Understanding Psychological Pain

UNDERSTANDING

Psychological pain is deﬁned as intense and unbearable emotional pain associated with suﬀering, guilt, anguish, fear, panic, angst, loneliness, and helplessness. Unresolved, psychological pain can sometimes result in self-harming behaviors, addiction, and death by suicide.

SOURCE: https://en.wikipedia.org/wiki/Psychological_pain WHY DO PEOPLE ENGAGE IN SELF-HARMING BEHAVIORS? There are no simple answers. Everyone faces unique life challenges, which may include experiencing intense pain or trauma. For some, the emotions can feel overwhelming, leading them to hurt themselves on purpose to escape or cope.

STOPPING OR ESCAPING COPING WITH UNDERLYING TRAUMA INTENSE PSYCHOLOGICAL PAIN To return from numbness: Emotional trauma To gain control: Self-harming can sometimes lead to disassociation (or a lack of behaviors are attempts to regain feelings). As a result, some people may engage subjective control over helplessness in behaviors to generate a strong physical or powerlessness by shifting attention sensation to bring them back to to distract from something more feeling “something” again. overwhelming or painful. To express their feelings: To release tension: Sometimes people have Sometimes self-harming GAIN diﬃculty acknowledging CONTROL behaviors provide RETURN or articulating their temporary relief and FROM inner emotional turmoil escape for the pain. NUMBNESS in a healthy way and Unfortunately, it the only way to can become an EXPRESS communicate their addictive cycle FEELINGS pain is by expressing when the body through physical and brain adapt self-harm, and develop a aggression, and tolerance. other forms of risky and reckless To experience behaviors. Other euphoria: Some RELEASE times, their actions self-harming TENSION are a silent cry behaviors trigger for help. an endorphin or EXPERIENCE To punish themselves: dopamine release EUPHORIA known as the Psychological trauma “pleasure chemicals.” or abuse can generate These hormones can long-lasting eﬀects and activate the brain’s impact a victim’s reward center, which self-esteem, self-worth, reinforces enjoyable mental health, and emotional sensations and can encourage well-being. Distorted feelings the desire to repeat behaviors. of being a “bad person” or perceived wrongdoing can PUNISH sometimes result in self-punishment. THEMSELVES

SOURCE: https://www.nami.org/Blogs/NAMI-Blog/March-2018/Why-Some-People-Harm-Themselves

SELF-HARMING BEHAVIORS & ADDICTION Deliberate self-harm and other forms of risky behaviors as a coping mechanism or an outlet for suﬀering can become addictive because of the heightened rush of endorphins, dopamine, and other brain chemistry during these activities. Let’s take a closer look.

SOURCE: https://dualdiagnosis.org/self-harm-addiction/

Self-harm Risky and Reckless behavior Self-harm is any form of Engaging in harmful risk-taking behaviors hurting oneself on purpose; as a form of mood modiﬁcation to provide it is not an attempt to kill temporary relief from intense emotional pain oneself. This can include can be dangerous to self and others. These self-mutilation by cutting, include reckless driving, getting into ﬁghts, scratching, carving, burning unhealthy dietary behaviors, shoplifting, or piercing skin; pulling hair vandalism and other criminal activities, the out; picking at existing “choking game” or the pass out challenge wounds, or head banging. (self-asphyxia), or erotic asphyxiation. With the associated shame, guilt, and stigma around Many risk-takers perceive their actions and outcomes as desirable. mental health, people often keep it a secret. About 17% For example, street racing, excessive drinking, substance use, or of people will self-harm during their lifetime but most promiscuous sex are viewed as an exhilarating fast ride, having a good often it occurs during the teenage and young adult time getting high, or sexual prowess. Unfortunately, sometimes these years. 45% use cutting as their method of self-harm. activities can end in tragic accidents, overdose, STDs or HIV infections.

