SELFINJURY

1
SELF-INJURY

• What is self-injury?
• Who is a self-injurer?
• When does self-injury become an issue which needs
  to be addressed with family and individual
  therapy?
• Typical and not-so-typical characteristics of a
  self-injurer

2
Dr. Terence Barrett

• Bodily Harm by Karen Conterio and Wendy Lader,
  Hyerion New York, New York 1998.
• Women Who Hurt Themselves by Dusty Miller, Basic
  Books New York, New York 1994

3
OTHER RESOURCESA Bright Red Scream, by Marilee
Strong, Viking New York, New York,
1998.Cutting the Pain Away Understanding
Self-Mutilation, by Ann Holmes with Senior
Consulting Editor, Carol C. Nadelson, M.D.,
Chelsea House Publishers Philadelphia,
2000.See My Pain! by Susan Bowman, Ed.S., LPC
and Kaye Randall, LMSW, YouthLight, Inc.
Chapin, SC, 2005.Secret Scars Uncovering and
Understanding the Addiction of Self-Injury, by
V.J. Turner, Hazeldon Center City Minnesota,
2002.
4
RESOURCES, CONTINUED

• Websites
• www.self-injury.org
• www.crystal.palace.net
• www.AmericanSelfHarmInformationClearingHousewebrin
  g
• www.christians-in-recovery.org
• www.mentalhealth.org
• www.selfharm.net
• www.xanga.com

5
DEFINITION

• Self-Harm is Harming oneself with the purpose
  of causing relief, but without the purpose of
  killing oneself.
• Other terms commonly used self-mutilation,
  self-injury, parasuicide, self-destructive
  behavior, self-cutting

6

• A person engages in Self-Harm in an effort to
  provide emotional relief.
• Emotional tensions are often due to frustration,
  sexual abuse, romantic break up, friendship
  conflicts, perceived excessive control by parents
  or other authority figures.
• Imprisonment

7
STATISTICS

• Estimated 750 out of 100,000 people self-harm.
• Age at onset ranges from 5 and up, but usually
  between 14 and 24.

8
Typical Characteristics of a person who is a
self-injurer

• Female
• Intelligent
• White, middle class
• Low self esteem
• Difficulty relating to people and forming
  intimate relationships
• Finds it extremely difficult to articulate
  thoughts and feelings

9

• Victim of sexual abuse, physical and/or emotional
  abuse
• Children of alcoholics
• Grew up in a rigid household with strict rules
• Grew up in a home where parental nurturing is
  absent or minimal
• Insatiable need for love and acceptance
• Accompanying eating disorder
• Other psychiatric disorder(s) such as depression,
  anxiety, borderline personality

10

• Secretive
• Events that might precipitate an episode of
  self-injury
• Anger, frustration
• Loss of a friendship, other relationship
• Sense of helplessness

11

• Wear long sleeves, even in summer
• Refuse to participate in PE
• Who do they tell
• Where does the self-injury take place
• inpatient/residential homes
• prisons
• home
• school

12

• When is it a crisis?
• Determine if the person needs immediate medical
  help
• Do not panic

13
DIAGNOSTIC LABELS

• There is no DSM-IV Diagnosis for self-injury.
• However, there are some commonly associated
  diagnoses
• - Major Depression
• - Psychosis
• - Multiple Personality Disorder
• - Bi-polar Disorder (manic depression)
• - Borderline Personality (most commonly used)

14
Other Commonly Co-existing Diagnoses

• Anxiety
• Post-traumatic Stress Disorder
• Obsessive-Compulsive Disorder
• Addiction, Substance Abuse
• Impulse Control Disorder

15
FORMS OF SELF-INJURY

• Most commonly used forms are cutting and burning.
• Other methods
• - Head banging
• - Breaking bones
• - Chewing the lips, tongue or fingers
• - Facial skinning
• - Amputation of limbs, breasts, digits,
  genitals
• - Ingesting sharp or toxic objects
• Only limited to the individuals creativity and
  imagination.

16
CLASSIC CASES

• THESE ARE CASES WHERE PEOPLE USE
• - Knives
• - Razors
• - Scissors
• - Cigarette tips
• - Cigarette lighters

17
SELF-INJURY VS. SUICIDE VS. HARMING OTHERS

• Self-injurers commonly experience suicidal
  thoughts, but few end their lives in suicide.
• Almost no self-injurers have harmed others.

18
PEER INFLUENCE/CONTAGION

• Teens learn about self-injury from peers or from
  idols in the popular culture.
• Can you think of any actors/actresses/musicians
  who reportedly engage in self-injury?

19
WHY DO IT?

• Most commonly reported consequence of
  self-injuring is to obtain the calming, analgesic
  effect.

20
COMMON PARENTAL REACTIONS

• Fear
• Baby-sitting, going everywhere with the teen,
  staying up at night
• Issue ultimatums
• Take away all potentially dangerous objects
• Decide that the teens cutting is manipulative
  behavior and they will not succumb to it.
• The above does not help the self-injurer.
• It is likely that the self-injurer will panic and
  become increasingly disorganized and distressed.

21
FOUR INDICATIONS THAT A PARTICULAR BEHAVIOR IN A
PARTICULAR SITUATION IS POTENTIALLY HARMFUL TO
THE BODY AND COULD BE CONSIDERED SELF-INJURY
22

• Feeling compulsively drawn to engage in the
  behavior.
• Getting a high from the way the activity feels
  physically.
• If the behavior consumes ones thoughts or
  interferes with ones ability to function
  normally.
• Not being able to stop the behavior.

23

• What behaviors can be considered self-harm?
• -Picking at a scab?
• -Body piercing?
• -Cosmetic surgeries?
• -Scratching?
• -Excessive drinking?
• -Use/Abuse of drugs?
• -Eating Binges or Starving Oneself?

24

• What should we mental health professionals do if
  we learn that a student or client is involved in
  self-harming behavior?
• Is self-harm addictive?
• What treatments are available in your local area?