Understanding Self-Injurious Behavior

1
Understanding Self-Injurious Behavior
2
Self Injurious Behavior

• Other Terms
• Cutting
• Self-harm
• Self-inflicted violence
• Self mutilation
• Para-suicidal behavior

3
Definition

• Any socially unacceptable behavior involving
  immediate, deliberate, direct and usually
  repetitive physical injury to ones own body,
  resulting in mild to moderate self harm, usually
  without conscious suicidal intent.
• Remuda Ranch Treatment Center

4
Common Examples

• Scratching
• Cutting
• Carving
• Burning
• Repetitive rubbing
• Abrading
• Punching

5
Common Examples, cont.

• Pinching
• Biting
• Head banging
• Hair pulling or plucking
• Some SIBs may mimic suicidal behaviors, but they
  serve a different purpose.

6
Less Common Examples(Increasing in Popularity)

• Scarification
• Cutting and preventing healing
• ? Reopening of barely healed wounds
• ? Branding

7
Excluded Behaviors

• Tattooing
• Body piercing
• These are culturally sanctioned behaviors and are
  thus excluded from the SIB definition.

8
Tools

• Razor blades
• Pins
• Paper clips
• (Any object that can be made sharp or cause
  injury)
• Cigarettes, matches, candles (burning)

9
Body Parts

• Wrists
• Forearms
• Legs
• Usually hidden areas (depends on motivation)

10
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

11
Variations of SIB

• Compulsive
• Closely associated with Obsessive Compulsive
  Disorder
• Prompted by anxiety
• Different intention and root than impulsive forms

12
Variations of SIB, cont.

• Impulsive Episodic Type
• Not premeditated
• Response to emotional trigger
• Not self-identified as a cutter

13
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)

14
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

15
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 of control

16
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

17
Function Specifics

• Stimulation
• Escape dissociation through an intentional
  gesture to feel ones body
• Self-grounding technique
• Punishment
• Self-imposed response to
• Guilt
• Shame
• Weakness

18
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

19
Function Specifics, cont.

• Diversion
• Inducing a trance-like state to avoid attending
  to
• An emotional trigger
• Specific issue
• Specific subject
• Suicidal thoughts

20
Function Specifics, cont.

• Social Motives/Attention
• Obtaining self-affirmation
• Showing self and others ones strength
• Achieving nurturing and protection through the
  response of others
• Alteration
• Making ones body unattractive to others through
  scarring

21
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

22
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

23
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

24
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

25
Therapeutic Intervention, cont.

• Goals of treatment, cont.
• Make connections between thoughts, feelings,
  behaviors
• Identify triggers
• Emotions
• Situations
• People
• Other external stimuli
• Behavior chain analysis

26
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 452, 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 412, 13

27
Miscellaneous Notes, cont.

• Gods 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 self-injure
  can provide them a new way of thinking.

28
Helpful websites

• www.selfinjury.com or SAFE (Self-Abuse Finally
  Ends) - 800-366-8288
• 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

29
Contact Information

• Catherine Jantzen, MS, LMHC
• Lead Therapist, Family Care Center
• 2821 Hillegas Road
• Fort Wayne, IN 46808
• 260-471-1950
• cathyj_at_familycarectr.org