I wasn t trying to kill myself
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I Wasn’t Trying to Kill Myself…. Prepared and Presented By: Julia Valley, MSW Youth Community Developer Western Ottawa Community Resource Centre. What is Self-Injury?. Self-injury is the act of inflicting physical harm on oneself without the intent to cause death . Favazza, A. (1998).

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I Wasn’t Trying to Kill Myself…

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I wasn t trying to kill myself

I Wasn’t Trying to Kill Myself…

Prepared and Presented By:

Julia Valley, MSW

Youth Community Developer

Western Ottawa Community Resource Centre


What is self injury

What is Self-Injury?

Self-injury is the act of inflicting physical harm on oneself without the intent to cause death

Favazza, A. (1998)


I wasn t trying to kill myself

Why?


People engage in self injury for a variety of reasons

People engage in self injury for a variety of reasons…

Self-Injury


Affect regulation

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)


Affect regulation1

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)


Communication

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)


Control punishment

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)


I wasn t trying to kill myself

Video


Self injury in adolescence

Self-Injury in Adolescence


Adolescents are particularly vulnerable

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)


Why adolescence

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)


Risk factors

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)


Risk factors1

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)


Protective factors

Protective Factors

  • Family cohesiveness

  • Social connectedness

  • Confidence re: problem-solving ability

  • Positive self-image

  • Academic success

Nixon, M., Clouthier, P., & Jansson, M., (2008)


Types of self injury

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)


What to look for

What to Look For


What to look for1

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


What to look for2

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


How to help

How To Help


How to help during a self injurious episode

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


How to help during a self injurious episode1

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


How to help after a self injurious episode

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


The don ts

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


The do s

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


The do s1

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


Suggestions to help manage the urge

Suggestions to Help Manage the Urge


Managing the urge

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)


Managing the urge1

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


Managing the urge2

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


Managing the urge3

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


Questions

Questions?

For More Information…

Julia Valley, M.S.W.

Youth Community Developer

Western Ottawa Community Resource Centre

613-591-3686

[email protected]


References

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.


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