Not All Self-Harm is Physical: A DBT Strategy for Self-Destructive Impulses

I have been very open about my journey and plan to continue to be. We all need to have realistic expectations about recovery, including me.  It's definitely not all smooth sailing. I still meet several of the criteria for BPD, and with those symptoms often comes suffering.  I am still quite an emotionally sensitive person.

It's overall been a great past six months. I had two books come out on Borderline Personality Disorder and Dialectical Behavior Therapy (and they are doing well and helping many people), I started grad school, and my website has been gaining a lot of attention -- especially in light of my recent announcement that I no longer meet the criteria for a diagnosis of BPD. 

Issues which have caused me a great deal of stress and anxiety lately include some changes in my personal life (which I am not yet ready to discuss publicly) and the fact that I've been instructed to wean off of the low dosage (30 mg) of Celexa that has kept depression and OCD symptoms at bay so significantly so that my psychiatrist recently updated the latter diagnosis to be "in remission." (My psychiatrist informed me that some people have heart problems due to Celexa, and when I went for my EKG, it indicated I could be in the trouble zone.)

Unfortunately, during this weaning, it is becoming evident that the low level of SSRI that I have been taking for years had been largely responsible for the obsessive compulsive symptoms that tortured me being in remission.  I am making the switch to Prozac as of next Tuesday, and I look forward to the relief that I anticipate I'll experience once I am up to a therapeutic level.

Obsessions and compulsions have been quite triggering. My emotional vulnerability has increased due to both the toll that this weaning and medication switch is taking on my mind and body, and then there are the personal life issues.

The triggering aspect has come about due to my reduced ability to resist impulsive behaviors that can be damaging to me.  While I have no physical harm impulses, I do have impulses to do things like reach out to people from the past, and even upon receiving dreaded rejection and experiencing feelings of abandonment, I've felt compelled, against my better judgment and that of those around me who care about me, to continue acting on these impulses and compulsions.

These behaviors have led to high feelings of frustration, moments of hopelessness, and utter disappointment in my lack of restraint.  When I am able to address the critical voice within, I am able to, even if briefly, tap into my Wise Mind, and perhaps even more importantly right now, my heart, which holds compassion for myself and others. In doing this, I realize that it there is cause from many angles for why I am feeling this way. 

I am most compassionate for the parts of my brain struggling to maintain the stability I have grown accustomed to while, though ill-guided, it is also driving me to follow through with compulsions that provide temporary relief from anxiety and mental tension (only to, ironically, create more of these.) I also have much compassion for the part of me that wants to feel loved and reassured.

So, what DBT skills can I apply during this difficult time?  It's time for me to come up with a self-care plan, and here it is:

1.) When the impulse arises to contact an "emotionally unsafe" person from the past, I will remember that between the impulse and action is a sacred moment where I have CHOICE. I will treat this like any other self-harm impulse and intervene with Distress Tolerance skills that are meant for crisis intervention. For example, I will run and grab an ice cube, or put a piece of lemon in my mouth, or start walking out of my house and keep walking until the urge subsides. (I've thus far deleted all emails with any mention of this person's name, deleted him from my contacts, and withdrew a Facebook friend request. In my current state, this took strength.) 

2.) I will remember, from a place of compassion, the cause reasons for my current state and tell myself that I am not at my normal level of resilience. I don't want to do things I'll regret because I am more emotionally vulnerable right now. I'll turn to my DBT PLEASE skills, such as making sure I'm getting enough sleep and eating as healthfully as I can. I will also continue to go to yoga, follow medication directions exactly, and start reading The Mood Cure, as recommended by my DBT Life Coach, Teresa Lynne.

3.) I am going to begin to trust Life again and to trust that my heart holds wisdom. Life knows that I want to be loved and cherished, and I'd like to let go of the fear and self-damnation that had been standing in the way of me remembering and truly believing this. I deserve way more that what I have been pursuing, all the while feeling a literal sensation in my gut that I was trying to force something that wasn't supposed to happen in my life right now and that I was heading for trouble if I didn't heed the very visceral warnings I have been receiving.  To build this trust, I will engage not only in self-soothing acts that allow me to love, cherish, and bring honor to myself, but I will also work on my life worth living by visiting the DBT Adult Pleasant Activities sheets, picking some tried and true activities and adding some new ones to my agenda.  Building positive experiences help us to grow and provide mood boosts.

I think this is a good start, and I'll keep you posted.

What skills have helped you when feeling emotionally vulnerable or impulsive? As always, your comments are welcomed and encouraged.

Thanks for reading.
More soon.


  1. Wow Debbie. Thank you so much for posting this. It helps to know that I am not the only one who has these issues. I deal with so much self-loathing and rejection because of my past actions, that I have a hard time not reaching out to feel acceptance or love, whether real or imaginary. So I have to try and stay very aware of my actions so that I am only making positive moves, and not harmful ones. Thank you again for sharing :)

    1. You are very welcome, Crimson, and thanks for your kind comment. :-)

  2. Debbie, thank you so much for sharing. It is amazing to me that some of what you are feeling and going through are things that I think and feel. Your page has helped me a lot. The last few months have been so very difficult for me. I believe now that I am on the right track to some sense of stability. I thank you for all you do to help people. Melanie

    1. You're welcome, Melanie. I am so pleased to read this. Thank you very much! :-)

  3. Another great post Debbie. I find recognizing if I am in the emotional, rational or wise mind to be a good skill to use in situations like this. (Skill-Wise Mind) For instance noticing I am in the emotional mind and about to make a rash decision, I can step away and work on moving into Wise Mind giving me time to deescalate and then make an often wiser decision in a better "head space."

    1. Thank you so much for sharing, Alicia, and for your kind words. :-)

  4. Debbie,

    Tapering off your medication and starting a new medication is quite difficult, my thoughts are with you. Always remember that it isn't just you and you're not alone in what you're going through. Both tapers in medication and newly introduced medication cause us 'all' to experience a vast array of effects that can be very negative. The effects we may feel don't last forever, there is a light at the end of the tunnel, and issues that were once capped by other medication can be put into remission again. You know it's possible. It may seem slow going getting there but all journeys lead to a destination with time. :) My thoughts are with you always.

  5. Glass, thank you for taking the time to leave this kind, insightful comment. ♥

  6. ((((hugs))))prayers for you Debbie.

  7. I AM happy i clicked on this post you shared!! i am so JUST BEGINNING anything DBT & this is very helpful to see that even after just one DBT one on one therapy session with a counsellor, that i see with only focusing on the Mindfulness at the present time with counselling, i do see there is hope for overwhelming & challenging to remember to do all these thing ie. "self-care plan", which i know i will find difficult at first but with support i am sure i will figure it out. thanks again for your sharing!!! i have so much to read & experience with BPD & using DBT with it, it is quite challenging right now. I hope you made it thru this situation you wrote about here & are feeling much better with all of it :) HUGS Judie



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