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Self-injury: Self Mutilation and Cutting

Self-injury: Self Mutilation and Cutting. 14th Annual Chronic Illness Conference Linda Mintle, Ph.D. Saturday, November 14, 2009. Interchangeable terms. Self injury Self harm Self mutilation. Self-injury Video. Self-injury is NOT…. A suicidal behavior An addiction

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Self-injury: Self Mutilation and Cutting

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  1. Self-injury: Self Mutilation and Cutting 14th Annual Chronic Illness Conference Linda Mintle, Ph.D. Saturday, November 14, 2009

  2. Interchangeable terms • Self injury • Self harm • Self mutilation

  3. Self-injury Video

  4. Self-injury is NOT… • A suicidal behavior • An addiction • Any type of physical harm • A behavior that is psychotic • Simply way to get attention • A sign that a child can’t feel pain • Something the child will outgrow

  5. Self-injury is… • More common in females than males • More common in singles than married • Prevalent in all races and economic groups • Often associated with eating disorders and BPD • Usually begins in the teen years or young adulthood but is being seen at younger ages

  6. Self-injury… • Involves inner distress • Relates to a predisposition for lower tolerance for frustration • Found in homes in which communication is indirect and at times violent • May have experienced sexual abuse • Found in families who don’t respond to more subtle cries for help • Found with a family history of mood disorders and other forms of addiction

  7. Self-injury • A dangerous and futile coping strategy which interferes with intimacy, productivity and happiness • No “safe” or “healthy” amount of self-harm • Can be transformed from an uncontrollable impulse to a choice

  8. The progression • Saw or heard of someone who cut • Needs relief from intense feelings or trauma • Cutting brings relief and works to stop the pain • Feels guilt and shame from cutting • Becomes a coping mechanism

  9. Most common methods • Cutting: Scratches with sharp objects • Branding: Burning self with a hot object or friction burn=rubbing a pencil or eraser on skin • Picking at skin or re-opening wounds • Hair pulling • Hitting • Multiple piercings or tattooing • New--self embedding

  10. Functions of self-injury: Affect regulation or self preservation • Temporality relieves intense feelings of pressure, anxiety and upsetting feelings • Breaks emotional numbness and reconnects person to body after dissociative experience (pain = alive) • Validates inner pain through outward expression • Helps avoid suicidal feelings

  11. Communication • Express what cannot be spoken • Indirect way to express self-care (nurture the wound after injury) • Indirect way to draw attention to a need that must be met

  12. Control and punishment • Trauma is reenacted on the self • Punishment may involve bargaining and magical thinking, e.g., If I hurt myself, the bad thing I fear will be prevented • Punishment for having strong feelings (form of self-loathing) • Controls and manages emotional pain

  13. Warning signs • Mood problems and/or experiences of shame, self-anger or sadness • History of sexual abuse • Presence of an eating disorder • Major stress • Loss and abandonment • Cuts on the arms, legs or abdomen

  14. Warning signs 2 • Wearing long sleeves in hot weather or all the time at home • Avoiding situations where more revealing clothing might be expected (e.g. the beach) • Frequent complaints of accidental injury (e.g., cat scratches arm) • Chaotic family environment • Lack of parental support • Dissociative experiences

  15. Helpful Tips • Understand that self-harming behavior is an attempt to maintain a certain amount of control which in and of itself is a way of self-soothing • Let the person know that you care about them and are available to listen • Encourage expressions of emotions including anger • Spend time doing enjoyable activities together • Offer to help them find a therapist or support group • Don’t make judgmental comments or tell the person to stop the self-harming behavior – people who feel worthless and powerless are even more likely to self-injure

  16. Treatment • Cognitive Behavior Therapy • Dialectical Behavior Therapy (DBT)--designed to treat people with self-injury. Teaches self-acceptance • Address PTSD if trauma in history

  17. Specific interventions • Relaxation techniques • If present, working through issues of past abuse. • Learning to stay present and not escape the moment through self-harm. • Learning to tolerate and regulate emotions.

  18. Problem Behaviors Chain analysis Triggers/cues Use new skills Consequences of using new skills Consequences

  19. Family work • Interpersonal dynamics that allow the behavior to develop • Expression of negative emotions, stress, expectations and demands, conflict resolution, problem-solving and more meaningful relationships • Spend time doing fun things together

  20. Group Work • Lower the shame • Practice and support healthy emotional expression • Learn new skills to replace self-injury

  21. Goals of treatment • Give up the "escape" (self-injury) • Identify feelings and find better solutions for the problem • Identify and challenge thoughts that fuel escalation rather than calming • Accept uncomfortable feelings like anger and sadness • Learn healthy coping skills that work in everyday life

  22. Child must… • Admit she has a problem and want help • Recognize her solution to emotional pain is self-destructive • Learn and practice relaxation methods. • Identify the triggers or cues that set her behavior in motion and try new solutions • Be willing to substitute new activities in place of the self-harm

  23. MedicationCautious use with children and teens • May be used to reduce initial impulse to harm before coping skills are taught. • Low dose of neuroleptics for anxiety (limited time) • Antidepressants

  24. Resources • 800 DONTCUT • SAFE ALTERNATIVES www.selfinjury.com own • Conterio, K., Lader, W., Ph.D. & Bloom, J. (1998). Bodily Harm:  The breakthrough healing program for self-injurers, New York:  Hyperion. • Alderman, T. (1998)  The Scarred Soul:  Understanding & Ending Self-inflicted Violence, CA, New Harbinger Publications.

  25. Articles • M., Comtois, K. & Linehan, M. (2002 Reasons for Suicide Attempts and Nonsuicidal Self-Injury in Women With Borderline Personality Disorder. Journal of Abnormal Psychology. 111(1): 198-202. • Courtois, C.A. (2004) Complex Trauma, Complex Reactions:  Assessment and Treatment.  Psychotherapy:  Theory, Research, Practice, Training. 41(4): 412-425. • Glover, H., Lader, W., Walker-O'Keefe, J., Goodnick, P. (1997).  Numbing scale scores in female inpatients diagnosed with self-injurious behavior, dissociative identity disorder, and major depression.  Psychiatry Research 70, 115-123. • Glover, H., Lader, W., Walker-O'Keefe, J. (1995) Vulnerability scale scores in female patients diagnosed with self-injurious behavior, dissociative identity disorder, and major depression. Psychological Reports 77, 987-995  • M., Comtois, K. & Linehan, M. (2002 Reasons for Suicide Attempts and Nonsuicidal Self-Injury in Women With Borderline Personality Disorder. Journal of Abnormal Psychology. 111(1): 198-202.

  26. www.drlindahelps.com

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