Coping Through Pain: The Who, What, and Whys of SelfInjury

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Coping Through PainThe Who, What, and Whys of
Self-Injury

• Presented by
• Lori A. Hall, M.A., L.P.P.
• Student/Family Support Services Coordinator
• Officer Michael R. Grigsby
• School Resource Officer
• Pulaski County Schools

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What is Self-Injury?

• Definition to cause intentional harm to ones
  own body without the intent of suicide, without
  the assistance of another person, and with enough
  severity for tissue damage to result
• Otherwise Known As cutting, self-harm,
  self-inflicted violence, self-mutilation,
  self-injurious behavior
  
• Types of Self-Injury picking at wounds,
  scratching, cutting, burning, biting, hitting
  self, head banging, breaking bones, etc.
  
• Targeted Areas arms, wrists, inner thighs,
  chest, and abdomen
  
• Self-Injury is not for the intent of suicide but
  of survival. It is a desperate act!
  

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Who Self-Injures?

• The typical self-injurer is a white, adolescent,
  middle-class female who has average to above
  average intelligence, low self-esteem, and
  appears to be well-adjusted.
• The average age of onset for self-injury starts
  at age 14 and continues with increasing severity
  into the late 20s.
  
• Nearly 50 report they were either sexually,
  physically, or verbally abused during childhood.
  
  
• Many self-injurers report that they were
  discouraged from expressing emotion (some reports
  as high as 90).
  
• Some famous self-injurers include Johnny Depp,
  Christina Ricci, Angelina Jolie, Drew Barrymore,
  and Princess Diana

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Precipitants to Self-Injury

• Episodes of self-injury are often preceded by
• Fear, anxiety, and panic
• A frenzied mental state
• Flashbacks of abuse from the past
• Memories of traumatic events
• Anger, depression, frustration, even happiness
• A zone or dissociative state

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Why do People Harm Themselves?

• It gives the self-injurer a sense of being in
  control children of abuse often come to expect
  abuse with stressful situations they expect the
  pain self-injury helps them satisfy this need
  and establish control in stressful situations.
• It acts as a defense mechanism in that physical
  pain helps hide emotional pain the pain will
  bring on a sense of relaxation.
  
• It reinforces their feelings of inferiority and
  their desire to be punished people who are
  abused as children are taught that they are no
  good and deserve punishment.

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Why do People Harm Themselves?

• It makes them unattractive people who have been
  raped may choose to self harm so they will be
  unattractive to others and will be less likely to
  be raped again.
• It can be used as a medication to soothe an
  emotional state when self-injury occurs, the
  body releases endorphins that cause a calming
  effect this calming effect may become addictive
  to the self-injurer.
• It provides a sense of nurturance and attention
  called the wounding embrace satisfaction comes
  from the process of cleansing, bandaging, and
  otherwise tending to the wound some may
  interfere with the healing process so the injury
  and need for attention is prolonged.

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Why do People Harm Themselves?

• It may be a way of seeking out attention it
  often shocks people who in turn give attention
  and sympathy to the self-injurer.
  
• It can be a way to express emotions symbolically
  repressed anger can be expressed through
  self-injury.
  
• It can provide an emotional outburst without harm
  to others fearing they may harm someone else,
  self-injurers take their anger and frustration
  out on themselves.
• It may be used by women as an expression of
  dissatisfaction with their bodies women are
  taught they are to look a certain way this
  encourages women to view their bodies as
  imperfect and unacceptable.

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Bottom Line . . . .

• Self-injury occurs because a person is unable to
  appropriately cope with and express emotions or
  to communicate their needs to others.
  
• Remember It is a Desperate Act!

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Is Self-Injury Effective In Dealing With Problems?

• Self-Injury provides an unhealthy, temporary
  relief from problematic situations and emotional
  states but the problem underlying the self-injury
  remains.
• Self-Injury is a Symptom of a Problem!
• To overcome self-injury, you must face and
• overcome the underlying problem!

