Stimming and Self Harm
Stimming and Self Harm
Yesterday in 7 Questions About Stimming I described all the positive things about stimming and ways that you can support it.
Today I'm looking at the flipside... what happens when stimming is harmful or unhealthy? Why do people seek out dangerous stims, and what can you do to help?
When is stimming dangerous?
Most of the time stimming is a positive, healthy, satisfying outlet for pent up emotional and sensory pressure. But sometimes stims can cause harm to the person or others around them by being physically dangerous, unhealthy, distracting, interfering with learning or otherwise preventing the person from connecting with others.
People who stim in this way might hit themselves in the head, bite a body part, scratch their skin, pull their hair, pick their skin, cut or burn themselves. Unhealthy stimming also includes actions that are not physically harmful but are so preoccupying that they have secondary effects which are detrimental, like when self-care or education gets ignored or neglected.
Is dangerous stimming an autism thing?
This type of stimming is often falsely thought to be exclusive to autism and other developmental disabilities, but like other forms of stimming it occurs in the general population too. Think about eating a hot chili pepper, taking a too-hot shower or running a marathon - these are all endorphin-triggering painful-yet-pleasurable activities.
It might just be more obvious in these populations because the stim is considered less socially acceptable, or the person is less likely to hide the stim or be aware of others noticing it. People with autism might also find themselves in more situations which are overloading and painful, so have a greater need for this kind of stimming.
Why do people do it?
Unhealthy stimming happens for all of the same reasons as healthy stimming - sensory regulation, release, thought blocking, emotional regulation, entertainment, connecting with self and the world, frustration, self expression and pain regulation (you can read more about those reasons in 7 Questions About Stimming).
Let’s focus first on stimming that causes pain, because it can be hard for people who don’t stim in this way to understand why anyone would want to voluntarily do that to themselves. But the answer is really quite simple - pain is a very efficient source of sensory input.
It’s intense, quick, reliable and slow to fade or attenuate. Pain is a powerful distractor, it makes the body immediately stop what it’s doing and focus on it. And probably most importantly, pain triggers the release of endorphins, the body’s natural feel-good drug. All of this makes pain a very tempting and accessible yet potentially dangerous source of sensory input.
For this reason, stims that cause pain are often used to mask or counter other forms of pain. People who are experiencing intense emotional, sensory or physical distress need a distraction quickly, in a controlled way. And they need that distraction to be equal to or greater than the pain they are already feeling. That’s why a good general rule is that the stronger or longer the stim, the more intense the feelings are that it’s trying to release, balance, block or mitigate.
Other reasons that someone might stim dangerously include not being aware that the action they’re doing is unsafe, not being able to self-manage how long or how intensely they stim, and not receiving enough sensory feedback to realize that they’re hurting themselves. This last one can be particularly true for people who are hyposensitive and need to inflict greater damage on themselves in order to feel a sensation.
Stims can also start out as healthy and safe but become unhealthy over time. The repetitive nature of stimming makes it very easy for even seemingly harmless actions to become harmful over time, like a slow stream of water wearing away at a rock. Joint wear from hyperextension, repetitive strain injuries, tooth wear from grinding, bald patches from rubbing skin, worn carpet from pacing and damage to vocal chords from grunting can all sneak up from the cumulative effects of safe stims.
How can you help someone who stims unsafely?
The support of dangerous stims requires a four pronged approach:
- Protect the person from harm
- Assess the level of harm
- Investigate the reason
- Remove the reason, add supports or replace the stim
There is no correct order in which to do these steps, it will depend on the type and severity of the stim and the amount of harm caused by it (and sometimes the steps might have to happen simultaneously).
Note that these tips equally apply whether you’re looking to support the stimming of someone in your care or you’re trying to self-manage your own potentially unhealthy stims.
PROTECT FROM HARM
Before you do anything else, if anyone is in immediate danger of being injured then you need to provide some kind of protection. Where possible this protection needs to be something that doesn’t completely stop the stim, until you’ve figured out why the stim is happening and how it can be redirected to a safer source of input or release.
This protection might be something like a pillow or helmet to soften the impact of head banging, trimming nails to reduce the injury causing by scratching or picking, or simply moving the person to another area. This is still an important step even for threats that are less imminent, but there is less urgency to do this step first.
