presented by: center for research and academic excellence 3centerae.com understanding self-injury
TRANSCRIPT
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PRESENTED BY:CENTER FOR RESEARCH AND ACADEMIC
EXCELLENCE3CENTERAE.COM
Understanding Self-Injury
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1.WHO SELF INJURES?2. WHY DO THEY DO IT?3. WHAT IT IS AND IS NOT.4. HOW CAN WE HELP?
Self Injury
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Caroline Kettlewell from Skin Games
“I needed to cut the way your lungs scream for air when you swim the length of the pool underwater in one breath. It was a craving so organic it seemed to have risen from my skin itself.”
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Self-Injury Terms
Self Inflicted Violence
Cutting
Self Harm
Self Mutilation
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SI BehaviorsCuttingScratching Abrading BurningSome forms of hair pullingBitingInserting foreign objects into the bodyInterference with wound healingIngesting toxins
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Warning signs
Unexplained frequent cuts or burnsWearing long sleeves or pants in warm
weatherAvoiding swimming pools or the beachWearing thick bracelets to cover wristsHaving sharp objects in purse, book bag,
or bedroomDifficulty expressing feelingsWithdrawal from close relationships
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What is the Definition
Self injury is the intentional harm of one’s own body without conscious suicidal intent. (Aldeman, 1998, Favazza, 1998, van der Kolk, et al., 1991)
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What Self Injury is NOT
It is not a suicide attempt (attempting to feel better, not escape all feelings)
It is not usually attention seeking
It is not a danger signal to others
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NOT SUICIDAL BEHAVIOR
“…self-mutilation is distinct from suicide…A basic understanding is that a person who truly attempts suicide seeks to end all feelings where as a person who self-mutilates seeks to feel better.” (Favazza, 1998)
Intention-does not intend to die as a result of his/her acts. Intends to live.
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Who Self-Injures
Roughly 2% (1-4%) of the population. In some studies reported as high as 8 million Americans self-mutilate.
30 times the rate of suicide attempts 140 times the rate of completed suicides May also suffer from eating disorders 90% who cut began as teenagers
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Typical profileFemaleMid 20’s to early 30’sBegan cutting as a teenMiddle to upper classIntelligent, well
educatedPerfectionist
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Profile (cont)Males and femalesAll races and socio-economic levels
Ages 15-50’sNot easily identifiable
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Characteristics
are often depressed, feel powerless or anxious
have low self esteem /negative body image
have difficulty expressing their emotions verbally
experience difficulty with relationships aim for perfectionoften have negative body imagelack impulse control/suppressed angerdo not have a repertoire of coping
skillsmay have serotonin dysfunction possible trauma
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Abuse?
Many who self-injure did not suffer childhood abuse (Zweg-Frank, et.al, 1995, Brodsky, et. al., 1998)
50-60% suffered childhood abuse or trauma. That means that 40-50% did not (Favazza,1998)
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Then Why?
Invalidating environments (Lineham, 1993) Expression of private experiences and feelings
are not validated Feelings are trivialized, punished or ignored Experience of painful emotions are disregarded. Child’s interpretation of his or her behavior is
dismissed
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In their own words . . .
“There are times when I hurt too deep for tears, so I cut and it lets out some of the hurt. It’s like when you see the blood flowing out, the pain and fear are flowing with it.”
“Watching the blood flow out makes me feel clean, purified. It feels like something bad or dirty is leaving with the blood.”
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In their own words . . .
“The stopped voice becomes a hand lifting knife, razor, broken glass to cut, burn, scrape, pop, gouge. The skin erupts in a mouth, tongue less, toothless. A voice drips out, liquid…a voice sears itself for a moment, in the flesh. This is a voice emerging on the skin, a mouth appearing on the skin. The body which could not be air on the larynx becomes the stroke of a razor on the breastbone or of a red-hot-knife-tip upon the wrist…” .
Janice McLane (1996)
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Why do they harm themselves?
To release intense feelingsThe physical pain may be easier to deal with than the emotional pain
To feel real, aliveTo exert some controlActing out self punishment
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Cycle of Cutting
Shame, guilt,
remorse, disgust
Mounting anxiety, anger or self hatred, alienation
Disassociation
Cutting
Relief
Into the Void
Panic
Muller 2005
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In own words . . .
