Self Injury

Report
Understanding Self-Injury
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CENTER FOR RESEARCH AND ACADEMIC
EXCELLENCE
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Self Injury
1.WHO SELF INJURES?
2. WHY DO THEY DO IT?
3. WHAT IT IS AND IS
NOT.
4. HOW CAN WE HELP?
Caroline Kettlewell from Skin Games
 “I needed to cut the way your lungs scream for
air when you swim the length of the pool
underwater in one breath. It was a craving so
organic it seemed to have risen from my skin
itself.”
Self-Injury Terms
Self Inflicted Violence
 Cutting
 Self Harm
 Self Mutilation
SI Behaviors
 Cutting
 Scratching
 Abrading
 Burning
 Some forms of hair pulling
 Biting
 Inserting foreign objects into the body
 Interference with wound healing
 Ingesting toxins
Warning signs
 Unexplained frequent cuts or burns
 Wearing long sleeves or pants in warm





weather
Avoiding swimming pools or the beach
Wearing thick bracelets to cover wrists
Having sharp objects in purse, book bag, or
bedroom
Difficulty expressing feelings
Withdrawal from close relationships
What is the Definition
 Self injury is the intentional
harm of one’s own body without
conscious suicidal intent.
(Aldeman, 1998, Favazza, 1998, van der Kolk, et al., 1991)
What Self Injury is NOT
 It is not a suicide attempt
(attempting to feel better, not escape all feelings)
 It is not usually attention seeking
 It is not a danger signal to others
NOT SUICIDAL BEHAVIOR
 “…self-mutilation is distinct from suicide…A
basic understanding is that a person who
truly attempts suicide seeks to end all
feelings where as a person who self-mutilates
seeks to feel better.” (Favazza, 1998)
 Intention-does not intend to die as a result
of his/her acts. Intends to live.
Who Self-Injures
 Roughly 2% (1-4%) of the population. In some
studies reported as high as 8 million
Americans self-mutilate.

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30 times the rate of suicide attempts
140 times the rate of completed suicides
May also suffer from eating disorders
90% who cut began as teenagers
Typical profile
 Female
 Mid
20’s to early 30’s
 Began cutting as a teen
 Middle to upper class
 Intelligent, well educated
 Perfectionist
Profile (cont)
 Males and females
 All races and socio-economic
levels
 Ages 15-50’s
 Not easily identifiable
Characteristics
 are often depressed, feel powerless or






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
anxious
have low self esteem /negative body
image
have difficulty expressing their emotions
verbally
experience difficulty with relationships
aim for perfection
often have negative body image
lack impulse control/suppressed anger
do not have a repertoire of coping skills
may have serotonin dysfunction
possible trauma
Abuse?
 Many who self-injure did not
suffer childhood abuse (Zweg-Frank, et.al,
1995, Brodsky, et. al., 1998)
 50-60% suffered childhood abuse or trauma.
That means that 40-50% did not (Favazza,1998)
Then Why?
 Invalidating environments (Lineham,
1993)
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Expression of private experiences and feelings are
not validated
Feelings are trivialized, punished or ignored
Experience of painful emotions are disregarded.
Child’s interpretation of his or her behavior is
dismissed
In their own words . . .
“There are times when I hurt too deep for tears,
so I cut and it lets out some of the hurt. It’s like
when you see the blood flowing out, the pain and
fear are flowing with it.”
“Watching the blood flow out makes me feel clean,
purified. It feels like something bad or dirty is
leaving with the blood.”
In their own words . . .
“The stopped voice becomes a hand lifting knife,
razor, broken glass to cut, burn, scrape, pop,
gouge. The skin erupts in a mouth, tongue less,
toothless. A voice drips out, liquid…a voice sears
itself for a moment, in the flesh. This is a voice
emerging on the skin, a mouth appearing on the
skin. The body which could not be air on the
larynx becomes the stroke of a razor on the
breastbone or of a red-hot-knife-tip upon the
wrist…” .
Janice McLane (1996)
Why do they harm themselves?
 To release intense feelings
 The physical pain may be easier to
deal with than the emotional pain
 To feel real, alive
 To exert some control
 Acting out self punishment
Cycle of Cutting
Cutting
Disassociation
Into the Void
Panic
Relief
Shame, guilt,
remorse, disgust
Mounting anxiety, anger
or self hatred, alienation
Muller 2005
In own words . . .
“It’s like opening up a safety valve or letting steam out of a
covered pot.”
“Sometimes I cut just to make myself feel something
because I am just totally numb.”“
(In Strong, 1998, p.7)
Why Self-Mutliate?
“I felt like I was isolated from the world, dead,
with no emotions at all. The blood told me I was
alive, that I could feel…Also I couldn’t cry, and
bleeding was a different form of crying.”
(Lindsay in Strong, p.57)
DSM IV Classification
Currently listed as a symptom
associated with a number of
mental health disorders
Some mental health professionals
are advocating for self injury to
be listed as a separate diagnosis
SI is often associated with:
 Borderline Personality Disorder
 Obsessive-Compulsive Disorder
 Post-Traumatic Stress Disorder
 Dissociative Identity Disorder
 Eating Disorders
 Substance Abuse
 Depression
DIAGNOSIS (Ferreira de Castro, et.al., 1998)
Self-Injure
Suicide Attempt
14%
16%
56%
26%
2%
9%
Dysthymia
12%
7%
Adjustment
disorder with
depressed mood
24%
6%
Major Depression
Alcohol
Dependence
Schizophrenia
Therapeutic Goals
 Encourage communication about self-injury and
relevant aspects of the child’s life.
 Improve the quality of client’s life as it relates
to self-injury.
 Explore themes of guilt and shame.
 Diminish use of self-injury as the coping skill
when client desires to make changes. (Conners,
Rubin, et, al,2002).
Helping: What to Do
(Alderman, 1997)
 Learn about self-injury.
 Talk about SI. Ask about it.
 Be supportive. Show you care.
 Acknowledge the effort to cope with very

