Transcript Understanding Self-Injurious Behavior

Understanding
Self-Injurious Behavior
Self Injurious Behavior
 Other Terms





Cutting
Self-harm
Self-inflicted violence
Self mutilation
Para-suicidal behavior
Definition
 “Any socially unacceptable behavior
involving immediate, deliberate, direct
and usually repetitive physical injury to
one’s own body, resulting in mild to
moderate self harm, usually without
conscious suicidal intent.”
Remuda Ranch Treatment Center
Common Examples







Scratching
Cutting
Carving
Burning
Repetitive rubbing
Abrading
Punching
Common Examples, cont.




Pinching
Biting
Head banging
Hair pulling or plucking
Some SIB’s may mimic suicidal behaviors,
but they serve a different purpose.
Less Common Examples
(Increasing in Popularity)
 Scarification
 Cutting and preventing healing
 Reopening of barely healed wounds
 Branding
Excluded Behaviors
 Tattooing
 Body piercing
These are culturally sanctioned behaviors
and are thus excluded from the SIB
definition.
Tools
 Razor blades
 Pins
 Paper clips
(Any object that can be made sharp or cause injury)
 Cigarettes, matches, candles (burning)
Body Parts




Wrists
Forearms
Legs
Usually hidden areas (depends on motivation)
Statistics







1% of general population
1.8% teens (usually cut with sharp objects)
12% college age
4.3-13% people with mental disorders
25-45% people with eating disorders
Most common in unmarried females
Positive correlation with sexual trauma
Variations of SIB
 Compulsive
 Closely associated with Obsessive
Compulsive Disorder
 Prompted by anxiety
 Different intention and root than impulsive
forms
Variations of SIB, cont.
 Impulsive Episodic Type
 Not premeditated
 Response to emotional trigger
 Not self-identified as a “cutter”
Variations of SIB, cont.
 Impulsive Repetitive Type
 Rumination about SIB
 Self-identified as a “cutter”
 Behavioral response to both positive,
negative stressors
 Impulse Control Disorder NOS (Axis I)
Risk Factors






Early abuse history
High levels of dissociative defenses
Highly chaotic family environments
Lack of sufficient parental control
Extensive psychosocial stressors
Severe mood disorder
Levitt, Sansone, Cohn 2004
Function Overview
 Relief from overwhelming painful
emotions
 Stopping/preventing dissociative state
 Addiction to euphoric endorphins
released
 Voice for emotional pain
 Self-punishment for behaviors, feelings
or needs (likely to hide evidence of SIB)
 Re-enactment of abuse to gain a sense
Function Overview, cont.
“When I could not find the words, cutting had
become the language to describe the pain,
communicating everything I felt.”
A client
“Youth who self-mutilate may choose this
behavior because it meets a multitude of needs
at one time. The most common
functions….are expressing and controlling
overwhelming emotions, and maintaining a
coherent sense of self when threatened with
the loss of identity.”
Suyemoto and Kountz, 2000
Function Specifics
 Stimulation
 Escape dissociation through an intentional gesture
to feel one’s body
 Self-grounding technique
 Punishment
 Self-imposed response to
Guilt
Shame
Weakness
Function Specifics, cont.
 Punishment, cont.
Anger
Lack of discipline
 Relaxation
 Pleasure response to warmth of blood
and/or physical sensation of pain
 Form of tension reduction
 Endorphin release
Function Specifics, cont.
 Diversion
 Inducing a trance-like state to avoid
attending to
An emotional trigger
Specific issue
Specific subject
Suicidal thoughts
Function Specifics, cont.
 Social Motives/Attention
 Obtaining self-affirmation
Showing self and others one’s strength
 Achieving nurturing and protection through the
response of others
 Alteration
 Making one’s body unattractive to others through
scarring
What clients say…
 Perceived loss and/or abandonment precedes
the act
 Experience of shame is high prior to SIB
 Self-anger and/or sadness are common
feelings both before and after
 Isolation almost always occurs before SIB
What clients say… cont.
 Frequently reported goals




Diminish negative feelings
Self-punishment
Avoidance of painful memories
Induction of trance-like state
 70% report release of tension and
anxiety, and a sense of satisfaction
following SIB
Therapeutic Intervention
 Therapist must understand
 Risk factors
 Variations
 Function
 Approaches to treatment






Assessment (initial and ongoing)
Education
Medication
Family therapy
Individual and group therapy
Experiential therapy
Therapeutic Intervention,
cont.
 Goals of treatment
 Safety first (validate emotion, but not behavior, thoughts)
 Skill training (DBT works well)
 Self-soothe
 Manage emotions
 Resolve psychological schemas
 Replace lies with truth about
God
Self
Others
Therapeutic Intervention,
cont.
 Goals of treatment, cont.
 Make connections between thoughts,
feelings, behaviors
 Identify triggers
 Emotions
 Situations
 People
 Other external stimuli
 Behavior chain analysis
Miscellaneous Notes
 Baal
 I will go before you and will level the mountains; I will
break down the gates of bronze and cut through the
bars of iron. I will give you the treasures of darkness,
riches stored in secret places, so that you will know I
am the Lord, God of Israel who summons you by
name.
Isaiah 45:2, 3
 For the word of God is full of living power. It is sharper
than the sharpest knife, cutting deep into our innermost
thoughts and desires. It exposes us for what we really
are. Nothing in all creation can hide from Him.
Everything is naked and exposed before His eyes.
Hebrews 4:12, 13
Miscellaneous Notes,
cont.
 God’s unconditional love knows each of
us to the depths of our pain, shame and
joy. Only He can truly understand what
that excruciating sorrow is like. Through
and with Him we have a hope and a
future. Bringing this to those who selfinjure can provide them a new way of
thinking.
Helpful websites
www.selfinjury.com or SAFE (Self-Abuse Finally Ends) - 800-3668288
http://secured.nmha.org/mpower/411Cutting.htm
http://dmlive.com/index.html
http://groups.google.com/group/Fading-Scars
http://www.selfmutilatorsanonymous.org
http://www.Focusas.com/SelfInjury.html
http://www.self-injury.org/index.html
Contact Information
Catherine Jantzen, MS, LMHC
Lead Therapist, Family Care Center
2821 Hillegas Road
Fort Wayne, IN 46808
260-471-1950
[email protected]