1 / 38

CUTTING AND OTHER SELF HARMING BEHAVIOR IN ADOLESCENTS

CUTTING AND OTHER SELF HARMING BEHAVIOR IN ADOLESCENTS. PRESENTED BY: Janice Gabe, LCSW, MAC New Perspectives of Indiana, Inc. 6314-A Rucker Road Indianapolis, IN 46220 (317) 465-9688 (317) 465-9689 Facsimile www.newperspectives-indy.com barb6308@earthlink.net.

jorn
Download Presentation

CUTTING AND OTHER SELF HARMING BEHAVIOR IN ADOLESCENTS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CUTTING AND OTHER SELF HARMING BEHAVIOR IN ADOLESCENTS PRESENTED BY: Janice Gabe, LCSW, MAC New Perspectives of Indiana, Inc. 6314-A Rucker Road Indianapolis, IN 46220 (317) 465-9688 (317) 465-9689 Facsimile www.newperspectives-indy.com barb6308@earthlink.net

  2. HOW DO ADOLESCENTS PHYSICALLY SELF HARM? • Cutting • Stabbing • Scratching the skin • Scraping and rubbing skin, removing top layer • Placement of sharp objects under the skin or in body orifices • Gnawing at the flesh

  3. HOW DO ADOLESCENTS PHYSICALLY SELF HARM? • Biting the inside of the mouth to make sores then regularly re-opening them • Picking at wounds • Burning skin using heat • Burning skin by using chemicals or caustic liquids • Pulling hair out, including eyelashes and eyebrows

  4. HOW DO ADOLESCENTS PHYSICALLY SELF HARM? • Hitting themselves hard enough to bruise self • Banging head against something • Tying items around neck, arms, legs to restrict blood flow • Ingesting small amounts of toxic substances, enough to get sick but not enough to die • Ingesting self harming objects such as straight pins

  5. SELF HARMING IS NOT NECESSARILY---- • A suicide attempt • An indication of early childhood abuse or trauma • An indication of sexual abuse • An indication of borderline personality disorder • A behavior which is limited to females • A bid for attention

  6. SELF HARM IS DIFFERENT FROM----- • Multiple body piercing • Tattoos • Branding

  7. UNDERSTANDING PATTERNS OF SELF HARMING • WHO DOES IT? A. 60% are young women between the ages of 16 and 25 B. In this culture it appears to be largely a Caucasian female issue C. 5% of adult self harmers report participating in this behavior in early childhood D. It is entirely possible that early childhood self harm is not reported or recognized E. With adults it is always connected to significant and early childhood trauma. This is not necessarily the case with teens

  8. II. WHAT PURPOSE DOES IT SERVE A. The primary purpose of self harming is to relieve emotional tension B. Adolescent girls describe self harming as a way to obtain relief from anxiety, agitation, anger C. Adolescent females often describe self harming as the only way to tolerate intense feelings without resorting to suicide

  9. D. Adolescent females report that self harming serves to: 1. Provide emotional relief 2. Alter their mood 3. Stop obsessive and troublesome thoughts 4. Stops them from behaving in a way that is considered “bad” or “unacceptable” 5. Communicate their anger at others without risking conflict or rejection 6. Express their anger toward themselves 7. Punish themselves for bad things they have done or emotions they should not have

  10. 8. Stop “voices of others” in their head 9. Stop thinking about trauma (if trauma has been present in their past) 10. Turn their emotional pain into physical pain 11. Help them not feel so dead or empty inside 12. Bring about calming effects 13. To let others know that they have been hurt and that they have been damaged by this hurt 14. To obtain care and nurturing to the skin and wound (perhaps as a way of repairing effects of earlier trauma

  11. WHAT ARE MOTIVATIONS I. Internal About me: what comes from within me, what exists inside of me what I think how I feel toward self II. External about me and others about others in reaction to to get reaction from

  12. III. About perceptions IV. Communication V. Emotions

  13. V. WHAT ARE THE PATTERNS OF SELF HARM? A. Self harm is usually a solitary experience. The exception to this are teens who are institutionalized B. Self harm is often learned from others. Teens hear their friends talking about it, or see something about it on TV and decide to try it C. Self harm is often a secret, and is kept hidden from adults because the teens are ashamed and afraid

  14. D. Self harm is usually an ongoing behavior once it comes to the attention of adults. Single incidents do not usually get detected E. Self harm takes on an addictive dimension. Teens like the predictable results and find it rewarding so they repeat it F. Self harm is often progressive in nature, they have to do more and more of it in order to get the desired result

  15. V. WHAT ARE THE BIOLOGICAL RESULTS OF SELF HARMING? A. Self harming produces the release of endogenous opioids. These are neurochemicals similar to drugs like heroin. They produce a feeling of calm and well- being. They are naturally released in the brain when a person feels danger or fear, or when a person is injured. This will enhance a persons ability to survive the trauma B. Environmental stimuli can trigger a trauma reaction and thus, the release of opioids

  16. C. We can become addicted to our own endogenous opioids and need more to be released to experience a sense of calm. Self harming is one way to get the body to do this D. Endogenous opioids are natural pain killers, this may be why some girls say they do not feel their pain

  17. E. When girls stop the self harming, they may experience withdrawal from these opioids which may increase their agitation and anxiety which in turn, triggers urges to continue to self harm F. When people are exposed to high levels of stress, they experience low levels of serotonin. Low levels of serotonin are linked to impulsive behavior and lack of constraint. Therefore, this makes it easier to indulge in self harming and more challenging to stop

