Self-Injurious and Suicidal Behaviors -- Information for Parents

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Self-Injurious and Suicidal Behaviors
Information for Parents

• Barrie Morganstein, Ph.D.
• Psychologist at Southeast Psych
• Candace Wilson
• ParentVOICE Program Director

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Differences Between SIB SB

• Key Characteristics of SIB
• Little physical damage/non-lethal means
• Frequent, chronic repetition
• Often various methods
• Intermittent emotional pain/discomfort
• Typically a decrease in tension afterward
• Key Characteristics of SB
• Serious physical damage/lethal means
• Can be, but is not often repetitive
• Usually one method
• Chronic emotional pain
• No decrease in discomfort afterward

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Direct Verbal Clues -- Suicide

• Im tired of life, I just cant go on.
• My family would be better off without me.
• Who cares if Im dead anyway.
• I just want out.
• I wont be around much longer.
• Im going to end it all.
• Pretty soon, you wont have to worry about me.
• If _____ doesnt happen, Ill kill myself.
• Im going to commit suicide.
• I wish I were dead.
• Ive decided to kill myself.

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Direct Verbal Clues -- SIB

• Few to no verbal clues
• SIB is very secretive and very hidden
• Clues are usually evident in behaviors and/or
  appearance

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Direct Behavior Clues -- Suicide

• Any previous suicide attempt
• Acquiring a gun or stockpiling pills
• Co-occurring depression, moodiness, hopelessness
• Putting personal affairs in order
• Giving away prized possessions
• Sudden interest or disinterest in religion
• Drug or alcohol abuse, or relapse after a period
  of recovery
• Unexplained anger, aggression, and irritability

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Direct Behavior Clues -- SIB

• Wearing long sleeves or long pants in warm
  weather
• Unexplained cuts and scratches
• Avoidance withdrawal from others
• Moodiness
• Blood stains on clothing
• Unexplained scars, bruises, or cuts
• Possession of sharp implements (razor blades,
  thumb tacks, knives, etc.)
• Secretive behavior - spending unusual amounts of
  time in bathroom, other isolated areas
• Appearance
• Cutting (with razors, glass, etc.) is not the
  only type of self-injury -- scratching or rubbing
  repeatedly with objects (e.g., pencils, erasers,
  pins, etc.), burning skin (with light bulbs,
  lighters, etc.), skin picking, bruising, etc.

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Situational Clues -- Suicide

• Being expelled from school
• A recent unwanted move
• Loss of any major relationship
• Death of a friend (especially if by suicide)
• Diagnosis of a serious or terminal illness
• Sudden unexpected loss of freedom/fear of
  punishment
• Loss of a cherished therapist, counselor or
  teacher
• Fear of becoming a burden to others

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Situational Clues -- SIB

• Very low frustration tolerance
• Very weak coping skills
• Creating or frequently being involved in drama
• Changes in social interactions or interests
• Art and writing displaying themes of pain,
  sadness, physical harm
• Having peers who use SIB
• Excessive anxiety and fears
• Excessive rage, depression
• Poor self-esteem or self-loathing
• Increased isolation and withdrawal
• Not connected with positive support system

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As a parent, what can I do?

• Question, Persuade, Refer

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Question
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Tips for Questioning

• If in doubt, dont wait, ask the question
• If your child is reluctant, be persistent
• Talk to your child alone in a private setting
• Allow your child to talk freely
• Give yourself plenty of time
• Have your resources handy

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Indirect Direct Approaches

• Indirect Approach --
• Have you been unhappy lately?
• Have you been so very unhappy lately that youve
  been thinking about ending your life?
• Do you ever wish you could go to sleep and never
  wake up?
• Direct Approach
• You know, when people are as upset as you seem
  to be, they sometimes wish they were dead. Im
  wondering if youre feeling that way, too?
• You look pretty miserable, I wonder if youre
  thinking about suicide?
• Are you thinking about killing yourself?

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Dos and Donts of Questioning

• Do --
• Talk openly about it and dont dance around the
  subject being direct gives the message that you
  are comfortable talking about the subject
• Ask about all forms of self-injury
• Ask about suicidal thoughts, plan and attempts
• Be supportive and non-judgmental
• Ask your kids to explain their thoughts and
  feelings behind their behaviors

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Dos and Donts of Questioning

• Don t --
• React with anger, fear, or revulsion
• Make assumptions about their reasoning or intent
• Assume self injury is manipulation
• Tell them to stop getting into a power struggle
  serves to increase resistance, impair your
  relationship, and does not stop the behavior

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Use Pop Culture to Discuss Tough Topics

• Use pop culture like movies, music, scripted TV
  shows, reality TV shows, You Tube, blogs, etc. to
  facilitate discussion of difficult topics like
  self injury and suicide
• Teens are not only very likely to connect to
  movies, songs, etc., but they are also more
  likely to address delicate issues and feel more
  comfortable discussing characters than
  discussing themselves directly

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Movies About Self Injury

• Thirteen
• Secret Cutting (made for TV)
• Dans ma Peau (In My Skin)
• Perfection
• Cut (documentary)
• Others?

