On the cutting edge:

1
On the cutting edge

• Working with teens who self injure

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On the cutting edge

• History of self-injury
• Why do people self-injure?
• Types of self-injury
• Description of a self injurer
• Role of the counselor
• Family dynamics

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Types of self-injury
Cutting skin
Burning oneself
Hitting oneself
Head banging/extracting hair to excess
Scratching to excess
Severe nail biting/biting oneself
Interfering with healing wounds
Chewing lips, tongue, or fingers
Ingesting sharp or toxic objects
Facial skinning
Breaking bones
Amputation of limbs, breasts, digits, etc...
Eye removal
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Self-injury characteristics

• Self-injury is a behavior done by yourself
• Self injury means there is some kind of physical
  violence
• Self-injury is not performed with the intention
  of suicide
• Self-injury is an intentional act
• Self-injury is not an alteration of appearance
• Self-injury is not ritual mutilation
• Self-injury is not a fad
• Self-injury is a purposeful act of self-help

5
Why do people self-injure?
Self-injury is a maladaptive coping style
Self-injury is a means of escape from
over-whelming feelings
Self-injury is a release of pain
Self-injury is an addiction (the endorphin theory)
Self-injury is a way to feel something
Self-injury is an abuse pattern
Lack of role models and invalidation as a child
Brain chemistry/biological predisposition theory
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The self-injurer

• All types of backgrounds
• Typical onset is puberty
• Above average to superior intelligence
• Low self-esteem
• Problem avoidance
• Eating disorder/alcohol and substance abuse
• Angry, impulsive, anxious, aggressive
• Senses are overwhelmed (dissociation)
• Relies on actions to gain relief
• An attempt to maintain psychological integrity
• Self-injury quickly and dramatically calms the
  body
• Trouble forming intimate relationships

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The family

• Traumatic losses, illnesses, or instability
• Neglect or abuse-physical,sexual,emotional
• Rigid, dogmatic code of values
• Impossible standards of perfection
• Lack of role models and invalidation
• Child takes adult responsibilities
• Poor communication
• Expressing feelings not allowed

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What the family and friends should know

• Look for telltale signs scars on arms or legs, a
  pattern of abrasions
• Signs can also be scarce or very subtle
• Being secretive or disappearing frequently
• Makes weak excuses for the wounds and may become
  guarded or anxious
• Wearing long sleeves and pants in warm weather
• Finding miscellaneous tools like razors or paper
  clips in odd places

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Psychological issues

• A history of trauma
• Physical or sexual abuse
• Dissociation
• Eating disorders
• Substance abuse
• Borderline personality disordrer

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Behavior changes to watch for

• Social withdrawal
• Sensitivity to rejection
• Difficulty handling anger
• Negative comments about themselves
• Showing feelings of shame, worthlessness, or
  self-loathing

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What parents need to know

• Openly talk with your teen as soon as you find
  out, more importantly, be a non-judgemental
  listener
• Clearly say that you want to help, acknowledge
  their feelings
• Avoid punishment and calling them crazy
• Control initial reaction
• Avoid power struggles and threats
• Consider the self injurers privacy
• Be available and supportive
• Take care of yourself and seek your own
  counseling if needed
• Although difficult, examine your part in the
  problem

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What the counselor needs to know

• Your theoretical orientation does not matter
• Your ability to form a therapeutic relationship
  does
• Your gender does not matter
• Do not try to control your clients use of
  self-injury
• Lack of experience is not a barrier to working
  with self-injuring clients
• Self-injury us a symptom of a more serious problem

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Any Questions?