Transcript Harming the Body to ease the Mind

Harming the Body to Ease the Mind:
Teenagers and Self Injury
School Health Conference
July 18-19, 2007
Elizabeth Rose, MEd
Counselor, Searcy High School
What is Self-Injury?
Self-injury (SI) has been defined as “all behaviors
involving the deliberate infliction of direct
physical harm to one’s own body without the
intent to die as a consequence of the behavior”
(Simeon & Favazza, 2001)
Physically harming one’s own body in order to feel
better.
Considered to be an Impulse Disorder
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This group of disorders includes alcohol and
substance abuse, suicide attempts, shoplifting,
and eating disorders.
Impulse behaviors have two factors in common:
1) They occur episodically
2) Some gratification achieved by the behavior
Self-Injury is not…
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A failed suicide attempt
A disease
An addiction (although it’s addiction-like)
An attention getting behavior
A manipulation tool
An indication that the self-injurer is dangerous to others
A tattoo or piercing
A phase
The Intent is the Key
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The key to determining if it is SI is the intentWhat is the intent of the person?
It’s not self-injury is the primary purpose is:
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Sexual Gratification
Body decoration (body piercing, tattooing)
Spiritual enlightenment via ritual
Fitting in or being cool
Suicide vs. Self-Injury
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80% of individuals who are suicidal report suicidal ideation
and give advance warning of their suicidal intentions
Rarely does the person who self-injures report suicide
ideation or give any advance verbal warning of the SI
behaviors
The intention behind SI is not to stop living- it’s a coping
strategy to deal with intolerable pain-a way of surviving.
However, there is always the risk that once the method stops
working, they could commit suicide-either accidentally or
purposefully.
Self-Injury and Clinical Populations
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Among clinical populations, SI is comorbid with
borderline personality, eating disorders, PTSD,
depression, anxiety disorders and a history of
abuse or trauma
Some researchers calling for a new DSM impulsecontrol disorder- deliberate self-harm syndrome
Most see SI as a manifestation of mental or
emotional disorders or of childhood trauma
History of Self-Injury
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Documented since biblical times-Mark 5:5 describes a man
who “night and day would cry aloud among the tombs and on
the hillsides and cut himself with stones.”
First case of client who engaged in SI was published in 1846
S.A.F.E. (Self-Abuse Finally Ends) Alternatives founded in 1984
as the first outpatient support group by Karen Conterio; first
structured inpatient program in 1985
Dr. Armando Favazza wrote the first comprehensive book
about SI, Bodies Under Siege, in 1987 (published 2nd Edition in
1996)
Three Types of Self-Injurious Behaviors
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Major Self-Mutilation
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Stereotypic Self-Mutilation
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Moderate or Superficial Self-Mutilation
Prevalence of Self-Injury
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SI is not a recent occurrence, but behaviors have become
more widely publicized and discussed
True prevalence remains unclear-no reliable estimates of
the prevalence of SI among the general US adolescent
population
Best estimates indicate 1%-4% of general population selfinjures
Several studies indicate around 13% of adolescents
engage in self-injury (4%-38% range)
Encompasses Broad Range of Behaviors
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Cutting (72%)
Burning/abrasions (15%-35%)
Self-hitting (21%-44%)
Skin-picking (22%)
Hair-pulling (10%)
Interfering with wound healing
Cutting and Burning
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Cutting and Burning are the most common types of SI
Some scratch or “draw” delicate web-like lines
Common weapons include razor blades, knives, scissors,
needles, safety pins, paper clips, eraser holders, thumb tacks,
aluminum or glass
Some use sharpened pencils, pen caps, “Coke can” tabs, bottle
caps or credit cards- injurers become very resourceful and can
turn anything into a weapon
Cutting ranges in intensity from superficial nicks to deep
gouges
Cutting and Burning
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Some make rounded punctures in their skin using sharply
rounded objects
Arms and legs are most common targets, followed by
breasts, abdomen, thighs and genitals
Sometimes they carve words into their skin- “fat” and
“ugly” most common for teenage girls
Many progress from cutting to burning finding they need
to wound themselves more severely to get the same relief
or “high”
Some vary their cutting tools and some rely on a single tool
Neurological Connection
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When the body is injured, it releases natural opiates
that help dull pain
The brain secretes endorphins that are natural
antidepressants.
Cutting inflicts a very real injury, and self-injurers may
be seeking the neurochemical kick that follows.
Who Self-Injures?
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Twice as many females as males
Specific ethnicity prevalence rates inconclusive
14 (or freshman year of high school) is the common
age for first engaging in SI
Typically have low self-esteem and self-worth
Have a perception that they are “not as good as” their
peers and are unable to live up to the expectations
placed upon them
Who Self-Injures?
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Up to half of self-injurers have suffered sexual
abuse
Many self-injurers also have or have had an eating
disorder (one study found 61%)
May have suffered from physical or emotional
neglect or abandonment by a parent or caregiver
Significantly more likely to meet the diagnostic
criteria for depression than those who do not selfinjure
Who Self-Injures?
