Trigger warning for behaviours related to mental health

Don't want to get overly personal or gross out anyone... but from elementary school through highschool I picked my skin... and then it went from bad to worse in my 20's. I would peel my skin to the extreme... and not even be conscious that I was doing it (yeah... I bet I was the life of the party back then). I would always peel my face to the point it was raw and bleeding.  I had to keep my nails cut way short because otherwise I'd have a pile of skin stacked up while I was watching TV. I've never met anyone else who did that.

Yes I relate to alot of what you have said. It became a routine, something that I just did. I wasn't in mental distress as is often described when people self harm. It really had no purpose other than it was a part of my day. It certainly didn't start like that, and that was when i was undiagnosed at the time in my late teens, I was under a lot of stress not knowing why I couldn't cope in the world. I thought there was something fundamentally wrong with me. Then it became a routine. I too get very stressed if I can't do my routines. I don't self harm anymore. I think because I learnt more about myself and my sensory needs, I can meet these needs without doing damage to my skin. I hate having the scars. Are you able to do a sensory assessment? It could give you some ideas of why you do it. Re suicidal ideation. I get this frequently. I hate being autistic and not being able to do the things I want to do. I need to be able to control my life and environment in order to function. Suicide is almost a comfort to think about. If things get really tough and its things I can't control, then suicidal ideation becomes a comfort.

THIS! You are on the right track. Its not exactly self-soothing... but its a distraction from the noise in your head from the ADHD. I outgrew this with help. Oddly its one of the few things I can do and be so singularly focused that I tune out the world.

My cousin is a fireman. As kids we had no idea what ADHD was. But he would be the one who just couldn't sit down in class (this was long before ritalin). My aunt took him to doctor after doctor. Finally one of them said his metabolism was upside down. Told her to give him a cup of coffee before school. And it worked. It made him MORE CALM. That was almost 50 years ago. We still joke about downing a pot of coffee before we start the work day... but its real... the steroid hit helps us focus. I'm 56 now, so I only drink about half a pot... but I take two 200mg time-release caffeine pills with it.

My cousin says to this day the only thing that truly calms down the flood of things going through his mind is the adrenaline rush of his job.

I say all that to say, it never goes away, but you can replace it. You aren't consciously aware of it, but with ADHD your brain is going a million different directions, and anything that feels like real focus feels real good. Every brain chemistry is different. try lions mane, ashwagandha, B6, etc. Ultimately what helped me was to get a treadmill. Crazy.. but it was my zen... a consistent daily routine that helped me burn off cortisol, that I actually looked forward to... and safer than being a fireman ;). Hope you find something helpful in all that.

H2whoa said:

that's the other element that I've been wondering about as well: whether the mental exhaustion of not realising that I am autistic for so long has internalised with a need to self harm.

The self harm for autists can be for a number of reasons. Quoting from the article https://autism.org/causes-and-interventions-for-self-injury-in-autism/

In many cases, self-injury serves as a means of communication. Often a child is trying to convey a feeling or idea they may not be able to express in words.

Self-injury can also be a form of sensory stimulation. An individual with autism may self-injure as a way to increase or decrease their level of arousal.     

These will not be the only reasons but seem the most common from what I have read.

My understanding is that a good therapist can help you get to understand where it comes from though a process called unpacking and once its origins are identified then replacement behaviours can be considered and practiced so you can use a healthier option when stimming / communicating or whatever.

It won't be cheap or available on the NHS unfortunately - expect at least £50/hour and probably 10+ sessions to be realistic. 

It isn't the kind of thing I have heard that responds to relf-help very much but if that is all you have open to you then doing a deep dive into the subject and finding how therapists treat it may be of some use.

We can all change long term behaviour patterns - I was able to change a lot following my diagnosis in my 50s but then I had a good therapist who really understood autism.

I live with my mother and she tells me she can hear my stimming. I'm not aware of it until she mentions it.

I'm not diagnosed. I try to ignore self harm thoughts. It's always there, but I don't want to look at it. My thoughts jumps around like jumping bean.