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difficult emotions
Set limits
Be available, but refer when appropriate
Don’t discourage self-injury
Recognize the severity of the distress
What Not to Do
 Be afraid to ask the question, “Do you self-injure?”
 Make eliminating the behavior the primary goal
 Make a safety contract or use contracts as a
reward or punishment
 Visibly monitor their injuries
 Make him or her feel ashamed or guilty about the
behavior
“This
is yet another secret I must hold to
myself because my therapist has given me an
ultimatum, either no more hurting myself or
we will have to discontinue our therapy. So a
little distance comes between us now, a secret
that hold great importance which we could
both learn from, if I was able to tell
her…JML
Interrupting the Cycle
 Dispute irrational thoughts, feelings
 Triggering event
 Unbearable tension, anxiety
 Dissociation
 Self injury
 Relapse
Expressive Arts
 Journals
 Poetry
 Music
 Art
Self-Injury Group
Respond to the following statements by
writing “A” for “agree” if you mostly agree
with the statement or “D” for “disagree” if you
mostly disagree. Be ready to explain your
responses.
___Self-injurers are survivors.
___Self-injurers are weak people.
___Self-injurers are harming themselves to
get attention.
___Self-injurers are perfectionists.
___Self-injury is a type of suicidal behavior.
___Self-injurers are proud of their scars.
___Self-injury helps people cope.
___Self-injurers are more sensitive than most
other
people.
Muller 2006
Self-Injury
If my wound could talk it would
say___________________________________
____________
_____________________________________
______________________________________
_______________________
_____________________________________
______________________________________
________________________
_____________________________________
______________________________________
_________________________
_____________________________________
______________________________________
_________________________
Muller 2006
Taking Care of Yourself
 Monitor your own horror and
confusion
 Broaden your perspective past the
behavior to the intent behind it
 Seek consultation
 Get support for yourself
Care and Concern
 The capacity to derive comfort
from another is the single
biggest predictor of whether
traumatized patients are able
to give up their selfdestructive habits. (van der Kolk)
Care and Concern
 The development of a safe and trusting
relationship is vital for the child to learn to
sooth and care for him or herself in a healthy
manner by internalizing their therapist’s care
and concern. (Strong, 1988)
Care and Concern
10
“_____ was the first to acknowledge that maybe I
was in pain, as opposed to ‘doing it for attention’ .
This affirmation of my inner pain was a healing
force. “ Shelley
Discussion
 Why the upsurge in self-injurious behavior?
 Students who look for fist fights?
 Tattoos and piercing?
 Addictive?
References:
 References:
 [email protected][email protected]
 http://www.helpguide.org/mental/self_injury.htm
http://vivianpencz.wordpress.com/2
012/01/11/breathing-whiledrowning-youth-who-self-harm/
Upcoming Webinars:
 Academic Success of Emotionally Disturbed
Students: November, 2012
 Compassion Fatigue: December, 2012
 Teenage Alcohol Abuse and Effects on the
Adolescent Brain: January, 2013
 ADHD, History, Symptoms, Medication, and
Non-Medication Treatments: January 2013
Please check the website for dates and
registration: 3centerae.com

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