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Self-Injury

Self-Injury. Kellie Szerlag, M.Ed. School Psychology Intern University of Massachusetts, Boston. What’s Happening: Adolescence. Time of transition and change. Maturing bodies and minds Combination of Thoughts/Feelings: center of attention, but alone in experiences.

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Self-Injury

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  1. Self-Injury Kellie Szerlag, M.Ed. School Psychology Intern University of Massachusetts, Boston

  2. What’s Happening: Adolescence • Time of transition and change. • Maturing bodies and minds • Combination of Thoughts/Feelings: center of attention, but alone in experiences. • Early Adolescence: world is more black and white. • Later Adolescence: better able to understand self. • Learning How to: • Establish and maintain relationships. • Define selfand purpose. • Understand themselves and the world.

  3. Why discuss Self-Injury? • Nonsuicidal self-injury (NSSI): is a growing public health concern among adolescents. • Self-injury is often identified in schools

  4. What is Self-Injury? • Terms: self-harm, cutting, self-mutilation, & non-suicidal self-injury (NSSI) • NSSI: “the deliberate destruction of one’s own body tissue without the intent of death” (Taylor, Peterson, & Fischer, 2012).

  5. Self-Injury vs. Suicide Attempts • Self-injurers are typically not attempting suicide. • Connection to thoughts of suicide later in life. • Physically harmful and dangerous • Related to impulsiveness • Dysfunctional/Maladaptive coping strategy

  6. Most Common Forms of Self-Injury • Skin cutting • Burning People who Self-Injure might: • Pick or interfere with wound healing • Engage in behavior secretively • Bathrooms or other secluded areas.

  7. Identifying Self-injury • Frequent unexplained scars/burns • Non-dominant arms, forearms, hands • Can be anywhere on body • “Covering-up” with clothing • Constant wearing of wrist bands, long sleeves, multiple bracelets

  8. Who is at-risk? • Victims of abuse • Family Conflict • Mental illness • Higher rates among: • Females • LGBTQ

  9. Who is at Risk? • Impulsivity • Low self esteem • Low levels of resiliency • Poor problem-solving skills • Difficulty regulating emotions • Often related drug and alcohol abuse

  10. Adolescents who self-injure reported they do it to: • Self-soothe • Reduce severe distress • “Feel good” • Express negative feelings • Hopelessness, worthlessness, depression, anxiety or distress • Fight feelings of numbness • Feel a sense of control

  11. Why Adolescents Self-Injure • Belief: self-injury achieves emotional equilibrium when they can’t regulate or control emotions (self-soothe). • To relieve intolerable emotional pain • To communicate a deep sense of anguish. • A cry for help

  12. Self-Injury in Social Groups • Sometimes considered “contagious” among groups of friends. • Importance of protocols for dealing with self-injury in schools. • Parent involvement and communication with children.

  13. Protective Factors • Connectedness • Access to mental health services • Spiritual life • Stable families

  14. Roles of the School • Communication is important between school-home-outside clinician. • Support Staff and Medical Professionals • School should be involved in the reinforcement of coping strategies and communication skills.

  15. Responding to Self-Injury • Medical attention • Outside counseling or therapy • Have a strong support system, treatment can be long and tough for parents. • Support siblings

  16. Responding to Self-Injury • Understand self-injury as a way to cope or handle intense feelings. • Encourage them to share feelings through journaling or in art (drawing, painting, creating). • Remove tools • After-school activities or hobby/interest. • Community outreach

  17. Things to Avoid • Avoid statements that might cause guilt or shame • Try not to appear shocked by this behavior. • Avoid talking about their self-injury in front of friends or with other relatives. • Try to teach them what you think they should do • Avoid punishment for self-injurious behaviors. • Overprotecting might be harmful, but try to be aware of what’s going on. • Don’t blame yourself for your child’s behavior.

  18. Communication and Bonds as Protective Factors • Family connectedness is a protective factor. • Reduced likelihood of harmful or dangerous behaviors (e.g., drugs, alcohol, or sex, etc.) • Fewer mental health problems • Increased likelihood of making “right” choices and standing up for believes. • Predicts more constructive coping skills and social skills • Difficult topics are better discussed when connectedness and communication are in place.

  19. But my child pulls away… • Searching for own identity. • Time spent with family drops an estimated 21% • More times with friends, work, or dating relationships. • Does not mean there is not a secure bond or good relationship • Conflicts happen • Not a sign of poor relationship • Important that parents and adolescent maintain understanding and empathy while disagreeing • Confidently state opinion  show empathy/understanding of other point of view.

