ADOLESCENT SELFINJURY BEHAVIOR

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ADOLESCENT SELF-INJURYBEHAVIOR

• Rhonda Lesniak, RN, BSN, MA, NCSN
• Christine E. Lynn College of Nursing
• Florida Atlantic University

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Key Terms

• Self-injury behavior (SIB)
• Self-inflicted violence (SIV)
• Self-harm
• Self-mutilation
• Cutting
• Self-abuse

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Definition

• Adolescent self-injury behavior is a call for
  nursing through the deliberate infliction of a
  wound to oneself in an attempt to seek expression
  of and immediate relief from intolerable feelings.

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Self-Injury is

• A coping mechanism
• A deliberate act
• Repetitive
• Private and personal
• An act of expression
• Non verbal communication
• A survival strategy
• A cry for help
• A call for nursing

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Self-Injury is not

• Attention seeking
• For pleasure
• A group activity
• A failed suicide attempt
• Manipulation
• A tattooing or body piercing trend

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Who is Self-Injuring?

• 1 in 10 teenagers
• More females than males
• Age of onset pre-teen to teenage
• May last well into their thirties

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Types of Self-Injury

• Cutting
• Scratching
• Burning
• Hair pulling
• Not allowing wounds to heal

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Difference Between SIB and Body Decoration

• Body piercing and tatooing are forms of body
  decoration which are not used to seek immediate
  relief from intolerable feelings.
• Body decoration can originate from a desire for
  peer approval.

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High Risk Indicators

• Childhood history of physical, emotional, mental,
  verbal, or sexual abuse
• Lacks validation
• Feelings of inadequacy
• Low self esteem
• Poor self image

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Calls for Nursing

• Expression may be realized through
• Poetry
• Creative writing
• Artwork
• Frequent school clinic visits
• Frequent absenteeism
• Student just wants to talk

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Antecedents to SIB

• Feels helpless, powerless
• Feelings of isolation and abandonment
• Feelings of worthlessness, emptiness, numbness
• Depression
• Frustration
• Anxiety
• Anger
• Tension

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Why Inflict Physical Pain?

• Physical pain distracts from emotional pain
• Means of communicating distress
• To disassociate from intolerable feelings
• To transfer emotional pain into physical pain
• To regain control over self
• Physical pain is easier to deal with than
  emotional pain
• To gain control
• IT WORKS

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Immediate Consequences of SIB

• Feels alive, functioning, able to act
• Clears the mind, helps to focus
• Release of endorphins
• Tension reduction
• Relief from stress or feelings
• Calmness
• Relaxation
• Sleep

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Later Consequences of SIB

• Guilt
• Shame
• Stigma
• Feelings of isolation and abandonment

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The Cycle of SIB
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ADOLESCENT SELF-INJURY BEHAVIOR
CALL FOR NURSING
DELIBERATE SELF-HARM EXPRESSION
INTOLERABLE FEELINGS
SHORT-TERM RELIEF
Adolescent Self-Injury Behavior is a call for
nursing through the deliberate infliction of a
wound to oneself in an attempt to seek expression
of and immediate relief from intolerable feelings.
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What To Look For

• Unexplained cuts, scratches, burns, or bruises
• Excuses such as, my cat scratched me
• Clothing inappropriate for the weather
• Reluctance to dress out for physical education
  class or swimming
• Dressing to fit in with the Goth crowd

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What To Do Once You Have Identified a Student as
a Self-Injurer

• Offer nonjudgmental, unconditional acceptance
• Provide quiet, private place to talk
• Assure confidentiality
• Establish a trusting relationship
• Above all, listen, listen, listen
• Do not tell student to stop SIB at this time

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Implications for Practice

• Explain to the student that you must notify
  parents of the SIB
• Assure student you will provide assistance,
  encouragement, and support
• Always keep an open door policy
• Establish your school clinic as a safe place
• Assure that wounds are not infected
• Teach wound care to student

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Implications for Practice

• Encourage the student to come to the clinic as
  needed (when feelings are beginning to escalate)
• Intervene at any point during the SIB cycle to
  disrupt the cycle as needed
• Encourage healthy coping mechanisms (drama,
  writing, art, sign language)
• Keep open communication with parents

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Referrals

• Assist parents with referrals to community
  resources, therapists, counselors, etc.
• Arrange for parents and students to meet with
  guidance counselor, if desired.
• The school nurse is the facilitator of this
  interdisciplinary approach and is the main
  resource person for the family.

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Therapeutic Regimens

• Diagnosed mental disorders (depression, bipolar,
  anxiety, compulsive disorder) will be treated
  traditionally with medication.
• Implications for school nurse become familiar
  with medications and potential adverse reactions
• Report any adverse reaction to parents

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Therapeutic Regimens

• Counseling and talking therapies
• Psycho-Dynamic therapy
• Cognitive behavioral therapy
• Person centered therapy
• Group therapy, self help, empowerment

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What About Suicide?

• Determine if student has suicidal ideations
• Are you having suicidal thoughts? Have you ever
  considered suicide?
• Are you harming yourself in any way? Have you
  hurt yourself recently?
• Do you have the intention to hurt yourself in the
  future?

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If Student is Suicidal

• Use the SLAP method
• Does the student have a plan and how Specific is
  the plan?
• How Lethal is the plan?
• How Accessible is the plan or method?
• In what Proximity could help be found?

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Suicide Prevention

• If you believe the student may be of serious harm
  to self or others, you must notify the school
  authorities, and follow the policy of your school
  district.

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Implications for Research

• Create an atmosphere of openness and trust.
• Encourage the student to share his or her story
  of the lived experience of an adolescent who
  self-injures.