Self Mutilation

1. Self Mutilation By Karen Fackrell

2. FACT: Approximately 1% of the US population uses physical self injury as a way of dealing with overwhelming feelings or situations, often using it to speak when no words will come

3. What is Self Mutilation • It goes by many names, self inflicted violence, self injury, self-harm, parasuicide, delicate cutting, self-abuse, and self mutilation • Broadly speaking self harm is the act of attempting to alter a mood state by inflicting physical harm serious enough to cause tissue damage to one’s body

4. Self Harm’s Different Forms Can Include Cutting or Burning Taking Overdoses of medicines Punching self Throwing self against something Pulling out hair or eyelashes Scratching, picking, tearing at skin Inhaling or sniffing harmful substances Inserting objects into body

5. Fact Researchers found that 53% of a social worker’s teen case load includes some form of self destructive behavior, with 14 to 16 year olds comprising the largest group. Out of a 143 sampled high school students, 39% participated in some form of self mutilation in the past year.

6. Strongly dislike/invalidate themselves Are hypersensitive to rejection Are chronically angry, usually at themselves; tend to suppress their anger High levels of aggressive feelings More impulsive and may lack impulse control Do not see themselves skilled at coping Do not think they have control over how they cope Tend to be avoidant Do no see themselves as empowered Tend to not plan for the future Suffer chronic anxiety Psychological Characteristics

7. Stereotypical Self Mutilators Typically the self injurer is female, in her mid 20s to early 30s and been hurting herself since her teens. She tends to be middle or upper class, intelligent, well educated, and from a background of physical and/or sexual abuse or a home with at least one alcoholic parent. Eating disorders are often reported

8. ??Why Do People Self Harm?? • Reduces physiological and psychological tension rapidly • May have learned at young age that their feelings were not allowed or interpretation of environment were always wrong • Can have a hard time communicating in words the anguish they feel inside • To punish themselves • To feel real

9. BUT THE FIX IS ONLY TEMPORARY SO A CYCLE DEVELOPS

10. Being female History of childhood sexual abuse History of childhood physical abuse Parental Substance Abuse Emotional Neglect Insecure Attachment Prolonged separation from caregivers Borderline Personality Disoder Substance Abuse PTSD Eating Disorders Antisocial Personality High levels of disassociation Low self esteem Risk Factors *Look at Precipitating Factors*

11. Quotes from Former Cutters “The objective was not to make myself bleed to death, just to let go of the ugly feelings holding me hostage, feelings that would leave at the sight of blood.” “I was actually one of the most popular kids in school… People would look at me like they wanted to be me and I thought if they found out who I really was, they would leave me alone.”

12. MOVIE TIME

13. Treatment for Self Injury • Evaluation or assessment is the first step, followed by a recommended course of treatment • The diagnosis for someone who self-injures can only be determined by a licensed psychiatric professional. Self-harm behavior can be a symptom of several psychiatric illnesses: Personality Disorders (especially Borderline Personality Disorder); Bipolar Disorder; Major Depression; and Anxiety Disorders. • Treatment options can include weekly appointments with a therapist, outpatient treatment, and inpatient hospitalization.

14. Effective Therapeutic Approaches • Cognitive Therapy: teaches a client how certain thinking patterns are causing their symptoms by giving them a distorted picture of what’s going on in their life. • Behavioral Therapy: helps a client weaken the connections between troublesome situations and their habitual reactions to them. It also teaches a client how to calm their mind and body in order for them to think more clearly and make healthier decisions.

15. Approaches (con) • Interpersonal Therapy: is an active therapy that focuses on four general areas: grief, role disputes, role transitions, and interpersonal deficits. It is present-oriented and emphasizes clients’ exploring their options and increasing their activities and social life. • Dialectical Behavioral Therapy: is a therapy that includes once-weekly psychotherapy sessions in which a particular problematic behavior or event from the past week is explored in detail, beginning with the chain of events leading up to it, going through alternative solutions that might have been used, and examining what kept the client from using more adaptive solutions to the problem. This therapy also includes weekly group therapy sessions.

16. Approaches (con) • Antidepressants or anti-anxiety medication is sometimes recommended for self-injurers. • Additional recommendations may be made if the self injurer has a coexisting condition such as an eating disorder or chemical dependency issues.

17. What Therapists Need to Know • Have a clear safety plan and review it during every session • This is a procedure to use when a client feels the urge to self-injure • Focuses on clients strengths and abilities • Identifies client as active agent in therapy • Works as a motivator and delay mechanism

18. In Therapy: • Convey understanding that self-injury has been a vital coping strategy that has helped the client survive. • Reinforce phone calls that come before self-injury. • Limit support if call comes directly after self-injury: • Establish if there is a need for medical attention only. • Save exploring underlying feelings or reasons for next session. • Avoid gratifying harmful behavior

19. Developing Coping Strategies • Develop at least five alternative coping strategies. • Choose activities that client can use to sooth self in non-violent ways. • Encourage positive distractions that draw from client’s reservoir of talents or interests. • Examples of coping strategies can include: Journaling Listening to music Taking a walk Praying Calling a friend Reading Napping Drawing Taking a bath Calling your therapist

20. Don’t Forget! • Teach client to identify: Warning signs of escalation (heart rate, respiration, muscle tension) Warning signs of dissociation (emotional numbing, disconnectedness) • Help client make a list of typical stressors and emotional triggers so client can learn to identify the causes of the urge to self-injure. • If client shares that she has self-injured since last clinical contact: Find out if there is any need for medical attention Review, revise and reinforce safety plan Explore feelings and fantasies that triggered self-injury Help client become more aware of how self injury damages herself and her relationships with others

21. Butler Hospital345 Blackstone Boulevard Providence, RI 02906 (401) 455-6200 Adolescent Psychiatric Services at Fairfax Hospital10200 N.E. 132nd Street Kirkland, Washington 98034 Telephone: 425-821-2000 Toll free: 800-435-7221 Fax: 425-821-9010 Behavioral Technology Transfer Group4556 University Way NE, Ste 222 Seattle, WA 98105 Phone: 206/675-8588 Fax: 206/675-8590 The Menninger ClinicPO Box 829 Topeka, KS 66601-0829 General 1-800-288-0317 Admissions/Care Coordination 1-800-351-9058 Karl Menninger School of Psychiatry & Mental Health Sciences 1-800-288-0317 Ext 5833 Resources for Self-Injury

22. Frederick County Mental Health Association357-359 W. Patrick Street Frederick, MD 21701 301-663-6135 24-hour Hotline: 301-662-2255 The Healing House5435 Balboa Blvd.Encino, California 91316Andrew Levander, M.A., M.A.C.Clinical Director213-470-7730 River Oaks Hospital Compulsive Behaviors program1525 River Oaks Road WestNew Orleans, LA 70123Phone: (504) 734-1740Toll-free: (800) 366-1740 SAFE Alternatives Program MacNeal Hospital Berwyn, IL 1-800-DONT CUT Resources for Self Injury

23. Any Questions