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Negative Consequences of Self-Injury

• Possibility of permanently disfiguring or harming
  ones body
  
• Embarrassment resulting in the need to hide scars
  and wounds
  
• Could result in more harm than intended including
  accidental suicide
  
• May develop the reputation of being unbalanced
  and mentally unstable
  
• As long as the person uses self-injury as their
  main coping mechanism, they will not be learning
  other, more adaptive ways to handle lifes
  pressures
• Self-Injury can become a vicious cycle

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Psychological Disorders Often Associated with
Self-Injury

• Borderline Personality Disorder
• Obsessive Compulsive Disorder
• Post-Traumatic Stress Disorder
• Dissociative Identity Disorder
• Eating Disorders
• Substance Abuse
• Mood Disorders
• Anxiety Disorders
• Impulse-Control Disorder

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Treatment for Self-Injury

• Treatment MUST focus on resolving the underlying
  problem and teaching individuals how to express
  and cope with feelings in a healthy way! An
  individual must learn how to separate thoughts
  from feelings and behaviors. This separation
  after repeated practice will help the individual
  practice impulse control, choose not to
  self-injure, and replace the desire to
  self-injure with a more mature, adaptive coping
  technique.
• Treatment MUST focus on encouraging the
  development of healthy and positive
  self-esteem/identity, self-acceptance,
  decision-making skills, goal-setting, and
  familial and/or social support.

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• A Schools Response
• To Self-Injury
• Protecting Students With Support
• And Education Without Reinforcing
• The Behavior or Increasing Shame

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School-Based Treatment Approaches

• Allow the Self-Injurer to develop a strong
  supportive relationship with a staff member (most
  often this will be with the guidance counselor or
  FRYSC staff)
• This relationship MUST be helpful, respectful,
  honest, sincere, and empathetic NEVER hurtful,
  punishing, or enforcing of ultimatums.
  
• Complete a Safety Contract with the self-injurer
  and be willing to and consistent in follow-up
  
• Always include the parents in the treatment
  process Be willing to educate them about
  self-injury and appropriate parental responses
  

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School-Based Treatment Approaches

• Refer the student for outpatient individual and
  family counseling
  
• Facilitate a support/educational group for
  self-injurers during school hours group MUST
  focus on development of coping, social, and
  decision-making skills, increasing positive
  self-esteem, and identifying/practicing
  alternative coping behaviors
• Encourage the student to become involved in a
  school activity or club

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School-Based Treatment Approaches

• Always monitor for an increase in severity and
  occurrence and assess for lethality and intent.
  
  
• If the self-injury begins to occur more
  frequently, inflicts severe harm, and is intended
  for suicide, hospitalization will be necessary.
  
• If the behavior persists even after outpatient
  counseling, school support, and acute
  hospitalizations, long-term treatment may be
  required.
• Ongoing collaboration with the student, parents,
  teachers, and outpatient agencies is a MUST!

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Law Enforcement Response

• The Misconception About
• Self-Injury

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Traditional vs. Modern Response

• Labeled them as being crazy
• Thought they were trying to kill themselves
• Restrain, transport and have them evaluated
• No training in responding dealt with the same as
  an attempted suicide

• Understand they need help
• Referrals to appropriate help
• Not crazy
• Not always an attempted suicide
• Need for more training and understanding

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New Roles and Response

• Self-mutilation has been thought to be child
  abuse/neglect
  
• Self-mutilation has been linked to Satanic
  behavior
  
• Inaccurate information about Self-Injury exists

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Help for the Helpers

• Not paying attention to self-injury does not make
  it vanish you MUST respond in some way. Here
  are some guidelines for dealing with an
  adolescent self-injurer
• Dont take it personally
• Educate yourself
• Understand your feelings
• Be supportive without reinforcing the behavior

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References

• Hawley, Kristel. Can You See My Pain?
  Northeastern Wisconsin In-School
  Telecommunications.
  
• Levander, Andrew. Self-Injurious Behavior
  Assessment, Treatment, and the Recovery Process,
  Cross Country University, 2004.
  
• SVE Churchill Media. (2002). Self-Injury From
  Suffering to Solutions Video.
  
• Turner, V.J. Secret Scars Uncovering and
  Understanding the Addiction of Self-Injury,
  Hazelden, 2002.