“
“It’s like opening up a safety valve or letting steam out of a covered pot.”
“Sometimes I cut just to make myself feel something because I am just totally numb.”
(In Strong, 1998, p.7)
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Why Self-Mutliate?
“I felt like I was isolated from the world, dead, with no emotions at all. The blood told me I was alive, that I could feel…Also I couldn’t cry, and bleeding was a different form of crying.”
(Lindsay in Strong, p.57)
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DSM IV Classification
Some mental health professionals are advocating for self injury to be listed as a separate diagnosis
Currently listed as a symptom associated with a number of mental health disorders
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SI is often associated with:
Borderline Personality DisorderObsessive-Compulsive DisorderPost-Traumatic Stress DisorderDissociative Identity DisorderEating DisordersSubstance AbuseDepression
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DIAGNOSIS (Ferreira de Castro, et.al., 1998)
Major Depression 14% 56%Alcohol Dependence 16% 26%
Schizophrenia 2% 9%
Dysthymia 12% 7%
Adjustment disorder with depressed mood
24% 6%
Self-Injure Suicide Attempt
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Therapeutic Goals
Encourage communication about self-injury and relevant aspects of the child’s life.
Improve the quality of client’s life as it relates to self-injury.
Explore themes of guilt and shame.Diminish use of self-injury as the coping
skill when client desires to make changes. (Conners, Rubin, et, al,2002).
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Helping: What to Do (Alderman, 1997)
Learn about self-injury.Talk about SI. Ask about it.Be supportive. Show you care.Acknowledge the effort to cope with very
difficult emotionsSet limits Be available, but refer when appropriateDon’t discourage self-injuryRecognize the severity of the distress
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What Not to Do
Be afraid to ask the question, “Do you self-injure?”
Make eliminating the behavior the primary goalMake a safety contract or use contracts as a
reward or punishmentVisibly monitor their injuriesMake him or her feel ashamed or guilty about
the behavior
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“This is yet another secret I must hold to myself because my therapist has given me an ultimatum, either no more hurting myself or we will have to discontinue our therapy. So a little distance comes between us now, a secret that hold great importance which we could both learn from, if I was able to tell her…JML
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Interrupting the Cycle
Dispute irrational thoughts, feelings
Triggering event Unbearable tension, anxietyDissociationSelf injuryRelapse
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Expressive Arts
Journals
Poetry
Music
Art
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Respond to the following statements by writing “A” for “agree” if you mostly agree with the statement or “D” for “disagree” if you mostly disagree. Be ready to explain your responses.
___Self-injurers are survivors.___Self-injurers are weak people.___Self-injurers are harming themselves to get attention.___Self-injurers are perfectionists. ___Self-injury is a type of suicidal behavior.___Self-injurers are proud of their scars.___Self-injury helps people cope.___Self-injurers are more sensitive than most other people.
Muller 2006
Self-Injury Group
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Self-Injury
If my wound could talk it would say____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Muller 2006
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Taking Care of Yourself
Monitor your own horror and confusion
Broaden your perspective past the behavior to the intent behind it
Seek consultation Get support for yourself
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Care and Concern
The capacity to derive comfort from another is the single biggest predictor of whether traumatized patients are able to give up their self-destructive habits. (van der Kolk)
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Care and Concern
The development of a safe and trusting relationship is vital for the child to learn to sooth and care for him or herself in a healthy manner by internalizing their therapist’s care and concern. (Strong, 1988)
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Care and Concern
“_____ was the first to acknowledge that maybe I was in pain, as opposed to ‘doing it for attention’ . This affirmation of my inner pain was a healing force. “ Shelley
10
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Discussion
Why the upsurge in self-injurious behavior?
Students who look for fist fights?
Tattoos and piercing?
Addictive?
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References:
References: [email protected]@bcps.orghttp://www.helpguide.org/mental/self_injury.h
tm
http://vivianpencz.wordpress.com/2012/01/11/breathing-while-drowning-youth-who-self-harm/
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