I can't focus properly. It's not a nice experience. 

Thanks, profdanger. Finding an alternative outlet would be good, but I certainly struggle with breaking away from ritualised compulsions and feel like I go into autopilot mode.

Thank you, Iain. Yes, that's the other element that I've been wondering about as well: whether the mental exhaustion of not realising that I am autistic for so long has internalised with a need to self harm.

Yes, I think that there is an element of stimming or self-soothing. I think it's probably also true that I have a higher tolerance to pain.

Intersting that you picked up on the ADHD element. I am indeed diagnosed with both ASD and ADHD.

Thank you very much for sharing these resources, Olivia

Dear H2whoa,

Welcome to the online community, I hope you enjoy your time here. Thank you for sharing your experiences of mental health issues, it sounds like you have had a hard time with it. If it any point these thoughts become to difficult  we advise you to contact 999 or any of the mental health crisis lines listed on our Urgent Help Page if you are at risk of immediate harm: https://www.autism.org.uk/what-we-do/help-and-support/urgent-help  

Help for anyone struggling to cope  

• Samaritans: Email jo@samaritans.org or call 116 123 for free, 24 hours a day, 365 days a year.  
• Shout 85258: A free, confidential, 24/7 text messaging support service for anyone who is struggling to cope. Text the word ‘shout’ to 85258
• Mind Infoline: 0300 1233393 for information and signposting (9am to 6pm, Monday to Friday)   
• SANEline: 0300 304 7000 for anyone experiencing a mental health problem or supporting someone else (4.30pm to 10.30pm, every day)  
• Campaign Against Living Miserably (CALM): 0800 58 58 58, for anyone who is struggling or affected by suicide or suicidal thoughts (5pm to midnight every day).    

You have had some great responses about others experiences. I have shared some resources below that could be worth taking a look at:

Preference for order, predictability or routine

Mental health and wellbeing

Please continue to reach out with any questions you have, It is great to have you as part of the online community.

Warmest wishes,

Olivia Mod

I have autism and have experienced suicidal ideation, but I have never self-harmed myself. My other half on the other hand has self-harmed repeatedly. My other half is definitely not autistic, but it's quite likely that she has ADHD. She tends to self harm when she gets upset, occasionally she exhibits suicidal ideation. I wonder if you could be one of those people that have both ASD and ADHD...?

Although if it's purely a routine related behavior then it could be some unusual ASD behavior. They like to lump us together but we all have our unique expressions. Maybe that's yours..

I've no experience of routine self harm.bBut I'd imagine it is a mixture of stimming and control.

When things are stressful or too much, from either emotions or images, or sensory input, here is something you can control.

Stimming also calms, so it is just a means to get sensory input. You may also have a higher tolerance to pain, so not be too bothered.

Hello H2whoa, welcome to the community.

H2whoa said:

my doctor suggested that the self harm behaviour in particular might be connected to my autism.

I don't think it is directly caused by autism but from the pressures that our autistic traits put on our lives and the way we percieve the world. There is a good article on this here:

https://www.autism.org.uk/advice-and-guidance/topics/mental-health/self-harm

It includes the corrolation between autism and self harm that may be of interest to you.

We are not allowed to offer medical advice but we do recommend you contact professionals in this field (ie therapists who understand autism) and work with them. The NHS is a bit light on this so it may need to be paid for privately.

Undertanding a lot more about your autism can be enlightening and can lead you to spot things that are stressers for you - tackling these can be a good ways to start lessening the anxiety load most of us carry.

Have you had much chance to read up on the subject and explore your autistic traits yet?

There is quite a lot you can do to improve things starting with the knowledge of what you are facing. 

Let us know if you have any specific areas you are strugling to understand and I'm sure you will get a lot of input on here.

H2whoa,

I have experienced suicidal ideation, but not routine self-harm. I appreciate that you put a trigger warning in the title.

I don’t have much advice in regards to breaking out of the routine except perhaps finding something more positive to obsess over like exercise could help.

I hope someone with similar experience to yours chimes in.