Understanding Self-Injurious Behavior

1. Understanding Self-Injurious Behavior

2. Self Injurious Behavior • Other Terms • Cutting • Self-harm • Self-inflicted violence • Self mutilation • Para-suicidal behavior

3. Definition • “Any socially unacceptable behavior involving immediate, deliberate, direct and usually repetitive physical injury to one’s own body, resulting in mild to moderate self harm, usually without conscious suicidal intent.” Remuda Ranch Treatment Center

4. Common Examples • Scratching • Cutting • Carving • Burning • Repetitive rubbing • Abrading • Punching

5. Common Examples, cont. • Pinching • Biting • Head banging • Hair pulling or plucking Some SIB’s may mimic suicidal behaviors, but they serve a different purpose.

6. Less Common Examples(Increasing in Popularity) • Scarification • Cutting and preventing healing  Reopening of barely healed wounds  Branding

7. Excluded Behaviors • Tattooing • Body piercing These are culturally sanctioned behaviors and are thus excluded from the SIB definition.

8. Tools • Razor blades • Pins • Paper clips (Any object that can be made sharp or cause injury) • Cigarettes, matches, candles (burning)

9. Body Parts • Wrists • Forearms • Legs • Usually hidden areas (depends on motivation)

10. Statistics • 1% of general population • 1.8% teens (usually cut with sharp objects) • 12% college age • 4.3-13% people with mental disorders • 25-45% people with eating disorders • Most common in unmarried females • Positive correlation with sexual trauma

11. Variations of SIB • Compulsive • Closely associated with Obsessive Compulsive Disorder • Prompted by anxiety • Different intention and root than impulsive forms

12. Variations of SIB, cont. • Impulsive Episodic Type • Not premeditated • Response to emotional trigger • Not self-identified as a “cutter”

13. Variations of SIB, cont. • Impulsive Repetitive Type • Rumination about SIB • Self-identified as a “cutter” • Behavioral response to both positive, negative stressors • Impulse Control Disorder NOS (Axis I)

14. Risk Factors • Early abuse history • High levels of dissociative defenses • Highly chaotic family environments • Lack of sufficient parental control • Extensive psychosocial stressors • Severe mood disorder Levitt, Sansone, Cohn 2004

15. Function Overview • Relief from overwhelming painful emotions • Stopping/preventing dissociative state • Addiction to euphoric endorphins released • Voice for emotional pain • Self-punishment for behaviors, feelings or needs (likely to hide evidence of SIB) • Re-enactment of abuse to gain a sense of control

16. Function Overview, cont. “When I could not find the words, cutting had become the language to describe the pain, communicating everything I felt.” A client “Youth who self-mutilate may choose this behavior because it meets a multitude of needs at one time. The most common functions….are expressing and controlling overwhelming emotions, and maintaining a coherent sense of self when threatened with the loss of identity.” Suyemoto and Kountz, 2000

17. Function Specifics • Stimulation • Escape dissociation through an intentional gesture to feel one’s body • Self-grounding technique • Punishment • Self-imposed response to Guilt Shame Weakness

18. Function Specifics, cont. • Punishment, cont. Anger Lack of discipline • Relaxation • Pleasure response to warmth of blood and/or physical sensation of pain • Form of tension reduction • Endorphin release

19. Function Specifics, cont. • Diversion • Inducing a trance-like state to avoid attending to An emotional trigger Specific issue Specific subject Suicidal thoughts

20. Function Specifics, cont. • Social Motives/Attention • Obtaining self-affirmation Showing self and others one’s strength • Achieving nurturing and protection through the response of others • Alteration • Making one’s body unattractive to others through scarring

21. What clients say… • Perceived loss and/or abandonment precedes the act • Experience of shame is high prior to SIB • Self-anger and/or sadness are common feelings both before and after • Isolation almost always occurs before SIB

22. What clients say… cont. • Frequently reported goals • Diminish negative feelings • Self-punishment • Avoidance of painful memories • Induction of trance-like state • 70% report release of tension and anxiety, and a sense of satisfaction following SIB

23. Therapeutic Intervention • Therapist must understand • Risk factors • Variations • Function • Approaches to treatment • Assessment (initial and ongoing) • Education • Medication • Family therapy • Individual and group therapy • Experiential therapy

24. Therapeutic Intervention, cont. • Goals of treatment • Safety first (validate emotion, but not behavior, thoughts) • Skill training (DBT works well) • Self-soothe • Manage emotions • Resolve psychological schemas • Replace lies with truth about God Self Others

25. Therapeutic Intervention, cont. • Goals of treatment, cont. • Make connections between thoughts, feelings, behaviors • Identify triggers • Emotions • Situations • People • Other external stimuli • Behavior chain analysis

26. Miscellaneous Notes • Baal • I will go before you and will level the mountains; I will break down the gates of bronze and cut through the bars of iron. I will give you the treasures of darkness, riches stored in secret places, so that you will know I am the Lord, God of Israel who summons you by name. Isaiah 45:2, 3 • For the word of God is full of living power. It is sharper than the sharpest knife, cutting deep into our innermost thoughts and desires. It exposes us for what we really are. Nothing in all creation can hide from Him. Everything is naked and exposed before His eyes. Hebrews 4:12, 13

27. Miscellaneous Notes, cont. • God’s unconditional love knows each of us to the depths of our pain, shame and joy. Only He can truly understand what that excruciating sorrow is like. Through and with Him we have a hope and a future. Bringing this to those who self-injure can provide them a new way of thinking.

28. Helpful websites www.selfinjury.com or SAFE (Self-Abuse Finally Ends) - 800-366-8288 http://secured.nmha.org/mpower/411Cutting.htm http://dmlive.com/index.html http://groups.google.com/group/Fading-Scars http://www.selfmutilatorsanonymous.org http://www.Focusas.com/SelfInjury.html http://www.self-injury.org/index.html

29. Contact Information Catherine Jantzen, MS, LMHC Lead Therapist, Family Care Center 2821 Hillegas Road Fort Wayne, IN 46808 260-471-1950 cathyj@familycarectr.org