  20. Communicating with your Child • Ask open questions (what or how) to encourage him/her to open up. • Allow conversations to revolve around what interests your child. • Spend time together, with their choice of activity. • Dinner time and Cooking together • Connections with other family members

  21. Safety • Independence but still developing good decision making skills. • Peer approval is important. • Discuss Safety and dangerous consequences of: • Motor vehicles • Substance abuse • Protective Gear in sports • Healthy Relationships • Internet Safety

  22. What helps your family stay connected? • Approaches to discussing difficult or sensitive topics that have worked for your families?

  23. Local Resources & Support Lines • Wayside Youth & Family Support (508)-879-9800http://www.waysideyouth.org/ • Advocates, Inc(508)-628-6300 www.adocatesinc.org • National Suicide Prevention Lifeline1-800-273-TALK (8255) • Samaritans Statewide Befriending Line1-877-870-HOPE (4673)   (24 hrs) • Samariteens Helpline1-800-525-TEEN (8336)3pm-9pm weekdays/9am-9pm weekends

  24. Additional Resources American Self Harm Information Clearinghouse • http://selfinjury.org National Mental Health Association (fact sheet) • www.nmha.org/infoctr/factsheets/selfinjury.cfm National Association of School Psychology (NASP) • http://www.nasponline.org/families/index.aspx

  25. Questions? Thank you!

  26. References Bakken, N. W., & Gunter, W. D. (2012). Self-cutting and suicidal ideation among adolescents: Gender differences in the causes and correlates of self-injury. Deviant Behavior, 33(5), 339-356. doi:10.1080/01639625.2011.584054 Brock, S. E. (2002). Crisis Theory: A Foundation for the Comprehensive School Crisis Response Team. In S.E. Brock, P.J. Lazarus, % S.R. Jimerson (eds.), Best Practices in School Crisis Prevention and Intervention (pp. 5-17). Bethesda, MD: National Association of School Psychologists. Brock, S. E., Nickerson, A. B., Reeves, M. A., Jimerson, S. R., Lieberman, R. A., & Feinberg, T. A. (2009). School Crisis Prevention and Intervention: The PREPaRE Model. Bethseda: National Association of School Psychologists. Bubrick, K., Goodman, J. & Whitlock, J. (2010). Non-suicidal self-injury in schools: Developing and implementing school protocol. [Fact sheet] Cornell Research Program on Self-Injurious Behavior in Adolescents and Young Adults. Retrieved from http://crpsib.com/userfiles/NSSI-schools.pdf

  27. Cromer B. Adolescent Development. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011: chap 104 Gonzales, A., & Bergstrom, L. (2013). Adolescent non‐suicidal self‐injury (NSSI) interventions. Journal Of Child And Adolescent Psychiatric Nursing, 26(2), 124-130. Guan, K., Fox, K. R., & Prinstein, M. J. (2012). Nonsuicidal self-injury as a time-invariant predictor of adolescent suicide ideation and attempts in a diverse community sample. Journal Of Consulting And Clinical Psychology, 80(5), 842-849. doi:10.1037/a0029429 Klonsky, E., May, A. M., & Glenn, C. R. (2013). The relationship between nonsuicidal self-injury and attempted suicide: Converging evidence from four samples. Journal Of Abnormal Psychology, 122(1), 231-237. doi:10.1037/a0030278 Lieberman, R. (2004) Understanding and Responding to Students Who Self-Mutilate. Principal Leadership Magazine, Vol. 4, No. 7, March 2004, Produced in cooperation with the National Association of School Psychologists.

  28. Muehlenkamp, J., Brausch, A., Quigley, K., & Whitlock, J. (2013). Interpersonal features and functions of nonsuicidal self-injury. Suicide And Life-Threatening Behavior, 43(1), 67-80. doi:10.1111/j.1943-278X.2012.00128.x Radovic, S., & Hasking, P. (2013). The relationship between portrayals of nonsuicidal self-injury, attitudes, knowledge, and behavior. Crisis: The Journal Of Crisis Intervention And Suicide Prevention,34(5), 324-334. doi:10.1027/0227-5910/a000199 Self-harm in young adults. National Alliance on Mental Illness. http://www.nami.org/Content/ContentGroups/Helpline1/SelfInjury_Fact_Sheet_FINAL.pdf. Accessed Oct. 11, 2010. Sornberger, M. J., Smith, N., Toste, J. R., & Heath, N. L. (2013). Nonsuicidal self‐injury, coping strategies, and sexual orientation. Journal Of Clinical Psychology, 69(6), 571-583. doi:10.1002/jclp.21947 Walsh, B. (2012). Treating Self-Injury: A Practical Guide (2 ed.). New York, New York: Guilford Publications.

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