Understanding Self-Injurious Behavior. Self Injurious Behavior Other Terms Cutting Self-harm ...
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Transcript of Understanding Self-Injurious Behavior. Self Injurious Behavior Other Terms Cutting Self-harm ...
Self Injurious BehaviorSelf Injurious Behavior
Other TermsOther Terms CuttingCutting Self-harmSelf-harm Self-inflicted violenceSelf-inflicted violence Self mutilationSelf mutilation Para-suicidal behaviorPara-suicidal behavior
DefinitionDefinition
““Any socially unacceptable behavior Any socially unacceptable behavior involving immediate, deliberate, direct involving immediate, deliberate, direct and usually repetitive physical injury to and usually repetitive physical injury to one’s own body, resulting in mild to one’s own body, resulting in mild to moderate self harm, usually without moderate self harm, usually without conscious suicidal intent.”conscious suicidal intent.”
Remuda Ranch Treatment CenterRemuda Ranch Treatment Center
Common ExamplesCommon Examples
ScratchingScratching CuttingCutting CarvingCarving BurningBurning Repetitive rubbingRepetitive rubbing AbradingAbrading PunchingPunching
Common Examples, cont.Common Examples, cont.
PinchingPinching BitingBiting Head bangingHead banging Hair pulling or pluckingHair pulling or plucking
Some SIB’s may mimic suicidal behaviors, Some SIB’s may mimic suicidal behaviors, but they serve a different purpose. but they serve a different purpose.
Less Common ExamplesLess Common Examples(Increasing in Popularity)(Increasing in Popularity)
Scarification Scarification Cutting and preventing healing Cutting and preventing healing
Reopening of barely healed woundsReopening of barely healed wounds
BrandingBranding
Excluded BehaviorsExcluded Behaviors
TattooingTattooing Body piercing Body piercing
These are culturally sanctioned behaviors These are culturally sanctioned behaviors and are thus excluded from the SIB and are thus excluded from the SIB definition.definition.
ToolsTools
Razor bladesRazor blades PinsPins Paper clipsPaper clips
(Any object that can be made sharp or cause injury)(Any object that can be made sharp or cause injury)
Cigarettes, matches, candles (burning) Cigarettes, matches, candles (burning)
Body PartsBody Parts
WristsWrists ForearmsForearms LegsLegs Usually hidden areas Usually hidden areas (depends on motivation)(depends on motivation)
StatisticsStatistics
1% of general population1% of general population 1.8% teens 1.8% teens (usually cut with sharp objects)(usually cut with sharp objects)
12% college age12% college age 4.3-13% people with mental disorders4.3-13% people with mental disorders 25-45% people with eating disorders25-45% people with eating disorders Most common in unmarried femalesMost common in unmarried females Positive correlation with sexual traumaPositive correlation with sexual trauma
Variations of SIBVariations of SIB
CompulsiveCompulsive Closely associated with Obsessive Closely associated with Obsessive
Compulsive DisorderCompulsive Disorder Prompted by anxietyPrompted by anxiety Different intention and root than impulsive Different intention and root than impulsive
formsforms
Variations of SIB, cont.Variations of SIB, cont.
Impulsive Episodic TypeImpulsive Episodic Type Not premeditatedNot premeditated Response to emotional triggerResponse to emotional trigger Not self-identified as a “cutter”Not self-identified as a “cutter”
Variations of SIB, cont.Variations of SIB, cont.
