Transcript Self-Injury.ppt

Self-Injury
What is self-injury?
• self-injury typically refers to a variety of behaviors in
which an individual intentionally inflicts harm to his
or her body for purposes not socially recognized or
sanctioned and without suicidal intent (Favazza,
1996).
Types of self-injury
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intentional carving or cutting of the skin
subdermal tissue scratching
burning
ripping or pulling skin or hair
swallowing toxic substances
self bruising
breaking bones
• Tattoos and body piercing are not typically
considered self-injurious unless undertaken with the
intention to harm the body.
• Although cutting is one of the most common and
well documented forms, over 16 forms have been
documented in a college population (Whitlock,
Eckenrode, & Silverman, 2006).
• several studies have shown that the number of forms
used by an individual varies significantly; from 1 to
over 10 (Laye-Gindhu & Schonert-Reichl, 2005;
Whitlock et al., 2006).
• Self-injury can be and is performed on any part of
the body, but most often occurs on the hands, wrists,
stomach and thighs.
• The severity of the act can vary from superficial
wounds to those resulting in lasting disfigurement.
• Among respondents in a two college study, 1 in 5
self-injurious students indicated that they had hurt
themselves more than intended at least once.
• 1 in 10 indicated that they had hurt themselves so
badly that they should have been seen by a medical
professional.
Who self-injures?
• It is commonly assumed that females are significantly
more likely to self-injure than males.
• Although multiple studies support this assumption,
there are other studies which suggest that males are
equally likely to self-injure as females, particularly
among non-clinical samples.
• Some of our recent works suggests that there may be
different self-injury groups or "classes“…
• The first one consists largely of men who use selfinjury forms which can be described as "selfbattery.“
• The second consists of more females.
• Members in this (2nd) group face heightened risk
for other adverse conditions, such as suicidality
and psychological distress, while members in the
1st group are likely to engage in these behavioral
patterns for shorter periods of time.
How common is self-injury among
adolescents and young adults?
• Because it so often occurs in private, it is very
difficult to identify one or more discrete self-injurer
"profiles.“
• Unless being treated for related conditions, such as
depression or anxiety, detecting self-injurious
individuals can be very difficult.
• Thus, most studies of self-injury have relied on
samples in clinical settings being treated for other
disorders (Brodsky et al., 1995).
• estimates of self-injury prevalence from 4% to 38%
percent
When does self-injury start and how long
does it last?
• Early onset self-injury is common around the age of
7, although it can begin earlier.
• Most often, however, self-injury behaviors begin in
middle adolescence between the ages of 12 and 15.
• Self injury can last for weeks, months, or years.
• For many self-injury is cyclical rather than linear
meaning that it is used for periods of time, stopped,
and then resumed.
• Although the majority of college students surveyed
report stopping within five years of starting, it is also
clear that the behavior can last well into adulthood.
Why do people self-injure?
• Reasons given for self-injuring are diverse. Many
individuals who practice it report overwhelming
sadness, anxiety, or emotional numbness as common
emotional triggers.
• Self-injury, they report, provides a way to manage
intolerable feelings or a way to experience some
sense of feeling.
• It is also used as means of coping with anxiety or
other negative feelings and to relieve stress or
pressure.
• Those who self-injure also report doing so…
– to feel in control of their bodies and minds…
– to express feelings…
– to distract themselves from other problems…
– to communicate needs…
– to create visible and treatable wounds…
– to purify themselves…
– to reenact a trauma in an attempt to resolve it…
– or to protect others from their emotional pain
– Some report doing it simply because it feels good
or provides an energy rush .
• Regardless of the specific reason provided, self-injury
may best be understood as a maladaptive coping
mechanism, but one that works – at least for a while.
Is self-injury a suicidal act?
• There are important distinctions between those
attempting suicide and those who practice selfinjurious behaviors in order to cope with
overwhelming negative feelings.
• Most studies find that self-injury is often undertaken
as a means of avoiding suicide.
• Perhaps one of the most paradoxical features of selfinjury is that most of those who practice self-injury
report doing so as a means of relieving pain or of
feeling something in the presence of nothing.
• The particular relationship between self-injury
undertaken without suicidal intent and self-injury
undertaken with suicidal intent are not clear since
individuals who report the former are also more
likely to report having considered or attempted
suicide
• although it is common to assume that non-suicidal
self-injury may be linked solely to suicidal ideation,
recent studies show that individuals with a history of
non-suicidal self-injury were over nine times more
likely to report suicide attempts, and seven times
more likely to report a suicide gesture and nearly six
times more likely to report a suicide plan than
individuals without a history of non-suicidal selfinjury.
• Nevertheless, since the majority of individuals with
self-injury history report not considering suicide,
non-suicidal self-injury may be best understood as a
symptom of distress that, if unsuccessfully mitigated,
may lead to suicide behavior.
What factors contribute to self-injurious
behavior?
• In clinical populations, self-injury is strongly linked to
childhood abuse, especially childhood sexual abuse.
• Self-injury is also linked to eating disorders,
substance abuse, post-traumatic stress disorder,
borderline personality disorder, depression, and
anxiety disorders.
