Self-Injurious Behavior in Adolescents WJCIA Annual Training Conference Stevens Point September 28,...
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Self-Injurious Behavior in Adolescents WJCIA Annual Training Conference Stevens Point September 28, 2007
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Transcript of Self-Injurious Behavior in Adolescents WJCIA Annual Training Conference Stevens Point September 28,...
Self-Injurious Behavior in Adolescents
WJCIA Annual Training ConferenceStevens Point
September 28, 2007
Self Injurious Behavior
How will you know I’m hurting If you cannot see my pain?To wear it on my body Tells what words cannot explain.
- C. Blount
Definition: An injury to one’s own body, done
without suicidal intent or intent to attain sexual gratification.
Self-inflicted harm is enough to cause tissue damage.
Not part of spiritual ritual or for ornamental purposes.
Done as a way to alter a perceived intolerable mood state.
Demographics
3 million Americans 1% of the general population Males and Females Middle class and educated History of abuse and/or trauma Often starts in early teens, peaks
from ages 18-24, decreases in 30’s and 40’s
Methods of SIB
Cutting Burning Scratching Picking Interfering with wound healing Head banging Hitting self
Methods of SIB cont…
Breaking bones Hair pulling Spooning Eating harmful objects – lightbulbs,
glass, plastic Ingesting chemicals Over/under eating
Comorbid behaviors
Reckless driving Unprotected sex Shoplifting Promiscuity Substance abuse Eating disordered behavior
Wound Severity
Extent of the damage Level of medical
intervention required Location of the wound
High Risk Groups
Emotionally disturbed children History of trauma/abuse Borderline Personality Disorder Young males with psychosis Gender identity disorders Dissociative disorders
High Risk Groups cont…
Substance abusers Teens whose parents are
physically or emotionally unavailable to them
Teens with untreated depression or anxiety
Why do people self injure?.
Because it works!!!
All self-injury is designed to feel good at
that moment.
Purpose of SIB
Relief from psychological pain Release of tension Affect regulation – can’t feel, feel
too much Communicate feelings – anger,
sadness, pain, etc.
Purpose of SIB cont…
Way of being in control Defense mechanism Feel the need to be punished To be unattractive Endorphins of physical pain cover
up the emotional pain “Event marker”
Attention seeking???
Not usually Sometimes done to induce
rescuing behaviors in others Can provide an opportunity for
self-care afterwards
Attention Seeking??? Actually it is often under-
diagnosed and under-reported due to:
Shame, guilt, fear, pride Learned distrust of others Fear of legal consequences Mixed feelings about treatment/recovery
SIB is often preceded by one or more of these emotional factors:
Depression Stress Hopelessness Powerlessness Purposelessness Anxiety Fear
Psychological characteristics of Self Injurers
Invalidate self Hypersensitive to rejection Pervasive anger Tend to suppress anger Impulsive High levels of aggressive feelings Act on immediate mood
Psychological characteristics cont . . .
Feel powerless over how or whether they cope with life
Not future-focused Depressed/suicidal/self-destructive Anxious Lack of coping skills Avoidant
How should we react?
Don’t ignore it! Always take it seriously. Don’t judge! Show concern. Stay calm and sincere. Don’t overreact, rescue or “hyper-
nurture”.
How should we react? Remember that it is a cry for help. Find out what is going on beneath
the behavior. Listen! Listen! Listen! Don’t punish! Any interventions
should be designed to protect, not to punish.
Acknowledge the SIB as a survival strategy.
How should we react? Assess the extent of the injury and
intervene appropriately. Let them know that it is OK to talk
about their SIB. State that you cannot talk to the
person while they are injuring because you care about them and it hurts you to see that.
How should we react?
Do not use ultimatums – i.e. stop or else!
Set reasonable limits.
Interventions/Referrals:
You must find something to replace the behavior. You
can’t just take it away.
Interventions/Referrals: Psychotherapy – many methods and
interventions Trauma work – therapy, PTSD
Workbook, EMDR Contracts – agree to try alternate
behaviors before SIB Alternate behaviors need to be harm
reducing – rubberband snapping, hands in ice, chewing cinnamon or hot peppers, etc.
Interventions/Referrals:
Medication Develop Personal Validation Spirituality Meditation Yoga, Tai Chi Appropriate physical releases
Interventions/Referrals:
Group therapy – DBT, Abuse survivors
Family therapy Change core beliefs and values Teach emotional literacy – feeling
lists, journaling Safety bag
Safety Planning Assessment questions
Do you need to hurt yourself? What has brought you to this point?
Have you been at this point before? What did you do then to deal with it? How did you feel then?
What have you done to ease this discomfort in the past? What else can you do that won’t hurt you?
Safety Planning
Assessment questions cont… How do you feel right now? How do you feel after hurting
yourself? How will you feel tomorrow morning?
Can you avoid this stressor, or deal with it better in the future?
Safety Planning
Contracts List alternate behaviors to use before
SIB Names and numbers of contact persons When to call Crisis When to seek medical attention Discuss placement options ahead of
time if possible – i.e. hospital, crisis bed, secure detention, family member, etc.
Safety Planning Decide who will be included in the
contract – parents, school personnel, mentor, physician, etc.
Determine length of contract viability Be clear about mandatory reporting
obligations and potential consequences Consult with Mental Health professional
QUESTIONS???