Impulsive Repetitive TypeImpulsive Repetitive Type Rumination about SIBRumination about SIB Self-identified as a “cutter”Self-identified as a “cutter” Behavioral response to both positive, Behavioral response to both positive,
negative stressorsnegative stressors Impulse Control Disorder NOS (Axis I)Impulse Control Disorder NOS (Axis I)
Risk FactorsRisk Factors
Early abuse historyEarly abuse history High levels of dissociative defensesHigh levels of dissociative defenses Highly chaotic family environmentsHighly chaotic family environments Lack of sufficient parental controlLack of sufficient parental control Extensive psychosocial stressorsExtensive psychosocial stressors Severe mood disorderSevere mood disorder
Levitt, Sansone, Cohn 2004Levitt, Sansone, Cohn 2004
Function OverviewFunction Overview
Relief from overwhelming painful emotionsRelief from overwhelming painful emotions Stopping/preventing dissociative stateStopping/preventing dissociative state Addiction to euphoric endorphins releasedAddiction to euphoric endorphins released Voice for emotional painVoice for emotional pain Self-punishment for behaviors, feelings or Self-punishment for behaviors, feelings or
needs needs (likely to hide evidence of SIB)(likely to hide evidence of SIB)
Re-enactment of abuse to gain a sense of Re-enactment of abuse to gain a sense of controlcontrol
Function Overview, cont.Function Overview, cont.
““When I could not find the words, cutting had When I could not find the words, cutting had become the language to describe the pain, become the language to describe the pain, communicating everything I felt.” communicating everything I felt.” A clientA client
““Youth who self-mutilate may choose this behavior Youth who self-mutilate may choose this behavior because it meets a multitude of needs at one because it meets a multitude of needs at one time. The most common functions….are time. The most common functions….are expressing and controlling overwhelming expressing and controlling overwhelming emotions, and maintaining a coherent sense of emotions, and maintaining a coherent sense of self when threatened with the loss of identity.”self when threatened with the loss of identity.”
Suyemoto and Kountz, 2000Suyemoto and Kountz, 2000
Function SpecificsFunction Specifics
StimulationStimulation Escape dissociation through an intentional gesture to Escape dissociation through an intentional gesture to
feel one’s bodyfeel one’s body Self-grounding techniqueSelf-grounding technique
PunishmentPunishment Self-imposed response toSelf-imposed response to
GuiltGuilt
ShameShame
WeaknessWeakness
Function Specifics, cont.Function Specifics, cont.
Punishment, cont.Punishment, cont.AngerAngerLack of disciplineLack of discipline
RelaxationRelaxation Pleasure response to warmth of bloodPleasure response to warmth of blood
and/or physical sensation of painand/or physical sensation of pain Form of tension reductionForm of tension reduction Endorphin releaseEndorphin release
Function Specifics, cont.Function Specifics, cont.
DiversionDiversion Inducing a trance-like state to avoid Inducing a trance-like state to avoid
attending toattending to
An emotional triggerAn emotional trigger
Specific issueSpecific issue
Specific subjectSpecific subject
Suicidal thoughtsSuicidal thoughts
Function Specifics, cont.Function Specifics, cont.
Social Motives/AttentionSocial Motives/Attention Obtaining self-affirmationObtaining self-affirmation
Showing self and others one’s strengthShowing self and others one’s strength
Achieving nurturing and protection through the Achieving nurturing and protection through the response of othersresponse of others
AlterationAlteration Making one’s body unattractive to others through Making one’s body unattractive to others through
scarringscarring
What clients say…What clients say…
Perceived loss and/or abandonment precedes Perceived loss and/or abandonment precedes the actthe act
Experience of shame is high prior to SIBExperience of shame is high prior to SIB
Self-anger and/or sadness are common feelings Self-anger and/or sadness are common feelings both before and afterboth before and after
Isolation almost always occurs before SIBIsolation almost always occurs before SIB
What clients say… cont.What clients say… cont.
Frequently reported goalsFrequently reported goals Diminish negative feelingsDiminish negative feelings Self-punishmentSelf-punishment Avoidance of painful memoriesAvoidance of painful memories Induction of trance-like stateInduction of trance-like state
70% report release of tension and anxiety, 70% report release of tension and anxiety, and a sense of satisfaction following SIBand a sense of satisfaction following SIB
Therapeutic InterventionTherapeutic Intervention
Therapist must understandTherapist must understand Risk factorsRisk factors VariationsVariations FunctionFunction
Approaches to treatmentApproaches to treatment Assessment (initial and ongoing)Assessment (initial and ongoing) EducationEducation MedicationMedication Family therapyFamily therapy Individual and group therapyIndividual and group therapy Experiential therapyExperiential therapy
Therapeutic Intervention, Therapeutic Intervention, cont.cont.