  18. TREATMENT INTERVENTIONS I. CREATING THE APPROPRIATE ATMOSPHERE A. Teens have to be able to talk about it when it happens. They won’t do this if they feel shamed or embarrassed or sense you are uncomfortable with them talking about it B. The role of the professional is to make it clear you disapprove of the behavior, but not them as a person. They need to know that the goal is for them to abstain, but this is clearly a therapeutic vs. a punitive goal

  19. C. How well they respond to therapy depends a great deal more on their relationship with the helper than any specific therapeutic orientation D. The adolescents need to know you will not be shocked or overwhelmed by their behavior

  20. II. DISCOVERING WHAT IT MEANS TO THEM A. One of the first steps in therapy is to decide what role or purpose the self harm has for this individual adolescent. We have to be cautious not to generalize what it usually means. Teens feel devalued when we approach them this way

  21. B. Help the teen recognize her pattern. Talking and journaling are excellent tools for helping with this. The girls do not see their patterns and if we are to help them, they have to be able to talk to us. We need to help them answer the following questions • What are the feelings that trigger this? • Are they feelings about you, about others, about your world? • What are the payoffs and benefits to you? • What happens in your thoughts before you do this? • When did you start, how did you learn about it? • What is your self harm history? (we are looking for progression and loss of control)

  22. Do others know and how have they responded? • What do you think about this behavior? • How do you feel during and after? • When don’t you self harm, what’s different about these times? What did you do to stop yourself and can you use those things again? • Are there any time patterns to your self harming? Do these behaviors occur the same time every day, week, month, season, a point in your menstrual cycle?

  23. Is this a reaction to trauma in your earlier life? Does the self harm patterns correlate with these past traumas? • What is your ritual before, during after? • How do you feel during the behavior; do you like the pain, do you feel the pain, does it clear your head, provide a release, change your mood?

  24. C. MOTIVATING CHANGE: We Have To Help Them Find Some Motivation For Changing This Pattern Of Behavior • How do you feel about yourself after the incident? • How have others reacted to you? • What have you had to do to cover the scars and what has happened when you have been unable to cover the scars? • What image do you have of your life after you are free from this?

  25. D. CLINICAL INTERVENTIONS: Teaching Skills For Overcoming Self Harm And Resolving Issues That Fuel Self Harming Behavior • If self harming is triggered by earlier trauma, we need to help the client recognize the connection between past and present feeling and self harming incidents. For many teens, talking about all their feelings about the original incident and understanding how it has impacted them is the extent to their ability to resolve trauma directly.

  26. Adolescent females need to be taught to identify feelings. There is a difference between anger and anxiety. We need to help them label and explain • Adolescent females need to identify when their self harming is a way to communicate something to others. We need to help them identify what message they are trying to send, for whom it is intended, and a more productive way to get their point across

  27. Adolescent girls perceive that their feelings are unmanageable and they cannot tolerate them. We have to encourage them to view this differently, particularly since many girls self harm to deal with feelings that are a normal part of the adolescent process • Adolescent girls tend to think in terms of all or nothing. They think in order to deal with unpleasant feelings, they have to be extinguished entirely. In reality, they have to lower their stress just enough to get it into the range of tolerable

  28. A significant portion of the work we must do with adolescent females involves changing scripts that do not serve them well. Examples of scripts and changes that have to occur with scripts include: “I cannot stand it when someone is mad at me.” BECOMES “I can survive someone being mad at me.” “I am so bad I deserve to be punished.” BECOMES “I am not perfect but I do not deserve to be punished.”

  29. “I cannot handle my terrible feelings.” BECOMES “My feelings are painful, but they will not last forever.” “I am not good enough.” BECOMES “I am good enough.” “I am not lovable.” BECOMES “I am lovable.”

  30. E. TEACHING BEHAVIORAL SKILLS TO DISRUPT THE CYCLE • Clear out objects that are instruments of self harm. • Develop a plan for sharing feelings when they occur. This includes recognizing the start of a cycle and talking to someone before the feelings escalate if possible. • Teach distraction techniques: finding an activity that is incompatible with self harming, leave the danger zone where self harming usually occurs, engage the body and mind in an activity.

  31. BEHAVIORAL SKILLS CONTINUED • Teach teens how to clear their heads and distract their thoughts: bumble bee breath, count backwards from twenty, say the alphabet backwards • Teach self soothing skills. Teach relaxation, anxiety reduction breath, calming rituals, moonbeams, music • Teach them to break things down into manageable components (I just have to deal with the next five minutes)

  32. BEHAVIOR SKILLS CONTINUED • Teach alternative discharge of hand energy (worry stones, koosh balls) • Recognizing triggers. Classify triggers into two categories: ones that can be avoided (avoid these), ones that can’t be avoided (come up with a plan to deal with these)

  33. F. CONSIDER REFERRAL FOR MEDICATION • Antidepressants • Mood stabilizers • Anti-anxiety medication

  34. G. WORK ON BOUNDARY ISSUES • Self Over Others • Others Over Self • External • Internal

  35. Parents As Part of The Solution * Assist them understanding and processing own reaction * Understanding what it means for their child and child’s triggers * Discuss appropriate - responses - monitoring - limits - consequences - communication * Develop plan for support

More Related