SOURCE: https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Self-harm https://pubmed.ncbi.nlm.nih.gov/30274648/ https://www.webmd.com/depression/features/depression-and-risky-behavior#1

Substance Abuse/Addiction Behavioral Addiction Addiction is a disease that affects a Behavioral addiction shares similarities person’s brain and behavior and can with substance addiction in terms of create physical dependence on how it affects the brain, tolerance, chemical substances such as illegal withdrawal, and relapse. These include drugs, alcohol, nicotine, opioid gambling, overeating, shopping, painkillers, and abuse of other compulsive exercise, technology legal substances. addiction (video games, internet, social media), hypersexuality, It can start with a pornography, body prescription drug, modification (tattooing, experimentation or piercing, cosmetic surgery), recreational use in social and even work (workaholism). situations, but for some, can lead to more frequent These behaviors can trigger use, larger dosages, the feel-good brain chemistry difficulty stopping, or associated with pleasure and feeling physically ill from can lead to strong impulses to withdrawal symptoms. partake and fuel compulsion. Vulnerable people can find In 2017, 53 million or almost themselves craving and 20% of Americans aged 12 participating in these activities years and older used illegal at unhealthy levels with adverse drugs or misused prescription and negative consequences to their drugs. Drug overdose deaths have physical, mental, and emotional more than tripled since 1990. And well-being that can cause distress over 34 million Americans committed to all areas of their lives. a DUI (driving under the influence). SOURCE: https://pubmed.ncbi.nlm.nih.gov/30274648/ https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Self-harm https://www.psychologytoday.com/us/blog/why-cant-i-stop/201606/what-is-behavioral-addiction BEHAVIORS DON’T ALWAYS INDICATE A PROBLEM Mental health challenges, self-harming behaviors, Unlike suicide, where the intent is often to end addiction, and suicide are complex issues and can the pain with death, people who engage in have fatal outcomes. Everyone’s experience is self-harming behaviors do not usually do different and there may be different levels of so as a suicide attempt. Although having severity. Many of these behaviors, like alcohol major depression does increase suicide consumption, gambling, tattooing, or risk, most people who have depression extreme sports are socially acceptable, do not have suicidal ideation, nor do and do not necessarily indicate a problem they attempt or commit suicide. or lead to complete devastation.

UNDERSTANDING SUICIDE Suicide is a major global health concern. According to the World Health Organization, close to 800,000 people die due to suicide every year, which is one person every 40 seconds. For each adult death by suicide, there may have been more than 20 others attempting suicide.

SOURCE: https://www.who.int/mental_health/prevention/suicide/suicideprevent/en/

SUICIDE AND SUICIDAL BEHAVIOR A suicide is deﬁned as death caused by self-directed injurious behavior with intent to die while a suicide attempt is when someone harms themselves with the intent to end their life, but they do not die as a result of their actions. Suicidal ideation refers to thoughts about killing themselves but do not go beyond thinking, considering, or planning suicide.

In the United States, according to a 2017 report from the Centers for Disease Control and Prevention (CDC): Suicide There are Between Suicide Firearms was the 2001 and rate among account among Americans 2017, the men nearly adults made adults aged 18+ for almost individuals as many die by suicide a non-fatal reported having leading ages suicides as suicide rate suicide suicide ideation cause of homicides each day women attempt of all suicide death deaths SOURCE: https://www.nimh.nih.gov/health/statistics/suicide.shtml WHY DO PEOPLE CONSIDER SUICIDE? There are many reasons that could lead a Depression and other mental health person to the decision to take their own life. conditions can increase someone’s risk Fatal or near fatal suicide attempts are of suicide, but suicidality usually includes most likely to occur when someone multidimensional risk factors. FEELINGS OF is experiencing: HOPELESSNESS