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Informational Websites

• www.bme.freeq.com/news/selfmutp.html
• wysiwyg//12/http//www.geocities.legePark/Quad/2
  423/selfinjury.html
  
• wysiwyg//24/http//www.service4you.net/selfinjury
  /brights.shtml
  
• www.worldchat.com/public/asarc/selfmutl.htm
• www.palace.net/llama/psych/injury.html
• www.selfabuse.com
• www.safe-alternatives.com
• www.self-injury.freeserve.co.uk

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Questions or Comments??
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To Contact the Presenters

• Lori A. Hall, M.A., L.P.P.
• Pulaski County Board of Education
• 606-679-1123 ext. 264
• lori.hall_at_pulaski.kyschools.us
• Officer Michael R. Grigsby
• Somerset Police Department
• 606-305-2920
• mike.grigsby_at_pulaski.kyschools.us

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Case Files of Self-Injurers

• WARNING Several of these pictures are disturbing
  and contain graphic images. These are from
  various law enforcement responses to Self-Injury
  incidents.

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13- year old self burn (3 days)
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15 year old - 4 years as a SI
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17 year old female - SI for 6 years
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Long term scaring, 14 year old female - SI for 4
years
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13 year old female - 2 years as a SI
Cut marks on upper thigh
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Posted on teen-web site The piercing was self-ap
plied
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Areas that are easy to reach
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The arms and shoulders are most common!
Cuts to areas that quickly produce bleeding and
are easy for the SI to reach will be the most
likely area for cut marks
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16 year old - 6 months as a SI
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Negative Self Image - FAT, FAT
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Self Mutilation leads to Self Degradation
Signs of self degradation may begin with claims,
I am so fat, or I am just stupid. Sometimes
these negative assumptions are reinforced by
peers and sometimes by parents or guardians
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Most common sign - simple slash cut marks
Cuts are horizontal across the arm
Cuts are deep enough only to produce blood
Some experts, think as Mutilation progresses, the
cuts become deeper
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Multiple Signs may generate different responses
among LEN Responders
Stars, pentagrams and other geometrical shapes
may lead First Responders to believe there is
some relation to the Occult
Various letter and/or random lines may be viewed,
do not have an outside meaning but may be very
significant to the victim
Loser and other such references, signs of doubt
of self worth and negative self image
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Self-Injury Signs
A pattern to injury area usually indicates
self-injury. This was done with an eyeliner with
the brush removed.
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Signs of Self-Injury
Some signs of SI include razors, bloody clothes,
bandages, towels, etc These may be explained by
the victim, as Oh, I cut my self shaving or
they may refuse to give any explanation
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Self-Injury Signs
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Self-Injury Signs
A mosaic of multiple self-injuries from the same
victim who is a 16 year old female
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Self-Injury Signs
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17 year old female Self-Injurer
Parents claim that they knew nothing
Victim passed out in bathroom and was found by 8
year old sister who called 911
Victim was taken to hospital and discharged 3
days later. Victim was found deceased 5 days late
r from reopening the wounds
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Underground Media Promotes Such Behavior
Dying, is an art, like everything else I do it
exceptionally well
Pay attention to posters, drawing, writing, etc..
Also observe current trends that are popular with
student population. You do not have to be an
expert but at least be aware.
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No Control of Anything Except Their Bodies
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Advertisements are Found in Various Teenage
Magazines
There are a variety of ads in teen magazines that
express the occult and fascination with cutting
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Magazine Ad Promoting SI
Shes been everybody else's girl, Maybe one day
she will be her own
The need to be their own person and realize their
own worth is key in prevention!
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Simple Sketches
The interpretation?? The sense of falling and not
being able to catch their self, the nude figure
represents helplessness and being open to world
for pain, the red represents blood
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Cannot Get Over The Fence
Simple Cartoons can sometimes express the hidden
worries. SIs want to escape and feel like every
one is holding them back. SI have to obtain som
e release and usually do so through the pain they
inflict on themselves
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Poster from Web-site
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Drawing from 8th grader
Signs of hopelessness and wanting to give up can
be interpreted by LEN Responders as suicidal
behavior