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Self-Injury. Deliberate Harm to Self Smoking etc… Assessment of Severity Directness (intentionality) Lethality Repetition Tissue Damage Scratch, burn, cut. Self-Injurious Behavior. Prevalence In a study of 15-16 yo 10.3% reported engaging in self-injurious behavior (SIB)

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self injury
Self-Injury
  • Deliberate Harm to Self
    • Smoking etc…
  • Assessment of Severity
    • Directness (intentionality)
    • Lethality
    • Repetition
  • Tissue Damage
    • Scratch, burn, cut
self injurious behavior
Self-Injurious Behavior
  • Prevalence
    • In a study of 15-16 yo 10.3% reported engaging in self-injurious behavior (SIB)
      • Habitual SIB is estimated at 1%-3%
    • Females 4x more likely to engage in SIB
    • In the early part of this decade the demographic tended to be females age 20-30 (abuse and neglect)
      • Females are socialized to internalize anger whereas men externalize their anger
  • Methods
    • Burning, Scratching, Picking, Head Banging, Breaking Bones, Pills, Cutting (highest at 72%)
etiology
Etiology
  • Sexual, Emotional, or Physical Abuse
    • A way of being in control
    • A way of repressing feelings (Freud)
      • Stop feeling, feel something, release from tension.
    • A way to punish themselves for being bad
      • Control and predictability
  • Invalidation
    • 1) Self-Attribution (blame, low self-worth)
  • Biological
    • Low serotonin levels are associated with aggression and low impulse control
    • Release of natural opiates (endorphins) when injury occurs
  • Behavioral
    • Operant Conditioning (rewards; e.g. distraction or attention)
    • Classical Conditioning (interoceptive conditioning; e.g. ns=)
slide4
Why?
  • Affect Regulation
    • Dissociative reconnection
      • Makes it real
  • Communication
    • Expression of things that cannot be said
      • Alexithymia (state of not being able to describe the emotions one is feeling)
  • Control/Punishment
    • Trauma reenactment
risk factors
Risk Factors
  • Mood Disorder (Anxiety/Depression)
  • Low Self-Esteem
  • Withdrawal
  • Few Friends
  • Hypersensitivity to rejection
  • Chronic anxiety
  • Avoidant in their personality
  • Strong dislike for themselves
  • Chronically angry with suppression
  • Abuse and Neglect
  • Mood Disorder
treatment
Treatment
  • Continuum of Care
    • Outpatient Treatment to Hospitalization
  • Treatment
    • Medication (Depression and Anxiety)
    • Interpersonal Therapy
    • Cognitive Behavioral Therapy
      • Identify Negative Automatic Thoughts
      • Educate about Vicious Cycle and Reinforcement
      • Alternatives
      • Behavioral Contracts
    • Problem Solving Therapy and DBT are most effective
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