My partner of almost a decade has severe anxiety and other mental health issues. Every time he thinks he’s made a mistake or that he thinks someone thinks he made a mistake, he begins punishing himself (think Dobby from Harry Potter). He bangs his head on the wall and punches himself repeatedly and yells that he wants to die. It usually lasts around 10 seconds and as soon as the moment passes, he feels incredibly sorry. He’s never violent or angry toward others, only himself. Nobody who met him would suspect he secretly does this (at work or social occasions, he sneaks out to the car or bathroom to harm himself). This isn’t something he does to get attention or manipulate me or others– he’s typically alone when he does it.
The thing is that we rent an apartment and I’m sure others can hear. He’s been in many kinds of therapy and treatment for years, since he was a teenager, but the biggest effect that therapy has is making him feel incredibly guilty and apologetic after one of his outbursts. (I’m in therapy, too, FYI.)
Sometimes when I hear him sobbing and punching walls after a small frustration, I start begging him not to damage our home because I don’t want us to be evicted. I know it sounds selfish to worry about the home, but he’s already made holes in the wall about a year ago and I’m worried he’ll make one where visitors will be able to see it. As a woman, I am concerned that neighbors will think he’s abusing me rather than himself. I really don’t want anyone to call the police on him because I know that whenever he sees police, he has the impulse to ask them to shoot him.
Every time I try to talk to him about it, it sends him into a panic spiral worrying that he’s abusing me. He knows this behavior is maladaptive, but he’s unable to resist. It’s a different kind of self-harm than you often hear about and I have no idea how to talk to him about it in a way that won’t cause more harm. I reassure him that I will always love him no matter what and that I know he’s doing his best. I really want to stay in our apartment together. What should I do?
Let me start by saying I appreciate your love and courage in trying to maintain your relationship. It doesn’t sound easy, but you have tremendous resilience!
This type of anger management requires some finesse, and I’d encourage you to help your boyfriend find an anger management expert. Anger comes from a need that hasn’t been met, and this type of self-abuse makes understanding this need difficult. Until then it may be important for the two of you to think about what might be done to manage rather than prevent the eruptions.
A good anger management clinic or specialized therapist will have access to getting an accurate diagnosis for your partner. Is this a type of intermittent explosive disorder, bipolar reaction? Or something altogether different? Hard to know, but an evaluation by a clinical psychologist or psychiatrist or perhaps a neurologist is a good start.
While I could never offer a diagnosis I think it is important to understand that an adequate label may be very helpful because it can help specify specific types of treatment that are known to be effective. As an example, the aforementioned Intermittent explosive disorder, IED, is characterized by these features drawn from this article on LifeHelper.
- Sudden episodes of explosive anger.
- The reaction of the anger or rage is extremely disproportionate to the situation.
- The events happen suddenly with little or no warning.
- May involve yelling, throwing or breaking objects or physical aggression.
- Episodes may occur as often as several times a week or as seldom as once every few months.
- Each episode typically lasts fewer than 30 minutes.
- The sufferer may be impulsive, angry or irritable much of the time.
- Some people with the disorder experience emotional changes before an episode, such as growing agitation or irritability.
- As the tension and energy are released through rage, many report feeling relief or even pleasure.
- Once the episode is over, however, the sufferer may experience significant stress, regret, and embarrassment.
- The disorder often takes a terrible toll on the sufferer’s relationships, self-esteem, and career.
The important part of an accurate diagnosis is it helps to pinpoint a treatment. As an example, IED is best helped by two types of therapy, cognitive-behavioral therapy (CBT), cognitive relaxation, and coping skills therapy (CRCST), or medication such as selective serotonin reuptake inhibitors (SSRI) or mood stabilizers.
Until this diagnosis is made you may want to have some couple therapy to help talk about strategies that are more functional to help. You can find a therapist in the Find Help are at the top of the page, or through this organization.
Wishing you patience and peace,
Dr. Dan
