I Wasn’t Trying to Kill Myself…

1. I Wasn’t Trying to Kill Myself… Prepared and Presented By: Julia Valley, MSW Youth Community Developer Western Ottawa Community Resource Centre

2. What is Self-Injury? Self-injury is the act of inflicting physical harm on oneself without the intent to cause death Favazza, A. (1998)

4. Why?

6. People engage in self injury for a variety of reasons… Self-Injury

7. Affect Regulation • To escape from emptiness and depression • To ease tension • To provide relief • By causing pain, an individual may engage in self-injury in order to reduce emotional and physiological arousal to a more bearable level • To relieve anger • Individuals who engage in self-injury may find that the act helps them to vent their feelings Favazza, A. (1998)

8. Affect Regulation • To escape numbness • Many of those who self-injure say they do it in order to feel something… to know that they're still alive • To ‘ground’ themselves • When feeling overwhelmed by emotions, individuals may use self-injury as a way to centre their thoughts • To maintain a sense of security • To achieve a feeling of euphoria • To prevent themselves from engaging in a suicidal action Favazza, A. (1998)

9. Communication • To express emotional pain • To obtain/ maintain influence over the behavior of others • To communicate to others the extent of their inner turmoil • To communicate a need for support • To express or cope with feelings of alienation/ isolation • To validate emotional pain • The wounds can serve as evidence that the feelings are real Favazza, A. (1998)

10. Control/ Punishment • To punish oneself for being "bad" • To obtain biochemical relief • There is some thought that an individual can become addicted to crisis behavior… and self-harm can perpetuate this kind of crisis state • To divert attention (inner or outer) from issues that are too painful to examine • To exert a sense of control over one's body Favazza, A. (1998)

11. Video

12. Self-Injury in Adolescence

13. Adolescents are Particularly Vulnerable • Prevalence rate – 16.9% of youth between the ages of 14 and 21 • Mean age of onset – 15.1 • Most adults who self-injure began in adolescence Nixon, M., Clouthier, P., & Jansson, M., (2008)

14. Why Adolescence? • Stress levels drastically increase during adolescence • Less likely to have developed alternative coping skills • Less likely to consider possible long-term consequences (i.e. scarring)

15. Being female (77%) Symptoms of: Depression Anxiety Impulsivity Disruptive disorders Borderline Personality Disorder Low self-esteem Problems with anger control and anger discomfort Risk Factors Nixon, M., Clouthier, P., & Jansson, M., (2008)

16. Risk Factors • Substance misuse • Familial problems • Having self-harming family members • Emotional neglect • Impaired communication • Family-related stressors • Poverty • History of physical and/or sexual abuse • Awareness of self-harm in peers • History of suicidal ideation and attempts Nixon, M., Clouthier, P., & Jansson, M., (2008)

17. Protective Factors • Family cohesiveness • Social connectedness • Confidence re: problem-solving ability • Positive self-image • Academic success Nixon, M., Clouthier, P., & Jansson, M., (2008)

18. Types of Self-Injury • In adolescence, the most common types of self-injurious behaviours are: • Cutting (83.2%) • Scratching (80.4%) • Self-hitting (79.3%) • Ingesting a medication in excess of the prescribed or generally recognized dosage (31.5%) • Ingesting a recreational or illicit drug or alcohol as a means to harm self (16.9%) • Other non-specified forms of self-injury (9.4%) Nixon, M., Clouthier, P., & Jansson, M., (2008)

19. What to Look For

20. What to Look For • Cut or burn marks/ scars • Arms, legs, and abdomen are most common • Finding sharp objects within the individual’s possession • i.e. Knifes, razor blades, box cutters, pieces of glass • Wearing inappropriate seasonal clothing (in order to hide injuries/scars) • i.e. Wearing long-sleeved shirts and/or pants during the summer

21. What to Look For • Low self esteem • Problems handling emotions • Problems with relationships • The teen's peers cut or burn themselves • Reports from others about suspicions that the individual is engaging in self-injurious behaviours • Noticing that the individual tends to respond to stressful issues by locking him/herself away in a room or by stepping out to go to the washroom

