Self-Injury

1. Self-Injury Presented By Sonia Campos, M.Ed., LPC, NCC, CART Lisa Garcia, M.S., LPC, NCC, CART

2. AGENDA • Introduction • Definition of Self-Injury • Understanding Self-Injury • Categories of Self-Injury • Underlying Causes and Functions of Self-Injury • Suggestions for Professionals & Family • Treatment Strategies • Websites • Resources • Questions and Answers

3. Scars have the strange power to remind us that the past is real. Cormac McCarthy, All the Pretty Horses

4. Definition • “Self-Injury is intentional, self-effected, low lethality bodily harm of a socially unacceptable nature, performed to reduce psychological distress. (Walsh 2006) • The act is NOT to commit suicide • Psychologically motivated

5. Understanding Self-Injury

6. Understanding Self-Injury Manifestation from the phenomenon “Self-Harm” It is a difficult and disturbing behavior that communicates one’s pain and self-destructiveness A direct form of violence upon one’s body Powerful statement of one’s psychological distress that has distorted the individuals ability to manage and soothe their pain A sense of powerlessness

7. Understanding Self-Injury • “A specific language of pain that communicates the suffering of past and current trauma, which is spoken loudly by the self-inflicted repetition of that trauma upon one’s own body” (Conterio & Lader, 1998). • “My body looks how I feel.” • A self-injurer

8. Self-Injury as a Diagnosis? • Yet to be a discrete disorder • Partially referenced for the diagnosis of Borderline Personality Disorder in DSM IV TR • PTSD • Dissociative Identity Disorder • Bipolar Disorder • Common in Eating Disorders • Impulse Control Disorders

9. Prevalence • Typically starts during adolescence and ranges into young adulthood • Studies estimate that 1,400 per 100,000 people during the 90’s • Significantly more prevalent in Females • 3 to 4 times higher than males • Girls internalize anger

10. Prevalence • Contributing factors • abuse • lack of parental psychological presence • divorce • sexual orientation • daily pressures • body pressure

11. Understanding Self-Injury • Common Forms of Self-Injury • Cutting (72%) • Carving • Burning (35%) • Self-hitting (30%) • Picking at scabs (22%) • Hair pulling (10%) • Biting • Peeling layers of skin • Ingesting sharp objects Study by Favazza and Conterio 1988 Cutting, to this day, is the most often used method

12. Manifestations of Self-Injury • Wrists and arms are the common areas to cut • Studies render that legs, abdomens, heads, chests, and genitals are other cut areas • Self-injurers report that once they cut they experience little to no pain compared to their emotional suffering • Instruments used vary: • Scissors, razor blades, knives, scalpels, shards of glass, pieces of metal

13. Manifestations of Self-Injury • Instruments used vary: • Scissors • Razor blades • Knives • Scalpels • Shards of glass • Pieces of metal

14. Categories of Self-Injury

15. Categories of Self-Injurious Behaviors Proposed by Simeon and Favazza 2001 • Stereotypic Self-Injurious Behaviors • Biologically driven force that is highly repetitive, fixed, rhythmic, and usually contentless acts, anywhere from mild to severe injury • Major Self-Injurious Behaviors • Most dramatic kind (castration, amputation) that involves suffering and severe psychotic pathology

16. Categories of Self-Injurious Behaviors Proposed by Simeon and Favazza 2001 3. Compulsive Self-Injurious Behaviors • Behaviors that are repetitive and ritualistic, multiple times per day (hair pulling, nail biting) 4. Impulsive Self-Injurious Behaviors • Preoccupation of harming oneself, hard to resist impulse, feeling to tension prior to act and relief at execution, no suicidal intent

17. Underlying Causes

18. Underlying Causes • Self-Injury is not easily explained or accounted by a single cause. • Trauma exposure, Personality characteristics, and Comorbid clinical features have been identified in self-injurers. • Exposure to trauma is associated with the development of maladaptive personality features and clinical diagnosis. • Major depressive disorder, generalized anxiety dirosder, PTSD

19. Underlying Causes • The end result of trauma is the invalidation of one’s sense of self, in which the individual turns to the body for solace. • It is an effort not to feel what cannot be tolerated.

