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Self-Injury. Presented By Sonia Campos, M.Ed., LPC, NCC, CART Lisa Garcia, M.S., LPC, NCC, CART. AGENDA. Introduction Definition of Self-Injury Understanding Self-Injury Categories of Self-Injury Underlying Causes and Functions of Self-Injury Suggestions for Professionals & Family

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self injury

Self-Injury

Presented

By

Sonia Campos, M.Ed., LPC, NCC, CART

Lisa Garcia, M.S., LPC, NCC, CART

agenda
AGENDA
  • Introduction
  • Definition of Self-Injury
  • Understanding Self-Injury
  • Categories of Self-Injury
  • Underlying Causes and Functions of Self-Injury
  • Suggestions for Professionals & Family
  • Treatment Strategies
  • Websites
  • Resources
  • Questions and Answers
slide3

Scars have the strange power to remind us that the past is real.

Cormac McCarthy, All the Pretty Horses

definition
Definition
  • “Self-Injury is intentional, self-effected, low lethality bodily harm of a socially unacceptable nature, performed to reduce psychological distress. (Walsh 2006)
  • The act is NOT to commit suicide
  • Psychologically motivated
understanding self injury
Understanding Self-Injury

Manifestation from the phenomenon “Self-Harm”

It is a difficult and disturbing behavior that communicates one’s pain and self-destructiveness

A direct form of violence upon one’s body

Powerful statement of one’s psychological distress that has distorted the individuals ability to manage and soothe their pain

A sense of powerlessness

understanding self injury1
Understanding Self-Injury
  • “A specific language of pain that communicates the suffering of past and current trauma, which is spoken loudly by the self-inflicted repetition of that trauma upon one’s own body” (Conterio & Lader, 1998).
  • “My body looks how I feel.”
          • A self-injurer
self injury as a diagnosis
Self-Injury as a Diagnosis?
  • Yet to be a discrete disorder
  • Partially referenced for the diagnosis of Borderline Personality Disorder in DSM IV TR
  • PTSD
  • Dissociative Identity Disorder
  • Bipolar Disorder
  • Common in Eating Disorders
  • Impulse Control Disorders
prevalence
Prevalence
  • Typically starts during adolescence and ranges into young adulthood
  • Studies estimate that 1,400 per 100,000 people during the 90’s
  • Significantly more prevalent in Females
    • 3 to 4 times higher than males
    • Girls internalize anger
prevalence1
Prevalence
  • Contributing factors
    • abuse
    • lack of parental psychological presence
    • divorce
    • sexual orientation
    • daily pressures
    • body pressure
understanding self injury2
Understanding Self-Injury
  • Common Forms of Self-Injury
    • Cutting (72%)
    • Carving
    • Burning (35%)
    • Self-hitting (30%)
    • Picking at scabs (22%)
    • Hair pulling (10%)
    • Biting
    • Peeling layers of skin
    • Ingesting sharp objects

Study by Favazza and Conterio 1988

Cutting, to this day, is the most often used method

manifestations of self injury
Manifestations of Self-Injury
  • Wrists and arms are the common areas to cut
  • Studies render that legs, abdomens, heads, chests, and genitals are other cut areas
  • Self-injurers report that once they cut they experience little to no pain compared to their emotional suffering
  • Instruments used vary:
    • Scissors, razor blades, knives, scalpels, shards of glass, pieces of metal
manifestations of self injury1
Manifestations of Self-Injury
  • Instruments used vary:
    • Scissors
    • Razor blades
    • Knives
    • Scalpels
    • Shards of glass
    • Pieces of metal
categories of self injurious behaviors
Categories of Self-Injurious Behaviors

Proposed by Simeon and Favazza 2001

  • Stereotypic Self-Injurious Behaviors
    • Biologically driven force that is highly repetitive, fixed, rhythmic, and usually contentless acts, anywhere from mild to severe injury
  • Major Self-Injurious Behaviors
    • Most dramatic kind (castration, amputation) that involves suffering and severe psychotic pathology
categories of self injurious behaviors1
Categories of Self-Injurious Behaviors

Proposed by Simeon and Favazza 2001

3. Compulsive Self-Injurious Behaviors

  • Behaviors that are repetitive and ritualistic, multiple times per day (hair pulling, nail biting)

