Harming the Body to Ease the Mind: Teenagers and Self Injury School Health Conference July 1819, 200

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Harming the Body to Ease the Mind Teenagers
and Self Injury School Health ConferenceJuly
18-19, 2007

• Elizabeth Rose, MEd
• Counselor, Searcy High School

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What is Self-Injury?

• Self-injury (SI) has been defined as all
  behaviors involving the deliberate infliction of
  direct physical harm to ones own body without
  the intent to die as a consequence of the
  behavior (Simeon Favazza, 2001)
• Physically harming ones own body in order to
  feel better.

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Considered to be an Impulse Disorder

• 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

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Self-Injury is not

• A failed suicide attempt
• A disease
• An addiction (although its 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

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The Intent is the Key

• The key to determining if it is SI is the intent-
  What is the intent of the person?
• Its not self-injury is the primary purpose is
• Sexual Gratification
• Body decoration (body piercing, tattooing)
• Spiritual enlightenment via ritual
• Fitting in or being cool

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Suicide vs. Self-Injury

• 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-
  its 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.

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Self-Injury and Clinical Populations

• 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
  impulse-control disorder- deliberate self-harm
  syndrome
• Most see SI as a manifestation of mental or
  emotional disorders or of childhood trauma

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History of Self-Injury

• Documented since biblical times-Mark 55
  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)

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Three Types of Self-Injurious Behaviors

• Major Self-Mutilation
• Stereotypic Self-Mutilation
• Moderate or Superficial Self-Mutilation

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Prevalence of Self-Injury

• 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 self-injures
• Several studies indicate around 13 of
  adolescents engage in self-injury (4-38 range)

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Encompasses Broad Range of Behaviors

• Cutting (72)
• Burning/abrasions (15-35)
• Self-hitting (21-44)
• Skin-picking (22)
• Hair-pulling (10)
• Interfering with wound healing

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Cutting and Burning

• 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

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Cutting and Burning

• 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

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Neurological Connection

• 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.

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Who Self-Injures?

• 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

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Who Self-Injures?

• 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
  self-injure

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Who Self-Injures?

• 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

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Feelings or Attitudes of a Typical Self-Injurer

• Helpless
• Alone
• Secretive/Ashamed
• Desperate/Lonely
• Impulsive
• Proud of being tough
• Label self bad

• Out of touch with physical body
• Invisible
• All or nothing thinking
• Blames self for events out of their control
• No ability to self-soothe

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Why Do Teens Self-Injure?

• 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

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Why Do Teens Self-Injure?

• 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

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Most Common Events Leading to Self-Injury in
Teenagers

• Recent Loss or Death
• Peer Conflict
• Intimacy Problems
• Impulse Disorder
• A Rejection of Human Interconnection
• Memories of Trauma
• Sights
• Smells

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Signs that an Adolescent is at Risk for
Self-Injury

• 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
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Indications that a Teen is Self-Injuring

• Fresh or healing wounds or scars- most prevalent
  on the arm opposite the students 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

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Indications that a Teen is Self-Injuring

• Wearing long sleeves or pants even on hot days
• Sudden shifts in mood- If a teen is mopey at
  500 and much better at 530 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

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Schools Role

• Provide Intervention
• Notify Parents or Appropriate Personnel
• Assist/Refer
• Advocacy
• Educate
• Prevention

Artist julieli Title
sorry http//galleryofpain.self-injury.net
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Provide Intervention

• Be aware of risk factors
• Open communication with faculty and staff
• Elicit information from students with
  non-threatening questions What is this from?,
  Could you say more about this?
• Create a safe environment
• Foster a strong alliance with the student

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Notify Parents or Appropriate Personnel

• Issue of confidentiality
• Parents 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 students parents or local
  authorities in helping the student

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Assist/Refer

• 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 students
  treatment process (safe person)

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Advocacy

• 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

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Educate

• 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

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Educate

• 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

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Specific Recommendations for Working with
Students Who Self-Injure

• 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

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Remember

• 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.

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• Self-Injury is the injurers 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
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Elizabeth Rose, Counselor Searcy High School 301
N. Ella Searcy, AR 72143 Phone
501.278.2243 erose_at_searcyschools.org