Self-Injury

Presented

By

Sonia Campos, M.Ed., LPC, NCC, CART

Lisa Garcia, M.S., LPC, NCC, CART

AGENDA• Introduction

• Definition of Self-Injury

• Understanding Self-Injury

• Categories of Self-Injury

• Underlying Causes and Functions of Self-Injury

• Suggestions for Professionals & Family

• Treatment Strategies

• Websites

• Resources

• Questions and Answers

Scars have the strange power to remind us that the past is real.

Cormac McCarthy, All the Pretty Horses

Definition• “Self-Injury is intentional, self-effected,

low lethality bodily harm of a socially unacceptable nature, performed to reduce psychological distress. (Walsh 2006)

• The act is NOT to commit suicide

• Psychologically motivated

Understanding Self-Injury

Understanding Self-Injury• Manifestation from the phenomenon

“Self-Harm”

• It is a difficult and disturbing behavior that communicates one’s pain and self-destructiveness

• A direct form of violence upon one’s body

• Powerful statement of one’s psychological distress that has distorted the individuals ability to manage and soothe their pain

• A sense of powerlessness

Understanding Self-Injury• “A specific language of pain that

communicates the suffering of past and current trauma, which is spoken loudly by the self-inflicted repetition of that trauma upon one’s own body” (Conterio & Lader, 1998).

• “My body looks how I feel.”» A self-injurer

Self-Injury as a Diagnosis?• Yet to be a discrete disorder

• Partially referenced for the diagnosis of Borderline Personality Disorder in DSM IV TR

• PTSD

• Dissociative Identity Disorder

• Bipolar Disorder

• Common in Eating Disorders

• Impulse Control Disorders

Prevalence• Typically starts during adolescence and

ranges into young adulthood

• Studies estimate that 1,400 per 100,000 people during the 90’s

• Significantly more prevalent in Females– 3 to 4 times higher than males

– Girls internalize anger

Prevalence• Contributing factors

– abuse

– lack of parental psychological presence

– divorce

– sexual orientation

– daily pressures

– body pressure

Understanding Self-Injury• Common Forms of Self-Injury

– Cutting (72%)– Carving– Burning (35%)– Self-hitting (30%)– Picking at scabs (22%)– Hair pulling (10%)– Biting– Peeling layers of skin– Ingesting sharp objects

Study by Favazza and Conterio 1988

Cutting, to this day, is the most often used method

Manifestations of Self-Injury• Wrists and arms are the common areas to

cut

• Studies render that legs, abdomens, heads, chests, and genitals are other cut areas

• Self-injurers report that once they cut they experience little to no pain compared to their emotional suffering

• Instruments used vary:– Scissors, razor blades, knives, scalpels, shards

of glass, pieces of metal

Manifestations of Self-Injury• Instruments used vary:

– Scissors

– Razor blades

– Knives

– Scalpels

– Shards of glass

– Pieces of metal

Categories of Self-Injury

Categories of Self-Injurious Behaviors

Proposed by Simeon and Favazza 2001

1. Stereotypic Self-Injurious Behaviors– Biologically driven force that is highly repetitive, fixed,

rhythmic, and usually contentless acts, anywhere from mild to severe injury

2. Major Self-Injurious Behaviors– Most dramatic kind (castration, amputation) that involves

suffering and severe psychotic pathology

Categories of Self-Injurious Behaviors

Proposed by Simeon and Favazza 2001

3. Compulsive Self-Injurious Behaviors– Behaviors that are repetitive and ritualistic, multiple

times per day (hair pulling, nail biting)

4. Impulsive Self-Injurious Behaviors– Preoccupation of harming oneself, hard to resist impulse,

feeling to tension prior to act and relief at execution, no suicidal intent

Underlying Causes

Underlying Causes

• Self-Injury is not easily explained or accounted by a single cause.

• Trauma exposure, Personality characteristics, and Comorbid clinical features have been identified in self-injurers.