20. Functions of Self-Injury

21. Functions of Self-Injury • Self-injurers do not seek death through attacking their body, they attempt to defy it. • Four functions of self-injury 1. Regulating affect, soothing emotional wounds, and managing dissociation 2. Seeking mastery over pain and past trauma 3. Communicating pain, controlling others, and seeking nurturance 4. Securing and authenticating a sense of self

22. Four Functions • Regulating affect, soothing emotional wounds, and managing dissociation • Provides a sense of deep relief from emotional distress • Self-injury is utilized to express and manage intolerable feelings • External soothing helps the individual feel a greater sense of security

23. Four Functions Cutting serves as a calming functioning by triggering endogenous opoids and transends distress to tranquility • Self-injury can alleviate the sense of emptiness and deadness. • They believe that they are connected to their bodies

24. Four Functions • Seeking Mastery Over Pain and Past Trauma • Derive a lack of control over others and their own destinies that they feel in-control by attacking their bodies • Better to create their own pain and be able to control it rather than be a victim to the pain • Sense of mastering their past unresolved feelings • Mastery and control provides a sense of hope

25. Four Functions • Communicating Pain, Controlling Others, and Seeking Nurturance • Inability of putting words to the pain they have experienced • The body speaks what the self-injurer can not articulate • A form of instilling shock onto others • Can be a desperate attempt to make others notice the he/she exists and is in pain and wants a connection • Can elicit posititve attention from others which is reinforcing the behavior

26. Four Functions • Securing Authenticating a Sense of Self • Have difficulty in creating and maintaining psychological and interpersonal boundaries • The behavior defends injurer from intense emotions of perceived abandonment • The injurer is able to experience her/his own vitality through the physical sensation of the act– seeing the blood and scars • The body and its wounding connect the individual’s inner and outer worlds

27. Suggestions for Professional Counselors, Social Workers, and Psychologists

28. Suggestions for Mental Health Professionals • Show the child/adolescent unconditional acceptance. 2. Accept him/her as a person regardless of the behavior. 3. Make understanding the underlying causes for the behavior a goal. 4. Encourage a commitment to try positive alternative behaviors for coping.

29. Suggestions for Mental Health Professionals-(Continued) • Suggest a list of coping techniques to be used rather than Self-Injury. • Understand that the list is flexible and can always change. • Encourage open communication no matter what the behavior. 8. Acknowledge his/her efforts to cope with very difficult emotions.

30. Suggestions for Mental Health Professionals-(Continued) • Show that you care about the injuries. • Communicate that it is okay to talk about Self Injury. • Help him/her discover their identity. 12. Remember that you are not responsible for the child/adolescent’s behavior. From: Bowman, S. & Randall, K (2006). See My Pain! Creative strategies and activities for helping young people who self-injure. Chapin, SC: YouthLight, Inc.

31. Suggestions for Teachers/ Educators

32. Suggestions for Teachers • Try to approach the student in a calm and caring way. 2. Accept him/her even though you do not accept the behavior. 3. Let the student know how much you care about him/her and believe in his/her potential. 4. Understand that this is his/her way of coping with the pain that he/she feels inside. 5. Refer that student to your school’s counselor, social worker, and/or nurse.

33. Suggestions for Teachers - (Continued) • Offer to go with that student to see the professional helper. • Listen! Allow the student to talk to you. Be available. • Discover what the student’s personal strengths are and encourage him/her to use those strengths. • Help him/her get involved in some area of interest, a club, sport, peer program, outreach project, e.g., volunteer at a local animal shelter or wildlife sanctuary, help an older person at a nursing home, become a tutor, or mentor. From: Bowman, S. & Randall, K (2006). See My Pain! Creative strategies and activities for helping young people who self-injure. Chapin, SC: YouthLight, Inc.

