August 21, 2012, IU 6 Fall In-service Day 2 By: Melissa Austen 1.

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August 21, 2012,

IU 6 Fall In-service Day 2

By: Melissa Austen

Self Injurious Behaviors in Mental

Health

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No universal definition currently exists

Self-injurious behavior (SIB): The deliberate harm to one’s body resulting in tissue damage, without a conscious intent to die. (Craigen and Foster, American Counseling Association)

Non-suicidal Self-Injury: any physically self-damaging act performed without intent of killing oneself, with intent of inflicting physical harm to one self. (Goldstein and Polling, Western Psychiatric Institute and Clinic, 2012)

Self-injury: physically damaging in a response to a psychological crisis and demonstrates a sense of disconnection and alienation from others. (Dallam, 1997 presented by Packard, Center for Behavioral Medicine Forum Health)

Definitions

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“The intentional destruction of body tissue without suicidal intent and for purposes not socially sanctioned.”

-Klonsky (2007)

Definitions

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Self-cuttingSelf-burningSelf-hittingSelf-scratchingSelf-carvingInterference with wound healingHair pullingBone breaking

Culturally Accepted SIB

Examples of Self Injurious Behaviors (SIB)

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ArmsWristLegsAbdomenHeadChestGenitals

Typical Injury Sites

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Three FactorsExtent of the DamageLevel of Medical AttentionLocation of the Wound

Severity

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Usually Adolescents to Young AdultsUndiagnosed or Untreated adolescents with

mental health diagnosisCan have comorbid diagnosis History of abuse

No difference between sex, race, or SES status

An accurate number is unknown because victims engage in secretive behaviors

Who

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Do not have required coping skills to manage their thoughts and feelings

Lack of support from caretakers

Self-injurious behaviors is one way to mark events’

“Creating a mark or an injury is a way to make interal, invisible wounds, external and visible.”

Form of self-medicatingAddictive

GENERAL WHY??

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A physical self- punishment

Many suffer from a history of trauma in their life

Release of anger, pain, emptiness, guilt, or anxiety

Seek escape from intense affect

Gain a sense of control

Achieve some level of

focusGround oneself to

realityFeeling physical pain

to escape emotional pain

Inflict pain on someone who is not available

Communicate a needPrevent suicide

Why engage in SIB

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1. Experimental Cutter2. Show-off Cutter3. Shock Cutter4. Rebellious Cutter5. Self-Punishment Cutter6. Distraction Cutter7. Coping Skill Cutter8. Mental Issues and Cutting

Types of Cutters

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Some think it is brave and coolMost feel shame and repulsive about the

behaviorFeel alienated and isolatedFeel powerless to stopDon’t want to disclose- feel like they have a

dirty secretIntense emotionsFeel as no on would understand themAs the behavior escalates, it increases

feelings of alienation, helplessness, and loss of power and control

SIB thoughts

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DissociativeNot aware of the act

until completedNumbness physically

and/or psychologicallyDetaches self from body,

environment, and behavior

Some of no memory of the SIB, and feel frightened when they discover the wound

Very aware of the act

Seeking the feeling of pain

Feel powerless to stop the SIB

Two Types

Nondissociative

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Repetitive or Cyclical Behavior

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After SIB occurs, individuals are reward with feelings of gratification, relief, comfort, and arousal

Body releases endorphins– individual feels a “high”

Seeing the blood allows some individuals to feel alive and real

Some become emotionally frozen and experience no emotions

“Self-injurious behaviors is an individuals way of self-medication (Moninger, 2011)”

Reinforcement

55%-85% of SIB have had at least one suicide attempt (Goldstein and Polling, 2012, Western Psychiatric Institute and Clinic)

60% are not trying to end their life (Moninger, 2011)

Self injury seeks to feel better while a suicidal ideation seeks to end all feelings

Suicide versus SIB

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Learn to deal with your own feelings and learn about the problem

Don’t scold or reprimand or judgeOffer Support

Individual Counseling with specific treatment therapies Know school policy on reporting SIB individuals Help the individual identify their support system Refer to SAP

Encourage communication It is like an addiction, so expect relapsesDon’t force them to stop behavior until new coping

mechanisms are in placeLet them know they deserve to feel better without having to

hurt themselves

Help

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Try to see the pain behind the behavior.

Offer acceptance and support. Let him or her know that you

understand the behavior is an attempt to cope with emotions or stress.

Offer observations or statements instead of too many questions (i.e., say something like “You seem to be under a lot of stress lately,” or “I noticed that you have been upset about something.”).

Assure the individual that he/she is not bad or insane.

Talk about feelings. Try to help the other person find words to express his or her feelings.

Seek professional help. Get an evaluation by a mental health professional with expertise in helping persons who injure themselves. Medication may be helpful in treating the underlying cause of the behavior. Your medical doctor should be able to help with referrals.

See if your school system or guidance counselor has programs to help self-injuring students.

Focus on increasing your teen’s confidence by concentrating on the things he/she does well and offering encouragement in those areas.

Generate ideas for other ways to deal with feelings: exercise, do things with a positive group of friends, help someone else.

What should I do if I suspect my teenis cutting?

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American Counseling Association http://counselingoutfitters.com/vistas/vistas05/Vistas05.art66.pdf

NYU Child Study Center http://www.aboutourkids.org/files/articles/nov_dec_3.pdf

HELPGUIDE .org (helpful for SIB to seek help) http://www.helpguide.org/mental/self_injury.htm

University of Tennessee https://

utextension.tennessee.edu/publications/Documents/SP681-S.pdf

S.A.F.E Alternatives (Self-Abuse Finally Ends) http://www.selfinjury.com 1-800-DON’T-CUT)

Resources

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Self-Injurious Behavior: Who’s Doing It, What’s Behind it, and How to Treat It http://

www.openskywilderness.com/wordpress/wp content/uploads/2012/02/Kirsten-Article-.pdf

American Academy of Child and Adolescent Psychiatry http://

aacap.org/page.ww?name=SelfInjury+in+Adolescents&section= Facts+for+Families

HeartLight Ministries http://www.heartlightministries.org/blogs/markgregston/20

07/06/05/self-mutilation-teens-and-cutting/

American Self-Harm Clearinghouse http://www.selfinjury.org

Resources

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QUESTIONS?Questions

QUESTIONS?