Goals of treatmentGoals of treatment Safety first Safety first (validate emotion, but not behavior, thoughts)(validate emotion, but not behavior, thoughts)
Skill training Skill training (DBT works well)(DBT works well) Self-sootheSelf-soothe Manage emotionsManage emotions
Resolve psychological schemasResolve psychological schemas Replace lies with truth aboutReplace lies with truth about
GodGod
SelfSelf
OthersOthers
Therapeutic Intervention, Therapeutic Intervention, cont.cont.
Goals of treatment, cont.Goals of treatment, cont. Make connections between thoughts, Make connections between thoughts,
feelings, behaviorsfeelings, behaviors Identify triggersIdentify triggers
EmotionsEmotions SituationsSituations PeoplePeople Other external stimuliOther external stimuli
Behavior chain analysisBehavior chain analysis
Miscellaneous NotesMiscellaneous Notes
BaalBaal I will go before you and will level the mountains; I will I will go before you and will level the mountains; I will
break down the gates of bronze and cut through the bars break down the gates of bronze and cut through the bars of iron. I will give you the treasures of darkness, riches of iron. I will give you the treasures of darkness, riches stored in secret places, so that you will know I am the stored in secret places, so that you will know I am the Lord, God of Israel who summons you by name.Lord, God of Israel who summons you by name.
Isaiah 45:2, 3Isaiah 45:2, 3
For the word of God is full of living power. It is sharper For the word of God is full of living power. It is sharper than the sharpest knife, cutting deep into our innermost than the sharpest knife, cutting deep into our innermost thoughts and desires. It exposes us for what we really thoughts and desires. It exposes us for what we really are. Nothing in all creation can hide from Him. are. Nothing in all creation can hide from Him. Everything is naked and exposed before His eyes.Everything is naked and exposed before His eyes.
Hebrews 4:12, 13Hebrews 4:12, 13
Miscellaneous Notes, Miscellaneous Notes, cont.cont.
God’s unconditional love knows each of God’s unconditional love knows each of us to the depths of our pain, shame and us to the depths of our pain, shame and joy. Only He can truly understand what joy. Only He can truly understand what that excruciating sorrow is like. Through that excruciating sorrow is like. Through and with Him we have a hope and a and with Him we have a hope and a future. Bringing this to those who self-future. Bringing this to those who self-injure can provide them a new way of injure can provide them a new way of thinking.thinking.
Helpful websitesHelpful websites
www.selfinjury.comwww.selfinjury.com or SAFE (Self-Abuse Finally Ends) - 800-366- or SAFE (Self-Abuse Finally Ends) - 800-366-8288 8288
http://secured.nmha.org/mpower/411Cutting.htmhttp://secured.nmha.org/mpower/411Cutting.htm
http://http://dmlive.com/index.htmldmlive.com/index.html
http://groups.google.com/group/Fading-Scarshttp://groups.google.com/group/Fading-Scars
http://www.selfmutilatorsanonymous.orghttp://www.selfmutilatorsanonymous.org
http://www.Focusas.com/SelfInjury.htmlhttp://www.Focusas.com/SelfInjury.html
http://www.self-injury.org/index.htmlhttp://www.self-injury.org/index.html
Contact InformationContact Information
Catherine Jantzen, MS, LMHCCatherine Jantzen, MS, LMHCLead Therapist, Family Care CenterLead Therapist, Family Care Center2821 Hillegas Road2821 Hillegas Road
Fort Wayne, IN 46808Fort Wayne, IN 46808
260-471-1950 260-471-1950
[email protected]@familycarectr.org