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It's hard to know where to begin, but to keep this brief: I'm safe. I've been with my fiancé for nearly a decade (we're both in our 40s, he's been diagnosed with borderline which was later revised to NPD, which he's been in twice weekly therapy for years)
My fiancé, 44M, has made immense progress in therapy in terms of self image, empathy, career and relationship stability, and I'm enormously proud of him for that. That said, since about the age of 40 (when our lives began to get very stressful as we became caregivers to my mom with alzheimer's who had since passed), he's developed the habit of, whenever he has a split/rage, repeatedly punching himself in the head until he's dazed, bruised, and sometimes bleeding.
Aside from being traumatic to witness, it terrifies me for his future. The risk of chronic traumatic encephalopathy is very real, but neither of us know where to begin in terms of redirecting his fists when he wants nothing more than to cause himself harm.
He is a brilliant writer, artist, and software engineer. His brain is everything and his self-awareness is the gift that has brought him so far in his life and therapy. We're both desperate for the habit to be broken, but don't know the best course to take.
At this stage, after so much therapy, I fear he needs pharmaceutical intervention, but I don't know where to begin. He is not prone to suicidal ideation and is not depressed. These episodes only happen when he's enraged and emotionally overwhelmed. They sometimes happen just once every 3-4 months, but sometimes they happen weekly, depending on life circumstances.
Any help or insight into what's the treatment or prognosis would be is helpful, barring that, even just pointing us in the right direction, as no talk therapy has ever made an impact and us only worsened over the years.
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