Transcript Self-Injurious Behavior in Adolescents

Self-Injurious Behavior
in Adolescents
WJCIA Annual Training Conference
Stevens Point
September 28, 2007
Kay F. Heimerl, MS LCSW
Outagamie County DHHS
[email protected]
(920)832-5270
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:
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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
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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
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Cutting
Burning
Scratching
Picking
Interfering with wound healing
Head banging
Hitting self
Methods of SIB cont…
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Breaking bones
Hair pulling
Spooning
Eating harmful objects – lightbulbs,
glass, plastic
Ingesting chemicals
Over/under eating
Comorbid behaviors
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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
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High Risk Groups
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Emotionally disturbed children
History of trauma/abuse
Borderline Personality Disorder
Young males with psychosis
Gender identity disorders
Dissociative disorders
High Risk Groups cont…
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Substance abusers
Teens whose parents are physically or
emotionally unavailable to them
Teens with untreated depression or
anxiety
Why do people
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self injure?
Because it works!!!
All self-injury is designed to
feel good at that moment.
Purpose of SIB
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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…
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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???
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Not usually
Sometimes done to induce rescuing
behaviors in others
Can provide an opportunity for self-care
afterwards
Attention Seeking???
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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:
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Depression
Stress
Hopelessness
Powerlessness
Purposelessness
Anxiety
Fear
Psychological characteristics of
Self Injurers
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Invalidate self
Hypersensitive to rejection
Pervasive anger
Tend to suppress anger
Impulsive
High levels of aggressive feelings
Act on immediate mood
Psychological characteristics
cont . . .
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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?
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Don’t ignore it!
Always take it seriously.
Don’t judge!
Show concern.
Stay calm and sincere.
Don’t overreact, rescue or “hypernurture”.
How should we react?
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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?
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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?
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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:
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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:
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Medication
Develop Personal Validation
Spirituality
Meditation
Yoga, Tai Chi
Appropriate physical releases
Interventions/Referrals:
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Group therapy – DBT, Abuse survivors
Family therapy
Change core beliefs and values
Teach emotional literacy – feeling lists,
journaling
Safety bag
Safety Planning
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Assessment questions
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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
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Assessment questions cont…
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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
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Contracts
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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
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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???