4. Impulsive Self-Injurious Behaviors

  • Preoccupation of harming oneself, hard to resist impulse, feeling to tension prior to act and relief at execution, no suicidal intent
underlying causes
Underlying Causes
  • Self-Injury is not easily explained or accounted by a single cause.
  • Trauma exposure, Personality characteristics, and Comorbid clinical features have been identified in self-injurers.
  • Exposure to trauma is associated with the development of maladaptive personality features and clinical diagnosis.
    • Major depressive disorder, generalized anxiety dirosder, PTSD
underlying causes1
Underlying Causes
  • The end result of trauma is the invalidation of one’s sense of self, in which the individual turns to the body for solace.
  • It is an effort not to feel what cannot be tolerated.
functions of self injury
Functions of Self-Injury
  • Self-injurers do not seek death through attacking their body, they attempt to defy it.
  • Four functions of self-injury

1. Regulating affect, soothing emotional wounds, and managing dissociation

2. Seeking mastery over pain and past trauma

3. Communicating pain, controlling others, and seeking nurturance

4. Securing and authenticating a sense of self

four functions
Four Functions
  • Regulating affect, soothing emotional wounds, and managing dissociation
    • Provides a sense of deep relief from emotional distress
    • Self-injury is utilized to express and manage intolerable feelings
    • External soothing helps the individual feel a greater sense of security
four functions1
Four Functions

Cutting serves as a calming functioning by triggering endogenous opoids and transends distress to tranquility

  • Self-injury can alleviate the sense of emptiness and deadness.
  • They believe that they are connected to their bodies
four functions2
Four Functions
  • Seeking Mastery Over Pain and Past Trauma
    • Derive a lack of control over others and their own destinies that they feel in-control by attacking their bodies
    • Better to create their own pain and be able to control it rather than be a victim to the pain
    • Sense of mastering their past unresolved feelings
    • Mastery and control provides a sense of hope
four functions3
Four Functions
  • Communicating Pain, Controlling Others, and Seeking Nurturance
    • Inability of putting words to the pain they have experienced
    • The body speaks what the self-injurer can not articulate
    • A form of instilling shock onto others
    • Can be a desperate attempt to make others notice the he/she exists and is in pain and wants a connection
    • Can elicit posititve attention from others which is reinforcing the behavior
four functions4
Four Functions
  • Securing Authenticating a Sense of Self
    • Have difficulty in creating and maintaining psychological and interpersonal boundaries
    • The behavior defends injurer from intense emotions of perceived abandonment
    • The injurer is able to experience her/his own vitality through the physical sensation of the act– seeing the blood and scars
    • The body and its wounding connect the individual’s inner and outer worlds
suggestions for mental health professionals
Suggestions for Mental Health Professionals
  • Show the child/adolescent unconditional acceptance.

2. Accept him/her as a person regardless of the behavior.

3. Make understanding the underlying causes for the behavior a goal.

4. Encourage a commitment to try positive alternative behaviors for coping.

suggestions for mental health professionals continued
Suggestions for Mental Health Professionals-(Continued)
  • Suggest a list of coping techniques to be used rather than Self-Injury.
  • Understand that the list is flexible and can always change.
  • Encourage open communication no matter what the behavior.

8. Acknowledge his/her efforts to cope with very difficult emotions.

suggestions for mental health professionals continued1
Suggestions for Mental Health Professionals-(Continued)
  • Show that you care about the injuries.
  • Communicate that it is okay to talk about Self Injury.
  • Help him/her discover their identity.

12. Remember that you are not responsible for the child/adolescent’s behavior.

From: Bowman, S. & Randall, K (2006). See My Pain! Creative strategies and activities for helping young people who self-injure. Chapin, SC: YouthLight, Inc.

suggestions for teachers
Suggestions for Teachers
  • Try to approach the student in a calm and caring way.

2. Accept him/her even though you do not accept the behavior.

3. Let the student know how much you care about him/her and believe in his/her potential.

4. Understand that this is his/her way of coping with the pain that he/she feels inside.

5. Refer that student to your school’s counselor, social worker, and/or nurse.

suggestions for teachers continued
Suggestions for Teachers - (Continued)
  • Offer to go with that student to see the professional helper.
  • Listen! Allow the student to talk to you. Be available.
  • Discover what the student’s personal strengths are and encourage him/her to use those strengths.
  • Help him/her get involved in some area of interest, a club, sport, peer program, outreach project, e.g., volunteer at a local animal shelter or wildlife sanctuary, help an older person at a nursing home, become a tutor, or mentor.