• Exposure to trauma is associated with the development of maladaptive personality features and clinical diagnosis.

– Major depressive disorder, generalized anxiety dirosder, PTSD

Underlying Causes

• The end result of trauma is the invalidation of one’s sense of self, in which the individual turns to the body for solace.

• It is an effort not to feel what cannot be tolerated.

Functions of Self-Injury

Functions of Self-Injury• Self-injurers do not seek death through

attacking their body, they attempt to defy it.

• Four functions of self-injury1. Regulating affect, soothing emotional wounds,

and managing dissociation

2. Seeking mastery over pain and past trauma

3. Communicating pain, controlling others, and seeking nurturance

4. Securing and authenticating a sense of self

Four Functions

1. Regulating affect, soothing emotional wounds, and managing dissociation– Provides a sense of deep relief from emotional

distress

– Self-injury is utilized to express and manage intolerable feelings

– External soothing helps the individual feel a greater sense of security

Four Functions

Cutting serves as a calming functioning by triggering endogenous opoids and transends distress to tranquility– Self-injury can alleviate the sense of emptiness

and deadness.

– They believe that they are connected to their bodies

Four Functions

2. Seeking Mastery Over Pain and Past Trauma– Derive a lack of control over others and their own

destinies that they feel in-control by attacking their bodies

– Better to create their own pain and be able to control it rather than be a victim to the pain

– Sense of mastering their past unresolved feelings

– Mastery and control provides a sense of hope

Four Functions

3. Communicating Pain, Controlling Others, and Seeking Nurturance– Inability of putting words to the pain they

have experienced

– The body speaks what the self-injurer can not articulate

– A form of instilling shock onto others

– Can be a desperate attempt to make others notice the he/she exists and is in pain and wants a connection

– Can elicit posititve attention from others which is reinforcing the behavior

Four Functions

4. Securing Authenticating a Sense of Self– Have difficulty in creating and maintaining

psychological and interpersonal boundaries

– The behavior defends injurer from intense emotions of perceived abandonment

– The injurer is able to experience her/his own vitality through the physical sensation of the act– seeing the blood and scars

– The body and its wounding connect the individual’s inner and outer worlds

Suggestions for Professional Counselors, Social Workers,

and Psychologists

Suggestions for Mental Health Professionals

1. Show the child/adolescent unconditional acceptance.

2. Accept him/her as a person regardless of the behavior.

3. Make understanding the underlying causes for the behavior a goal.

4. Encourage a commitment to try positive alternative behaviors for coping.

Suggestions for Mental Health Professionals-(Continued)

5. Suggest a list of coping techniques to be used rather than Self-Injury.

6. Understand that the list is flexible and can always change.

7. Encourage open communication no matter what the behavior.

8. Acknowledge his/her efforts to cope with very difficult emotions.

Suggestions for Mental Health Professionals-(Continued)

9. Show that you care about the injuries.

10. Communicate that it is okay to talk about Self Injury.

11. Help him/her discover their identity.

12. Remember that you are not responsible for the child/adolescent’s behavior.

From: Bowman, S. & Randall, K (2006). See My Pain! Creative strategies and activities for helping young people who self-injure. Chapin, SC: YouthLight, Inc.

Suggestions for Teachers/Educators

Suggestions for Teachers1. Try to approach the student in a calm and caring

way.

2. Accept him/her even though you do not accept the behavior.

3. Let the student know how much you care about him/her and believe in his/her potential.

4. Understand that this is his/her way of coping with the pain that he/she feels inside.

5. Refer that student to your school’s counselor, social worker, and/or nurse.

Suggestions for Teachers - (Continued)

6. Offer to go with that student to see the professional helper.

7. Listen! Allow the student to talk to you. Be available.

8. Discover what the student’s personal strengths are and encourage him/her to use those strengths.

9. Help him/her get involved in some area of interest, a club, sport, peer program, outreach project, e.g., volunteer at a local animal shelter or wildlife sanctuary, help an older person at a nursing home, become a tutor, or mentor.