LACK A “I have nothing to PERCEIVED SENSE OF BURDEN ON BELONGING look forward to.” OTHERS “I will never I Have I Feel “t’s too late get over what Others Are for me.” I Hate No One To Disconnected happened.” Better Oﬀ Myself Turn To From Others Without Me “I just want Social Feelings of “There is no Feeling Low self- to give up.” withdrawal rejection point in trying expendable esteem anymore.” or unwanted Family discord Low openness “Things will Self-blame, to experiences “I will never be never get Distress from shame, guilt Loss through happy again.” better.” ﬁnancial or humiliation death, divorce, Self-reported responsibility or incarceration loneliness (extreme debt/ Self-loathing: unemployment) Feeling useless Childhood Social isolation: abuse/ Living alone Distress Internalized Domestic from chronic oppression violence Negative medical illness outcomes of bullying Belief to be a burden to family or society

SOURCE: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3130348/

Risk factors and RISK FACTORS RISK WARNING SIGNS warning signs • Previous suicide attempt(s) • Talking about wanting to die • History of trauma or abuse FACTORS • Talking about feeling hopeless can't cause or • Family history of suicide or being a burden to others predict a suicide • Impulsive and/or aggressive tendencies • Talking about feeling trapped attempt, but • Access to ﬁrearms or other lethal means WARNING or in unbearable pain they're important • Stigma associated with asking for help • Acting anxious or agitated • Exposure to other deaths by suicide • Increased use of alcohol or drugs to be aware of. (community/media/internet) SIGNS • Sleeping too little or too much • Showing rage or wanting to seek revenge • Extreme mood swings SOURCE: https://suicidepreventionlifeline.org/how-we-can-all-prevent-suicide/

DON’T IGNORE THE WARNING SIGNS Stigma can prevent someone from seeking the support they need. Help promote mental health and emotional well-being. Start by recognizing the warning signs of self-harming behaviors, addiction, and suicide, and take them seriously.

IF YOU ARE STRUGGLING… IF YOU SUSPECT SOMEONE IS STRUGGLING… If you are experiencing intense psychological and Talking about suicide, addiction, and self-harming behaviors can be emotional pain, it does not mean you are weak, or difficult but the willingness to notice, listen, or show compassion can flawed. It just means that you have more pain than help break the mental health stigma. Gently start a conversation and you can cope with right now. Know that there is show that you care and want to support them. Be there and listen. hope. You are not alone and there are ways to get Give them reassurance and offer hope. Encourage them or help help to overcome the pain. Don’t bottle up your them connect to professional help or support resources. Follow up emotions. Reach out and talk to someone you trust. and continue to stay connected.

I’m concerned about you. Can we talk about what you’re experiencing?

I'm struggling with my mental health... can we talk?

SOURCE: https://www.helpguide.org/articles/suicide-prevention/are-you-feeling-suicidal.htm https://www.helpguide.org/articles/suicide-prevention/suicide-prevention.htm

WHERE TO GET HELP From your doctor: Talk to your primary care physician about your intense psychological and Get help immediately: If the situation emotional pain and ask them to connect you with is potentially life-threatening, call 911 the right mental health services. immediately. If you are having suicidal Get help via text: Crisis Text Line is a free 24/7 support thoughts or are worried that someone for those in crisis, connecting people in crisis to live you know might be suicidal or emotionally trained counselors. Text from anywhere in the USA, distressed, reach out to the National Suicide anytime, about any type of crisis and they will be there Prevention Lifeline. These centers provide to listen and help guide you. Text CONNECT to 741741 conﬁdential crisis counseling and mental health referrals. From your employer: Mental health services may be CALL: 1-800-273-TALK (8255) available to you through your health insurance plan at LIVE CHAT ONLINE: work or through an Employee Assistance Program (EAP) https://SuicidePreventionLifeline.org/chat/ provided. These outside counselors, resources, and referrals are provided conﬁdentially.

From online resources: National Suicide Prevention Lifeline https://suicidepreventionlifeline.org/ Get help and learn more Substance Abuse and Mental Health Services Administration (SAMHSA) https://www.samhsa.gov/ about self-harm, National Alliance on Mental Illness (NAMI) https://www.nami.org/ addiction and suicide Mental Health America (MHA) https://www.mhanational.org/ from these resources: National Institute of Mental Health (NIMH) https://www.nimh.nih.gov

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