Title: Center for Research and Academic Excellence
1Understanding Self-Injury
- Presented by
- Center for Research and Academic Excellence
- 3centerae.com
2Self Injury
- 1.Who self injures?
- Why do they do it?
- What it is and is not.
- How can we help?
3Caroline Kettlewell from Skin Games
- I needed to cut the way your lungs scream for
air when you swim the length of the pool
underwater in one breath. It was a craving so
organic it seemed to have risen from my skin
itself.
4Self-Injury Terms
5SI Behaviors
- Cutting
- Scratching
- Abrading
- Burning
- Some forms of hair pulling
- Biting
- Inserting foreign objects into the body
- Interference with wound healing
- Ingesting toxins
6Warning signs
- Unexplained frequent cuts or burns
- Wearing long sleeves or pants in warm weather
- Avoiding swimming pools or the beach
- Wearing thick bracelets to cover wrists
- Having sharp objects in purse, book bag, or
bedroom - Difficulty expressing feelings
- Withdrawal from close relationships
7What is the Definition
- Self injury is the intentional harm of ones own
body without conscious suicidal intent.
(Aldeman, 1998, Favazza, 1998, van der Kolk, et
al., 1991)
8What Self Injury is NOT
- It is not a suicide attempt
- (attempting to feel better, not escape all
feelings) - It is not usually attention seeking
- It is not a danger signal to others
9NOT SUICIDAL BEHAVIOR
- self-mutilation is distinct from suicideA
basic understanding is that a person who truly
attempts suicide seeks to end all feelings where
as a person who self-mutilates seeks to feel
better. (Favazza, 1998) - Intention-does not intend to die as a result of
his/her acts. Intends to live.
10Who Self-Injures
- Roughly 2 (1-4) of the population. In some
studies reported as high as 8 million Americans
self-mutilate. - 30 times the rate of suicide attempts
- 140 times the rate of completed suicides
- May also suffer from eating disorders
- 90 who cut began as teenagers
11Typical profile
- Female
- Mid 20s to early 30s
- Began cutting as a teen
- Middle to upper class
- Intelligent, well educated
- Perfectionist
12Profile (cont)
- Males and females
- All races and socio-economic levels
- Ages 15-50s
- Not easily identifiable
13Characteristics
- are often depressed, feel powerless or anxious
- have low self esteem /negative body image
- have difficulty expressing their emotions
verbally - experience difficulty with relationships
- aim for perfection
- often have negative body image
- lack impulse control/suppressed anger
- do not have a repertoire of coping skills
- may have serotonin dysfunction
- possible trauma
14Abuse?
- Many who self-injure did not suffer childhood
abuse (Zweg-Frank, et.al, 1995, Brodsky, et. al.,
1998) - 50-60 suffered childhood abuse or trauma. That
means that 40-50 did not (Favazza,1998)
15Then Why?
- Invalidating environments (Lineham, 1993)
- Expression of private experiences and feelings
are not validated - Feelings are trivialized, punished or ignored
- Experience of painful emotions are disregarded.
- Childs interpretation of his or her behavior is
dismissed
16In their own words . . .
- There are times when I hurt too deep for tears,
so I cut and it lets out some of the hurt. Its
like when you see the blood flowing out, the pain
and fear are flowing with it. - Watching the blood flow out makes me feel clean,
purified. It feels like something bad or dirty is
leaving with the blood.
17In their own words . . .
- The stopped voice becomes a hand lifting knife,
razor, broken glass to cut, burn, scrape, pop,
gouge. The skin erupts in a mouth, tongue less,
toothless. A voice drips out, liquida voice
sears itself for a moment, in the flesh. This is
a voice emerging on the skin, a mouth appearing
on the skin. The body which could not be air on
the larynx becomes the stroke of a razor on the
breastbone or of a red-hot-knife-tip upon the
wrist . - Janice McLane (1996)
18Why do they harm themselves?
- To release intense feelings
- The physical pain may be easier to deal with than
the emotional pain - To feel real, alive
- To exert some control
- Acting out self punishment
19Cycle of Cutting
Cutting
Disassociation
Relief
Into the Void
Shame, guilt, remorse, disgust
Panic
Mounting anxiety, anger or self hatred, alienation
Muller 2005
20In own words . . .
Its like opening up a safety valve or letting
steam out of a covered pot. Sometimes I cut
just to make myself feel something because I am
just totally numb. (In Strong, 1998, p.7)
21Why Self-Mutliate?