Is self-injury addictive?
• Most self-injury researchers agree that self-injury
does show some addictive qualities and may serve as
a form of self-medication for some individuals.
• A significant number of individuals who practice selfinjury report having a difficult time controlling their
urge to self-injure.
• Interviews conducted for several studies show that
many self-injurers describe both the immediate effect
and overall practice as something with addictive
properties.
• For example, many interviewees talk about moments of
feeling the strong need to injure even when there is no
obvious trigger…
• and about having "self-injury free" hours or days.
• They also liken it to other drugs and talk about needing
increasingly more or deeper injuries to feel the same
effect.
• Recognition of the addictive properties of self-injury for
some individuals is the basis for the "addiction hypothesis"
noted by Grossman and Siever (2001) and summarized by
Walsh (2005).
“The addiction hypothesis”
• The addiction theory suggest that self-injurious acts
may solicit involvement of the endogenous opioid
system (EOS) which regulates both pain perception
and levels of endogenous endorphins which occur as
a result of injury.
• Overestimation of the EOS can then lead to actual
withdrawal symptoms which in turn lead to more
self-injurious behavior.
Is self-injury contagious?
• self-injurious behavior has been shown repeatedly to
follow epidemic-like patterns in institutional settings
such as hospitals and detention facilities.
• For many, self-injury is a very private, hidden act.
• Some surveys suggest that there may be multiple
forms of self-injury in middle and high school
settings –groups of youth injuring together or
separately as part of a group membership.
Clinical signs
• Unexplained burns, cuts, scars, or other clusters of
similar markings on the skin can be signs of selfinjurious behavior.
• Fists, and forearms opposite the dominant hand are
common areas for injury.
• Inappropriate dress for season (consistently wearing
long sleeves or pants in summer).
• Constant use of wrist bands / coverings.
• Unwillingness to participate in events / activities which
require less body coverage (such as swimming or gym
class).
• Frequent bandages, odd / unexplainable
paraphernalia (e.g. razor blades or other implements
which could be used to cut or pound).
• Heightened signs of depression or anxiety.
Inquiring
• It is important that questions about the marks be nonthreatening and emotionally neutral.
• Evasive responses are common.
• Not knowing how to broach the subject is often what
restrains concerned individuals form probing.
• However, concern for their well-being is often what
many who self-injure most need.
• Persistent but neutral probing may eventually elicit
honest responses.
Intervention Strategy
• Kress, Gibon & Reynods (2004) maintain that structure,
consistency, and predictability are important elements in
forming relationships with self-injurious youth.
• Developing plans which emphasize:
– a) taking responsibility for the behavior,
– b) reducing the harm inflicted by the behavior
– c) identifying and more positively reacting to self-injury
triggers and physical cues
– d) identifying safe people and places for assistance when
needing to reduce the urge to self-injure
– e) avoiding objects which could be used to self-injure
(e.g., paper clips, staples, erasers, sharp objects)
Avoid displaying shock, engaging in shaming
responses, or showing great pity
• The intensely private and shameful feelings associated
with self-injury prevent many from seeking treatment.
• Because so little is known about self-injury, it is often
misunderstood by medical staff members.
• Staff reactions, if expressed in shocked or punitive ways,
may reinforce the self-injurious behavior and its
underlying causes, and encourage the self-injurer not to
seek care in the future.
• Being willing to listen to the self-injurer while reserving
shock or judgment encourages them to use their voice,
rather than their body, as a means of self-expression.
• Explicitly teaching more appropriate coping strategies may
be one way to provide self-injurers with adaptive
alternatives.
• Self-injury is most common in youth having trouble coping
with anxiety, depression, or other conditions that
overwhelm their capacity to regulate their emotion
(Chapman, Gratz, Brown, 2006).
• It is thus important to focus on enhancing awareness of
the environmental stressors that trigger self-injury and on
helping individuals identify, practice, and use more
productive and positive means of coping with their
emotional states.
• Focusing on elimination of the self-injury behavior
without enhancing positive means of regulating emotion
may simply lead to adoption of other self-destructive
behavior, such as drug abuse.
• Drug therapy may help in some cases as well. Some
patients using prescribed drugs for depression have
found a reduction in the urge to self-injure while taking
these medications (Walsh, 2005).
• Therapy may be useful in exploring the underlying causes
of self-injury.
Assess the safety of self-injurious practices
• DiClemente et al. (1991) found that over one quarter
of hospitalized adolescents who self-injured reported
that they had shared cutting implements with others.
Assess level of group involvement
• Evidence of self-injurious practices among groups of
youth is increasingly common.
• Group self-injury is often a means of group bonding and
membership and, as such, is undertaken with aims other
than reducing anxiety or coping with overwhelming
negative feeling.
• Since self-injurious behavior can be contagious in
institutional and school settings, identifying and
intervening in group self-injurious activities is important.
:‫למבקשים להרחיב ידע‬
About Self-Injury
Cornell Research Program on Self-Injurious
Behavior in Adolescents and Young Adults
Cornell University Family Life Development
Center