SELF-INJURYKellie Szerlag, M.Ed.

School Psychology Intern

University of Massachusetts, Boston

What’s Happening: Adolescence• Time of transition and change.

• Maturing bodies and minds• Combination of Thoughts/Feelings: center of attention,

but alone in experiences.• Early Adolescence: world is more black and white.• Later Adolescence: better able to understand self.

• Learning How to:• Establish and maintain relationships.• Define self and purpose.• Understand themselves and the world.

Why discuss Self-Injury?

• Nonsuicidal self-injury (NSSI): is a growing public health concern among adolescents.

• Self-injury is often identified in schools

What is Self-Injury?

• Terms: self-harm, cutting, self-mutilation, & non-suicidal self-injury (NSSI)

• NSSI: “the deliberate destruction of one’s own body tissue without the intent of death” (Taylor, Peterson, & Fischer, 2012).

Self-Injury vs. Suicide Attempts

• Self-injurers are typically not attempting suicide.

• Connection to thoughts of suicide later in life.

• Physically harmful and dangerous• Related to impulsiveness• Dysfunctional/Maladaptive coping strategy

Most Common Forms of Self-Injury

• Skin cutting• Burning

People who Self-Injure might:• Pick or interfere with wound healing• Engage in behavior secretively

• Bathrooms or other secluded areas.

Identifying Self-injury

• Frequent unexplained scars/burns• Non-dominant arms, forearms, hands• Can be anywhere on body• “Covering-up” with clothing• Constant wearing of wrist bands, long sleeves, multiple bracelets

Who is at-risk?

• Victims of abuse• Family Conflict • Mental illness• Higher rates among:

• Females• LGBTQ

Who is at Risk?

• Impulsivity• Low self esteem• Low levels of resiliency• Poor problem-solving skills• Difficulty regulating emotions

• Often related drug and alcohol abuse

Adolescents who self-injure reported they do it to:

• Self-soothe • Reduce severe distress • “Feel good”• Express negative feelings

• Hopelessness, worthlessness, depression, anxiety or distress

•  Fight feelings of numbness •  Feel a sense of control

Why Adolescents Self-Injure

• Belief: self-injury achieves emotional equilibrium when they can’t regulate or control emotions (self-soothe).

• To relieve intolerable emotional pain• To communicate a deep sense of anguish. • A cry for help

Self-Injury in Social Groups

• Sometimes considered “contagious” among groups of friends.

• Importance of protocols for dealing with self-injury in schools.

• Parent involvement and communication with children.

Protective Factors

• Connectedness• Access to mental health services• Spiritual life• Stable families

Roles of the School

• Communication is important between school-home-outside clinician.

• Support Staff and Medical Professionals • School should be involved in the reinforcement of

coping strategies and communication skills.

Responding to Self-Injury

• Medical attention

• Outside counseling or therapy

• Have a strong support system, treatment can be long and tough for parents.

• Support siblings

Responding to Self-Injury

• Understand self-injury as a way to cope or handle intense feelings.

• Encourage them to share feelings through journaling or in art (drawing, painting, creating).

• Remove tools• After-school activities or hobby/interest. • Community outreach

Things to Avoid

• Avoid statements that might cause guilt or shame • Try not to appear shocked by this behavior.• Avoid talking about their self-injury in front of friends or with other relatives.

• Try to teach them what you think they should do • Avoid punishment for self-injurious behaviors.• Overprotecting might be harmful, but try to be aware of what’s going on.

• Don’t blame yourself for your child’s behavior.

Communication and Bonds as Protective Factors

• Family connectedness is a protective factor.• Reduced likelihood of harmful or dangerous behaviors (e.g., drugs,

alcohol, or sex, etc.)• Fewer mental health problems• Increased likelihood of making “right” choices and standing up for

believes.• Predicts more constructive coping skills and social skills

• Difficult topics are better discussed when connectedness and communication are in place.

But my child pulls away…• Searching for own identity.• Time spent with family drops an estimated 21%

• More times with friends, work, or dating relationships.• Does not mean there is not a secure bond or good

relationship• Conflicts happen

• Not a sign of poor relationship• Important that parents and adolescent maintain

understanding and empathy while disagreeing• Confidently state opinion show

empathy/understanding of other point of view.

Communicating with your Child

• Ask open questions (what or how) to encourage him/her to open up.

• Allow conversations to revolve around what interests your child.