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Songs About Self Injury

• Hurt -- Nine Inch Nails
• Iris -- Goo Goo Dolls
• Breaking the Habit Linkin Park
• Pain Three Days Grace
• Bleed Like Me Garbage (inspired by the movie
  Thirteen)
• F---in Perfect Pink (video)

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Movies About Suicide

• The Virgin Suicides
• Girl, Interrupted
• Heathers
• Little Miss Sunshine
• Dead Poets Society
• Others?

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Songs About Suicide

• Bleed Collective Soul
• I Cant Stand Losing You The Police
• Death of a Cheerleader Marcy Playground
• Give Me Novacaine Green Day
• Haunted Kelly Clarkson
• Jumper Third Eye Blind
• Jeremy Pearl Jam
• Last Resort Papa Roach
• Adams Song Blink 182

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Persuade
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How to Persuade Your Child to Get Help

• Listen to the problem and give them your full
  attention
• Do not rush to judgment
• Remember that SIB and suicide are overt
  representations of covert struggles
• Offer hope in any form

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How to Persuade Your Child to Get Help

• Ask your child --
• Will you go with me to get help?
• Will you let me help you get help?
• Will you promise me that you will not hurt
  yourself while we work to find you some help?
• Will you promise me that you will tell me if you
  are feeling like you really want to hurt
  yourself?

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Protective Factors

• Lack of mental health issues (specifically
  depression, trauma, eating disorders, personality
  disorders, etc.)
• Effective clinical care for mental, physical and
  substance use disorders
• Strong connections to family, peer and community
  support
• Competence in problem solving, conflict
  resolution and nonviolent handling of disputes
• Cultural and religious beliefs that discourage
  suicide and self-injury and support
  self-preservation
• For Suicide --Restricted access to highly lethal
  means of suicide
• (U.S. Public Health Service 1999)

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Refer
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Referral

• The appropriateness of the referral is dependent
  upon whether or not the behavior is self injury
  or suicidal ideation or behavior
• Options for referral include outpatient
  treatment, partial hospitalization, inpatient
  hospitalization, and mobile crisis
• Outpatient treatment can be in many forms such as
  individual, group, and/or family therapy
  medication management case management etc.
• Inpatient hospitalization usually begins with a
  visit to the Emergency Room (ER)
• While the ER can be life-saving for individuals
  considering or attempting suicide, it may be very
  inappropriate for individuals with SIB

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Resources --Suicide
www.suicidepreventionlifeline.org
In partnership with the National Action Alliance
for Suicide Prevention, Facebook harnesses the
power of social networking and crisis support to
help prevent suicides across the Nation and
Canada. Facebook users can report a suicidal
comment they see posted by a friend to Facebook
using either the Report Suicidal Content link or
the report links found throughout the site. The
person who posted the suicidal comment will then
immediately receive an email from Facebook
encouraging them to call the National Suicide
Prevention Lifeline at 1-800-273-TALK (8255) or
to click on a link to begin a confidential chat
session with a crisis worker.
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Resources --Suicide
www.afsp.org
SAVE - SUICIDE AWARENESS VOICES of
EDUCATION www.save.org
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Resources--SIB
www.selfinjury.com
www.recoveryourlife.com
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Recommended Readings

• Helping Teens Who Cut Understanding and Ending
  Self Injury Michael Hollander, Ph.D.
• When Darkness Comes Saying No to Suicide
  Angerona S. Love
• When Your Child is Cutting A Parents Guide to
  Helping Children Overcome Self Injury -- Sony
  Khemlani-Patel Ph.D., Merry McVey-Noble, Ph.D.
  and Fugen Neziroglu Ph.D. ABBP ABPP
• Freedom from Self-Harm Overcoming Self-Injury
  with Skills from DBT and Other Treatments -- Kim
  Gratz
• Bodily Harm The Breakthrough Healing Program for
  Self Injurers Karen Conterio and Wendy Lader,
  Ph.D.
• Stopping the Pain A Workbook for Teens Who Cut
  and Self Injure Lawrence Shapiro, Ph.D.
• When Nothing Matters Anymore A Survival Guide
  for Depressed Teens Bev Cobain, RNC

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Open Discussion
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