22. How To Help

24. How to Help (During a Self-Injurious Episode) • Respond to all medical concerns, as appropriate (i.e. call EMS, provide access to first aid supplies) • Ask what is going on/ what triggered the behaviour • Listen non-judgmentally

25. How to Help (During a Self-Injurious Episode) • Complete a suicide risk assessment • Ask if they are thinking of dying by suicide • Current plan, history of previous attempts, access resources • Take an ASIST Suicide Intervention Training • Report, as required

26. How to Help (After a Self-Injurious Episode) • Help the individual to put words to their feelings • Set a time to re-connect and/ or connect the individual with appropriate support personnel • Help to develop a safety plan

27. The Don’ts • DO NOT demand that the person has to stop or tell them not to do it • DO NOT shame the person or dismiss the behaviour as manipulation or attention-seeking • DO NOT label the person • DO NOT minimize the feelings/ situation which has led to self-injury

28. The Do’s • Respond to injuries on a medical level… and not an emotional one • Tell the person you know something is going on and will assist in getting some help • Be there to talk • Be patient

29. The Do’s • Try to empathize • Look at the situation from the person's perspective instead of your own • This behavior is not horrible to this individual - It is helpful • Recognize that the person may need more help than you are able to provide • Offer to help the person to find alternative coping strategies to resist the urge • Take time out yourself

30. Suggestions to Help Manage the Urge

31. Managing the Urge • Call a friend, therapist or a crisis line • Do some deep breathing exercises/ yoga • Work with paint, clay, play-dough, etc. • Try not be alone (visit a friend, go shopping, etc.) • Draw a picture • Go to a church/ place of worship • Take a hot bath • Do some household chores (i.e. cleaning)

32. Managing the Urge • Listen to music • Cook/ bake • Go for a walk • Write in a journal • Wear an elastic around wrist and snap it when the urge arises • Break the object that is being used to self-injure as a symbolism of the ability to re-assert control • Take up a sport

33. Managing the Urge • Write a letter to someone to express emotion • One needs not to give the letter to the person that it was written to but it is a great way to release the feelings that are being carrying within • Some people find destroying the letters help (i.e. tearing them up, throwing them in a lake, etc.) • Hold ice cubes • The cold causes pain in the hands, but it is not dangerous or harmful • Draw red lines on themselves with washable markers (instead of cutting) • Punch a bed or a pillow

34. Managing the Urge • Go outside and scream and yell • Avoid temptation (i.e. avoid the area where the razor blades are kept, etc.) • Massage the area that tends to be injured • This may serve as a reminder of self-worth • Compare the advantages and disadvantages of engaging in self-harm • Advantages: • Gets feelings out • Improves mood • Disadvantages: • May leave a scar • Never seems to work for very long

35. Questions? For More Information… Julia Valley, M.S.W. Youth Community Developer Western Ottawa Community Resource Centre 613-591-3686 valley@wocrc.ca

36. References Favazza, A. (1998). The coming of age of self-mutilation. The Journal of Nervous and Mental Disease, 186, 259-268. Fortune, S., Sinclair, J., & Hawton, K. (2005). Adolescent views on the prevention of self harm, barriers to help seeking for self harm and how quality of life might be improved - A qualitatitve and quantitative study of school pupils in England. Centre For Suicide Research, Oxford University. Laye-Gindhu, A. & Schonert-Reichl, K. (2005). Nonsuicidal self-harm among community adolescents: Understanding the “whats” and “whys” of self-harm. Journal of Youth and Adolescence, 34, 447-457. Nixon M K, Cloutier P, Jansson M. Nonsuicidal self-harm in youth: a population-based survey. Canadian Medical Association Journal 2008;178(3):306-312. Trepal, H. & Webster, K. (2007). Self-injurious behaviors, diagnoses, and treatment methods: What mental health professionals are reporting. Journal of Mental Health Counseling, 29, 363-375.