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May have suffered the loss of a parent through
divorce or death
Tense or abusive relationship between the parents
may exist
Lack of communication concerning emotional
issues part of the family dynamics
Common Denominator: Grown up in “invalidating
environments”
Feelings or Attitudes of a
Typical Self-Injurer
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Helpless
Alone
Secretive/Ashamed
Desperate/Lonely
Impulsive
Proud of being “tough”
Label self “bad”
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Out of touch with physical
body
Invisible
All or nothing thinking
Blames self for events out
of their control
No ability to self-soothe
Why Do Teens Self-Injure?
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Overwhelmingly, self-injurers say they began cutting
for one of two reasons: to escape their feelings or to
feel something, anything (to feel less or to feel more)
To cope with feelings of confusion and emptiness
To ease tension/release emotions
To express emotional pain they feel they cannot bear
Why Do Teens Self-Injure?
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To make themselves unattractive or punish bodies
they believe betrayed them
To validate their emotional pain- the wounds serve as
evidence that those feelings are real
To escape emotional numbness
They can not think of any other way to deal with the
pressures that they are experiencing
They perceive a situation as unsolvable
Whatever the reason, it is always about coping
Most Common Events Leading
to Self-Injury in Teenagers
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Recent Loss or Death
Peer Conflict
Intimacy Problems
Impulse Disorder
A Rejection of Human Interconnection
Memories of Trauma*
Sights*
Smells*
Signs that an Adolescent is at Risk
for Self-Injury
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Mood swings
Low self-esteem
Poor impulse control
Sadness/tearfulness
Anger
Anxiety
Disappointment in
themselves
Inability to identify
positive aspects of their
lives
Artist: sarah lynn
Title: self portrait
http://galleryofpain.self-injury.net
Indications that a Teen
is Self-Injuring
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Fresh or healing wounds or scars- most prevalent on
the arm opposite the student’s dominate hand and
more likely on the forearm at an angle
Parallel scars or cuts, or scars or cuts on only one side
Blood or burn stains on inside of clothing
Locking him/herself in the bathroom for long periods
of time
Finding sharp objects hidden in their bedroom or the
bathroom
Indications that a Teen
is Self-Injuring
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Wearing long sleeves or pants even on hot days
Sudden shifts in mood- “If a teen is mopey at 5:00 and
much better at 5:30 you may want to know what
happened in that half-hour”
Not wanting to participate in activities where you
must change clothes at school or around other people
Becoming very defensive when questioned about
wounds or scars
School’s Role
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Provide Intervention
Notify Parents or
Appropriate Personnel
Assist/Refer
Advocacy
Educate
Prevention
Artist: julieli
Title: sorry
http://galleryofpain.self-injury.net
Provide Intervention
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Be aware of risk factors
Open communication with faculty and staff
Elicit information from students with nonthreatening questions: “What is this from?”,
“Could you say more about this?”
Create a safe environment
Foster a strong alliance with the student
Notify Parents or
Appropriate Personnel
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Issue of confidentiality
Parent’s rights vs. ethical responsibility to child client“Ethically the child is the client but legally the parent is the
client” (Ritchie & Norris Huss, 2000)
Encourage student to share important information with
parents
Familiarize yourself with state laws and codes
Legally, school counselors are obligated to contact the
student’s parents or local authorities in helping the
student
Assist/Refer
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Become familiar with community agencies and
private practitioners before the information
becomes needed
Assist the adolescent and his/her family in finding
a mental health provider who treats adolescents
who SI
Collaborate with the community professional and
continue to play a role in the student’s treatment
process (safe person)
Advocacy
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Advocate for students through faculty in-services
and parenting groups, and speaking in health
classes to students regarding self-injury
Help dispel myths and break down stereotypes
regarding self-injury
Encourage staff to release students from class to
visit the counselor when negative emotions
surface
Educate
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Educate teachers and other staff regarding self-injury,
how to recognize the signs and how to respond
appropriately
Educate teachers and other staff on the importance of
listening and empathizing with students
Incorporate SI training into your crisis team
responsibilities
Educate parents
Educate
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Talk to students about what to do if they
suspect a friend self-injures
Provide students with resources about what to
do and whom to talk to about getting help for
friends
Use caution when educating students- avoid
descriptions of why and how students hurt
themselves
Specific Recommendations for Working with
Students Who Self-Injure
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Always be supportive and show unconditional
acceptance
Communicate that it is okay to talk about self-injury
Help them to understand that there is an underlying
cause for the behavior
Suggest a list of coping techniques to be used rather
than self-injuring
Remember…
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Schools are not responsible for treating the
adolescent.
It is our job to be aware that the behavior exists,
detect the behavior, and react appropriately so as
not to further isolate the student.
Self-Injury is the
injurer’s attempt at a
solution to a problem,
but is not the
problem itself.
Therefore, to stop the
injury, the underlying
problems- the ‘why’must be addressed.
Artist: julieli Title: Two Sides to Every Story
http://galleryofpain.self-injury.net
Elizabeth Rose, Counselor
Searcy High School
301 N. Ella
Searcy, AR 72143
Phone: 501.278.2243
[email protected]