34. Suggestions for Family

35. Suggestions for the Family • Accept your child even though you do not accept his/her behavior. • Let your child know how much you love hem/her, not only when he/she Self-Injures, but at other times as well. • Understand that this is his/her way of coping with the intense pain that he/she feels inside. • Encourage healthier methods of coping by allowing him/her to brainstorm other ways other than hurting him/herself.

36. Suggestions for the Family – (Continued) 5. Listen! Keep communication open by talking about things that would interest him/her even if it doesn’t interest you. 6. Ask open questions (what or how) to encourage him/her to open up. Allow conversations to revolve around what he/she wants to talk about no matter how silly or crazy it may seem to you. 7. Allow him/her to share what they’re feeling deep inside either with words (journaling) or in art (drawing, painting, creating, or any other way he/she can communicate their feelings).

37. Suggestions for the Family – (Continued) • Make your home a “Safe Place” by removing anything that could be used as a tool for Self-Injury. • Have fun together! Try to do some fun things together (let him/her choose a fun activity that is interactive, not just going to the movies). Although he/she may complain at first, your child really does want to spend time with you. • Discover what his/her personal strengths are and encourage him/her to use those strengths during difficult times.

38. Suggestions for the Family – (Continued) 11. Help your child to get involved in some area of interest, after-school activity, a good cause, or other good will effort. 12. Encourage some kind of outreach in the community , e.g., volunteering at a local animal shelter or wildlife sanctuary, helping an older person at a nursing home, tutoring a young child after school, or mentoring a troubled younger child. From: Bowman, S. & Randall, K (2006). See My Pain! Creative strategies and activities for helping young people who self-injure. Chapin, SC: YouthLight, Inc.

39. Treatment Strategies

40. Treatment Strategies • Crucial Communication Skills • Personal Strength Coaching • Relaxation/Guided Imagery • Reflective Journaling • Visual Arts • Clay • Sand Tray

41. Treatment Strategies – (Continued) • Metaphors • Music • Story Telling • Tactile Diversion • Creative Dramatics • Mentoring • Animal Assisted Therapy • Prayer Power

42. Websites

43. Websites • NOTE: Some experts say that people who self-injure can be triggered by visiting Websites or chat rooms that discuss self-injury. • HealthyPlace Self-Injury Community • www.healthyplace.com/Communities/Self_Injury/site/ • Self-Injury: You are Not the Only One • www.palace.net/~llama/psych/injury.html

44. Websites – (Continued) • Focus Adolescent Services • www.focusas.com • Teen Health Centre • www.teenhealthcentre.com

45. Websites – (Continued) • SIARI: Self-Injury and Related Issues • www.siari.co.uk • S.A.F.E. Alternatives (Self-Abuse Finally Ends) • www.selfinjury.com • American Self-Harm Information Clearinghouse • www.selfinjury.org

46. References

47. References Bowman, S. & Randall, K. (2006). See my pain! Creative strategies and activities for helping young people who self-injure. Chapin, SC: YouthLight, Inc. D’Onofrio, A. (2007). Adolescent self-injury: a comprehensive guide for counselors and health care professionals. New York, NY: Springer Publishing Company, LLC. McVey-Noble, M. E., Khemlani-Patel, S., & Neziroglu, F. (2006). When your child is cutting: a parent’s guide to helping children self-injury. Oakland, CA: New Harbinger Publications, Inc. Walsh, B. W. (2006). Treating self-injury: a practical guide. New York, NY: Guilford Publications, Inc. Winkler, K. (2003). Cutting and self-mutilation: when teens injure themselves. Berkeley Heights, NJ: Enslow Publishers, Inc.

48. elements www.animationfactory.com