS, UTIs)
- Headaches (migraines, low blood sugar, low blood pressure, TMJ/jaw cramps)
Redirecting the behavior
Redirection involves identifying the sensory need that's creating the stim, and filling it another way.
Besides lip balm, another thing that keeps me from biting my lips is having chew toys on hand. My favorite stim toy supplier, Stimtastic, sells adult-friendly "chewelry" that looks nice to wear while still serving its purpose. Chew toys can also help with pica, though I would advise getting only the strongest toys, or else the toy itself can become the dangerous object.
I once worked with a teenage boy who chewed at his fingers and scraped them with his teeth nearly constantly. This would create ever-present wounds small and large on his hands. The only way I found to redirect this behavior was to give him something to hold with a rough texture. The more texture, the better. He could then rub the thing he was holding instead of rubbing his fingers against his teeth.
While I never had issues with chewing or scraping my fingers, I did bite my nails compulsively and unconsciously for over 10 years. I would bite them down so far that my fingers were constantly in pain. The process for overcoming this habit was long, and very methodical. I'll share the details, because I've found that the steps I used to break this habit have been essential in breaking others.
How I stopped nail biting
Because I was biting unconsciously, I couldn't simply decide to stop. I first had to identify the warning signs. For this, I enlisted the help of a second person.
I told my boyfriend at the time to watch me, without interrupting the biting, and tell me what the process looked like.
He told me that before I started biting, I would begin touching my fingernails. I would feel along my nails with the tips of my fingers, and rub my nails against my lips. I was feeling for rough patches. Then, when I inevitably found some irregularity, I would bite. This was the point of no return, because if I found a rough patch, I had to get rid of it. I couldn't choose not to. It became a compulsion.
At first I tried to stop feeling for rough patches. But this simply wasn't practical. I couldn't avoid touching my fingers in my everyday life, let alone break the habit of feeling for rough spots.
So I found a way to redirect, to choose a healthy alternative.
I started carrying a nail kit with me.
I kept a nail kit in my bag. And if I didn't have a bag, I made sure to have a nail file in my pocket.
From that point on, whenever I felt a rough spot on a nail, I could file it down. I could get rid of the rough patch without biting. And filing away a rough patch always removed less nail and skin than if I had tried biting it away, because biting only created more rough spots.
Eventually, as time went on, my nails grew long enough that I could fully redirect the habit into something no longer destructive. Now, I have a new stim to do with my fingers. Something I do constantly, unless I'm holding something. Now, I clean under my fingernails, whether there's something under them or not. It looks either snobby or slobby, depending on context. But at least I'm not biting!
To summarize, the best methods for redirecting bad habits involve finding a similar stimulus. If the habit involves the mouth, use gum, or a chew toy. If it involves the hands, find a fidget toy.
Some bad habits are more difficult to redirect, such as self-harm. A few quick examples of ways to redirect self-harm behaviors and distract yourself from these thoughts are:
- scribbling on a piece of paper until the entire page is black
- drawing pictures on your skin
- following other painful-but-safe coping strategies, like those listed above in the overload section (holding ice cubes, cold shower, loud music, and so on)
If you're struggling to break a habit or addiction to self-harm, feel free to contact me via email and I can help you design a more personalized coping plan.
Stimming is amazing, healthy, and necessary, yes, but sometimes it can be horrible and dangerous. I hope this post helps anyone struggling with unhealthy stimming. And to all my readers, please contact me if you have questions about anything I talked about here, or about anything I've left out. I'm here to help, if I can!