I felt like I was isolated from the world, dead,
with no emotions at all. The blood told me I was
alive, that I could feelAlso I couldnt cry, and
bleeding was a different form of
crying. (Lindsay in Strong, p.57)
22DSM IV Classification
Currently listed as a symptom associated with a
number of mental health disorders
Some mental health professionals are advocating
for self injury to be listed as a separate
diagnosis
23SI is often associated with
- Borderline Personality Disorder
- Obsessive-Compulsive Disorder
- Post-Traumatic Stress Disorder
- Dissociative Identity Disorder
- Eating Disorders
- Substance Abuse
- Depression
24DIAGNOSIS (Ferreira de Castro, et.al., 1998)
Self-Injure Suicide Attempt
Major Depression 14 56
Alcohol Dependence 16 26
Schizophrenia 2 9
Dysthymia 12 7
Adjustment disorder with depressed mood 24 6
25Therapeutic Goals
- Encourage communication about self-injury and
relevant aspects of the childs life. - Improve the quality of clients life as it
relates to self-injury. - Explore themes of guilt and shame.
- Diminish use of self-injury as the coping skill
when client desires to make changes. (Conners,
Rubin, et, al,2002).
26Helping What to Do (Alderman, 1997)
- Learn about self-injury.
- Talk about SI. Ask about it.
- Be supportive. Show you care.
- Acknowledge the effort to cope with very
difficult emotions - Set limits
- Be available, but refer when appropriate
- Dont discourage self-injury
- Recognize the severity of the distress
27What Not to Do
- Be afraid to ask the question, Do you
self-injure? - Make eliminating the behavior the primary goal
- Make a safety contract or use contracts as a
reward or punishment - Visibly monitor their injuries
- Make him or her feel ashamed or guilty about the
behavior
28- This is yet another secret I must hold to myself
because my therapist has given me an ultimatum,
either no more hurting myself or we will have to
discontinue our therapy. So a little distance
comes between us now, a secret that hold great
importance which we could both learn from, if I
was able to tell herJML
29Interrupting the Cycle
- Dispute irrational thoughts, feelings
- Triggering event
- Unbearable tension, anxiety
- Dissociation
- Self injury
- Relapse
30Expressive Arts
- Journals
- Poetry
- Music
- Art
31Self-Injury Group
- Respond to the following statements by writing
A for agree if you mostly agree with the
statement or D for disagree if you mostly
disagree. Be ready to explain your responses. - ___Self-injurers are survivors.
- ___Self-injurers are weak people.
- ___Self-injurers are harming themselves to get
attention. - ___Self-injurers are perfectionists.
- ___Self-injury is a type of suicidal behavior.
- ___Self-injurers are proud of their scars.
- ___Self-injury helps people cope.
- ___Self-injurers are more sensitive than most
other people.
Muller 2006
32- Self-Injury
- If my wound could talk it would
say_______________________________________________
- __________________________________________________
________________________________________________ - __________________________________________________
_________________________________________________ - __________________________________________________
__________________________________________________
- __________________________________________________
__________________________________________________
Muller 2006
33Taking Care of Yourself
- Monitor your own horror and confusion
- Broaden your perspective past the behavior to the
intent behind it - Seek consultation
- Get support for yourself
-
34Care and Concern
- The capacity to derive comfort from another is
the single biggest predictor of whether
traumatized patients are able to give up their
self-destructive habits. (van der Kolk)
35Care and Concern
- The development of a safe and trusting
relationship is vital for the child to learn to
sooth and care for him or herself in a healthy
manner by internalizing their therapists care
and concern. (Strong, 1988)
36Care and Concern
10
- _____ was the first to acknowledge that maybe I
was in pain, as opposed to doing it for
attention . This affirmation of my inner pain
was a healing force. Shelley
37Discussion
- Why the upsurge in self-injurious behavior?
- Students who look for fist fights?
- Tattoos and piercing?
- Addictive?
38References
- References
- lmuller_at_bcps.org
- mmathews_at_bcps.org
- http//www.helpguide.org/mental/self_injury.htm
http//vivianpencz.wordpress.com/2012/01/11/breath
ing-while-drowning-youth-who-self-harm/
39Upcoming Webinars
- Academic Success of Emotionally Disturbed
Students November, 2012 - Compassion Fatigue December, 2012
- Teenage Alcohol Abuse and Effects on the
Adolescent Brain January, 2013 - ADHD, History, Symptoms, Medication, and
Non-Medication Treatments January 2013 - Please check the website for dates and
registration 3centerae.com