From: Bowman, S. & Randall, K (2006). See My Pain! Creative strategies and activities for helping young people who self-injure. Chapin, SC: YouthLight, Inc.

suggestions for the family
Suggestions for the Family
  • Accept your child even though you do not accept his/her behavior.
  • Let your child know how much you love hem/her, not only when he/she Self-Injures, but at other times as well.
  • Understand that this is his/her way of coping with the intense pain that he/she feels inside.
  • Encourage healthier methods of coping by allowing him/her to brainstorm other ways other than hurting him/herself.
suggestions for the family continued
Suggestions for the Family – (Continued)

5. Listen! Keep communication open by talking about things that would interest him/her even if it doesn’t interest you.

6. Ask open questions (what or how) to encourage him/her to open up. Allow conversations to revolve around what he/she wants to talk about no matter how silly or crazy it may seem to you.

7. Allow him/her to share what they’re feeling deep inside either with words (journaling) or in art (drawing, painting, creating, or any other way he/she can communicate their feelings).

suggestions for the family continued1
Suggestions for the Family – (Continued)
  • Make your home a “Safe Place” by removing anything that could be used as a tool for Self-Injury.
  • Have fun together! Try to do some fun things together (let him/her choose a fun activity that is interactive, not just going to the movies). Although he/she may complain at first, your child really does want to spend time with you.
  • Discover what his/her personal strengths are and encourage him/her to use those strengths during difficult times.
suggestions for the family continued2
Suggestions for the Family – (Continued)

11. Help your child to get involved in some area of interest, after-school activity, a good cause, or other good will effort.

12. Encourage some kind of outreach in the community , e.g., volunteering at a local animal shelter or wildlife sanctuary, helping an older person at a nursing home, tutoring a young child after school, or mentoring a troubled younger child.

From: Bowman, S. & Randall, K (2006). See My Pain! Creative strategies and activities for helping young people who self-injure. Chapin, SC: YouthLight, Inc.

treatment strategies
Treatment Strategies
  • Crucial Communication Skills
  • Personal Strength Coaching
  • Relaxation/Guided Imagery
  • Reflective Journaling
  • Visual Arts
  • Clay
  • Sand Tray
treatment strategies continued
Treatment Strategies – (Continued)
  • Metaphors
  • Music
  • Story Telling
  • Tactile Diversion
  • Creative Dramatics
  • Mentoring
  • Animal Assisted Therapy
  • Prayer Power
websites
Websites
  • NOTE: Some experts say that people who self-injure can be triggered by visiting Websites or chat rooms that discuss self-injury.
  • HealthyPlace Self-Injury Community
      • www.healthyplace.com/Communities/Self_Injury/site/
  • Self-Injury: You are Not the Only One
      • www.palace.net/~llama/psych/injury.html
websites continued
Websites – (Continued)
  • Focus Adolescent Services
      • www.focusas.com
  • Teen Health Centre
      • www.teenhealthcentre.com
websites continued1
Websites – (Continued)
  • SIARI: Self-Injury and Related Issues
      • www.siari.co.uk
  • S.A.F.E. Alternatives (Self-Abuse Finally Ends)
      • www.selfinjury.com
  • American Self-Harm Information Clearinghouse
      • www.selfinjury.org
references
References

Bowman, S. & Randall, K. (2006). See my pain! Creative strategies and activities for helping young people who self-injure. Chapin, SC: YouthLight, Inc.

D’Onofrio, A. (2007). Adolescent self-injury: a comprehensive guide for counselors and health care professionals. New York, NY: Springer Publishing Company, LLC.

McVey-Noble, M. E., Khemlani-Patel, S., & Neziroglu, F. (2006). When your child is cutting: a parent’s guide to helping children self-injury. Oakland, CA: New Harbinger Publications, Inc.

Walsh, B. W. (2006). Treating self-injury: a practical guide. New York, NY: Guilford Publications, Inc.

Winkler, K. (2003). Cutting and self-mutilation: when teens injure themselves. Berkeley Heights, NJ: Enslow Publishers, Inc.

elements
elements

www.animationfactory.com