ASSESS THE LEVEL OF HARM
Not all unhealthy stims are the same, some can be incredibly harmful and immediately threatening while others have a more delayed or less damaging effect. A stim that is just annoying or distracting to others in class requires completely different interventions and supports than head banging to the point of blacking out.
So before you can decide how to help, you need to get an idea of both the time frame and degree of severity of the effects of the stim.
- How soon will the person experience damage or injury?
- Are they in immediate danger or it is a longer term cumulative effect?
- How severe is the damage or injury?
- How much impact is it having on the person’s health or wellbeing?
- What is the impact on the people around them?
INVESTIGATE THE REASON
Is there a medical cause?
People who self-harm when they stim are often trying to replace pain with pain. Look for possible underlying problems, things that might be hidden, cause diffuse pain or pain that’s hard to describe like stomach pain, UTIs, reflux, tooth pain, sinuses, ear pain, headaches and cramps.
Can the person escape if needed?
Do they have control over whether they can avoid things or spaces that are overwhelming, threatening, scary or unsafe? Note that this won’t necessarily be the same as the things that you consider to be threatening, scary or unsafe.
Can they express themselves?
Does the person have access to a reliable method for communicating? Are they able to use it? Is anyone listening when they do?
Are they having trouble with sensory regulation?
Is the environment too overloading or demanding?
Are they frustrated?
Are they doing work that is too difficult for them? Do they need supports to access their environment? Do they have enough autonomy and control over their day?
Are they bored?
Is the work too easy for them? Are they being given stimulating activities to do?
Are they having trouble with emotional regulation?
Is the person having harmful thoughts? Are they trying to block out a painful experience? Have they experienced a trauma?
Has a safe stim become harmful?
Unhealthy stims sometimes start out as healthy ones and progress to become harmful, either over time or during one session.
This is not an exhaustive list by any means, there are lots more potential reasons that someone feels the urge to stim in a harmful way.
REMOVE THE REASON, ADD SUPPORTS or REPLACE THE STIM
Removing the reason for the stim seems like a no-brainer solution, but it’s only an option when you know what that reason is. You also need to know when and where and how it happens, and have some control over stopping or avoiding or removing it. The reason might be hard to pinpoint or something intangible, and there are a lot of things you just can’t control like the fire alarm going off unexpectedly or illness or whether the student goes to class. So removing the reason isn’t always going to be the answer.
If you can’t remove the reason entirely, can you add supports to help the person cope better without needing to stim? You may not be able to prevent the fire alarm going off for example, but you can prepare noise cancelling headphones ahead of time to quickly block out the sound as soon as it does.
Replacing the stim with a safer one is about respecting the person’s need to stim but helping them to find a way to get the same input or release in a healthier way. It’s not always easy or possible to find a replacement however, or to get the person to switch to it. A key thing to remember is that in order to be attractive and effective, the replacement stim has to be just as intense and immediate in providing relief or distraction as the harmful stim was.
Remember the goal is a safer stim in comparison to the original one, but that may not always equate to a completely safe one. If the dangerous stim is very intense or rewarding, you may need to move slowly down a sliding scale of safe. Instead of trying to jump straight from a painful stim to a painless one, for example, you might need to start with a replacement stim that is ‘painful but slightly more safe’ until you fade all the way down into ‘painless and safe’ (or even ‘painful and safe’ although I’m not sure if there are any of those). So for example you might move from cutting to very hard pinching to light pinching to rubbing.
Some possible replacement stims to try are:
- Things you can squeeze hard (they need to have a lot of resistance to provide strong pressure, like a very firm stress ball or large binder/bull clip)
- Being squeezed hard
- Very loud music (I hear that metal works well for this)
- Loud singing or shouting
- Spinning or swinging very high or fast
- Strong vibrating
- A punching bag
- Deep pressure on the target area
Again the key is intense, immediate stimulation that is equal to but less damaging than the stim you’re trying to replace.
Dangerous stimming can be alarming to watch and difficult to manage, and is an unfortunate downside to what is usually a positive, pleasant, essential activity for many autistic people. I hope this article has helped you to understand a bit more about why people might seek out this type of stim, and how you can help them to stay safe and healthy.