• Spend time together, with their choice of activity.• Dinner time and Cooking together• Connections with other family members

Safety• Independence but still developing good decision making

skills.• Peer approval is important.• Discuss Safety and dangerous consequences of:

• Motor vehicles• Substance abuse• Protective Gear in sports• Healthy Relationships• Internet Safety

What helps your family stay connected?

Approaches to discussing difficult or sensitive topics that have worked for your families?

Local Resources & Support Lines• Wayside Youth & Family Support (508)-879-

9800http://www.waysideyouth.org/• Advocates, Inc (508)-628-6300

www.adocatesinc.org• National Suicide Prevention Lifeline

1-800-273-TALK (8255)• Samaritans Statewide Befriending Line

1-877-870-HOPE (4673)   (24 hrs)• Samariteens Helpline

1-800-525-TEEN (8336)3pm-9pm weekdays/9am-9pm weekends

Additional Resources

American Self Harm Information Clearinghouse• http://selfinjury.org

National Mental Health Association (fact sheet)• www.nmha.org/infoctr/factsheets/selfinjury.cfm

National Association of School Psychology (NASP)• http://www.nasponline.org/families/index.aspx

• Questions?

Thank you!

ReferencesBakken, N. W., & Gunter, W. D. (2012). Self-cutting and suicidal ideation among

adolescents: Gender differences in the causes and correlates of self-injury. Deviant Behavior, 33(5), 339-356. doi:10.1080/01639625.2011.584054

Brock, S. E. (2002). Crisis Theory: A Foundation for the Comprehensive School Crisis Response Team. In S.E. Brock, P.J. Lazarus, % S.R. Jimerson (eds.), Best Practices in School Crisis Prevention and Intervention (pp. 5-17). Bethesda, MD: National Association of School Psychologists.

Brock, S. E., Nickerson, A. B., Reeves, M. A., Jimerson, S. R., Lieberman, R. A., & Feinberg, T. A. (2009). School Crisis Prevention and Intervention: The PREPaRE Model. Bethseda: National Association of School Psychologists.

Bubrick, K., Goodman, J. & Whitlock, J. (2010). Non-suicidal self-injury in schools: Developing and implementing school protocol. [Fact sheet] Cornell Research Program on Self-Injurious Behavior in Adolescents and Young Adults. Retrieved from http://crpsib.com/userfiles/NSSI-schools.pdf

Cromer B. Adolescent Development. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF,

eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:

chap 104

Gonzales, A., & Bergstrom, L. (2013). Adolescent non‐suicidal self‐injury (NSSI) interventions. Journal Of Child And Adolescent Psychiatric Nursing, 26(2), 124-130.

Guan, K., Fox, K. R., & Prinstein, M. J. (2012). Nonsuicidal self-injury as a time-invariant predictor of adolescent suicide ideation and attempts in a diverse community sample. Journal Of Consulting And Clinical Psychology, 80(5), 842-849. doi:10.1037/a0029429

Klonsky, E., May, A. M., & Glenn, C. R. (2013). The relationship between nonsuicidal self-injury

and attempted suicide: Converging evidence from four samples. Journal Of Abnormal

Psychology, 122(1), 231-237. doi:10.1037/a0030278

Lieberman, R. (2004) Understanding and Responding to Students Who Self-Mutilate. Principal

Leadership Magazine, Vol. 4, No. 7, March 2004, Produced in cooperation with the

National Association of School Psychologists.

 

Muehlenkamp, J., Brausch, A., Quigley, K., & Whitlock, J. (2013). Interpersonal features

and functions of nonsuicidal self-injury. Suicide And Life-Threatening

Behavior, 43(1), 67-80. doi:10.1111/j.1943-278X.2012.00128.x

Radovic, S., & Hasking, P. (2013). The relationship between portrayals of nonsuicidal

self-injury, attitudes, knowledge, and behavior. Crisis: The Journal Of Crisis

Intervention And Suicide Prevention,34(5), 324-334.

doi:10.1027/0227-5910/a000199

Self-harm in young adults. National Alliance on Mental Illness.

http://www.nami.org/Content/ContentGroups/Helpline1/SelfInjury_Fact_Sheet_FINA

L.pdf. Accessed Oct. 11, 2010.

Sornberger, M. J., Smith, N., Toste, J. R., & Heath, N. L. (2013). Nonsuicidal self‐injury,

coping strategies, and sexual orientation. Journal Of Clinical Psychology, 69(6),

571-583. doi:10.1002/jclp.21947

Walsh, B. (2012). Treating Self-Injury: A Practical Guide (2 ed.). New York, New York:

Guilford Publications.