From: Bowman, S. & Randall, K (2006). See My Pain! Creative strategies and activities for helping young people who self-injure. Chapin, SC: YouthLight, Inc.

Suggestions for Family

Suggestions for the Family

1. Accept your child even though you do not accept his/her behavior.

2. Let your child know how much you love hem/her, not only when he/she Self-Injures, but at other times as well.

3. Understand that this is his/her way of coping with the intense pain that he/she feels inside.

4. Encourage healthier methods of coping by allowing him/her to brainstorm other ways other than hurting him/herself.

Suggestions for the Family – (Continued)

5. Listen! Keep communication open by talking about things that would interest him/her even if it doesn’t interest you.

6. Ask open questions (what or how) to encourage him/her to open up. Allow conversations to revolve around what he/she wants to talk about no matter how silly or crazy it may seem to you.

7. Allow him/her to share what they’re feeling deep inside either with words (journaling) or in art (drawing, painting, creating, or any other way he/she can communicate their feelings).

Suggestions for the Family – (Continued)

8. Make your home a “Safe Place” by removing anything that could be used as a tool for Self-Injury.

9. Have fun together! Try to do some fun things together (let him/her choose a fun activity that is interactive, not just going to the movies). Although he/she may complain at first, your child really does want to spend time with you.

10. Discover what his/her personal strengths are and encourage him/her to use those strengths during difficult times.

Suggestions for the Family – (Continued)

11. Help your child to get involved in some area of interest, after-school activity, a good cause, or other good will effort.

12. Encourage some kind of outreach in the community , e.g., volunteering at a local animal shelter or wildlife sanctuary, helping an older person at a nursing home, tutoring a young child after school, or mentoring a troubled younger child.

From: Bowman, S. & Randall, K (2006). See My Pain! Creative strategies and activities for helping young people who self-injure. Chapin, SC: YouthLight, Inc.

Treatment Strategies

Treatment Strategies

1. Crucial Communication Skills

2. Personal Strength Coaching

3. Relaxation/Guided Imagery

4. Reflective Journaling

5. Visual Arts

6. Clay

7. Sand Tray

Treatment Strategies – (Continued)8. Metaphors

9. Music

10. Story Telling

11. Tactile Diversion

12. Creative Dramatics

13. Mentoring

14. Animal Assisted Therapy

15. Prayer Power

Websites

Websites• NOTE: Some experts say that people who self-injure can be

triggered by visiting Websites or chat rooms that discuss self-injury.

• HealthyPlace Self-Injury Community• www.healthyplace.com/Communities/Self_I

njury/site/

• Self-Injury: You are Not the Only One• www.palace.net/~llama/psych/injury.html

Websites – (Continued)

• Focus Adolescent Services• www.focusas.com

• Teen Health Centre• www.teenhealthcentre.com

Websites – (Continued)

• SIARI: Self-Injury and Related Issues• www.siari.co.uk

• S.A.F.E. Alternatives (Self-Abuse Finally Ends)• www.selfinjury.com

• American Self-Harm Information Clearinghouse• www.selfinjury.org

References

ReferencesBowman, S. & Randall, K. (2006). See my pain! Creative

strategies and activities for helping young people who self-injure. Chapin, SC: YouthLight, Inc.

D’Onofrio, A. (2007). Adolescent self-injury: a comprehensive guide for counselors and health care professionals. New York, NY: Springer Publishing Company, LLC.

McVey-Noble, M. E., Khemlani-Patel, S., & Neziroglu, F. (2006). When your child is cutting: a parent’s guide to helping children self-injury. Oakland, CA: New Harbinger Publications, Inc.

Walsh, B. W. (2006). Treating self-injury: a practical guide. New York, NY: Guilford Publications, Inc.

Winkler, K. (2003). Cutting and self-mutilation: when teens injure themselves. Berkeley Heights, NJ: Enslow Publishers, Inc.

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