Harming the Body to Ease the Mind: Teenagers and

Self Injury

School Health ConferenceJuly 18-19, 2007

Elizabeth Rose, MEd Counselor, Searcy High School

What is Self-Injury?

Self-injury (SI) has been defined as “all behaviors involving the deliberate infliction of direct physical harm to one’s own body without the intent to die as a consequence of the behavior” (Simeon & Favazza, 2001)

Physically harming one’s own body in order to feel better.

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 episodically2) Some gratification achieved by the behavior

Self-Injury is not…

A failed suicide attempt A disease An addiction (although it’s 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

The Intent is the Key

The key to determining if it is SI is the intent- What is the intent of the person?

It’s not self-injury is the primary purpose is:– Sexual Gratification– Body decoration (body piercing, tattooing)– Spiritual enlightenment via ritual– Fitting in or being cool

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- it’s 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.

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

History of Self-Injury

Documented since biblical times-Mark 5:5 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)

Three Types of Self-Injurious Behaviors

Major Self-Mutilation

Stereotypic Self-Mutilation

Moderate or Superficial Self-Mutilation

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)

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

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

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

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.

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

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

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”

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

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

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

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*

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

portraithttp://galleryofpain.self-injury.net

Indications that a Teen is Self-Injuring

Fresh or healing wounds or scars- most prevalent on the arm opposite the student’s 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

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

5:00 and much better at 5:30 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

School’s Role

Provide Intervention Notify Parents or

Appropriate Personnel Assist/Refer Advocacy Educate Prevention Artist: julieli Title:

sorryhttp://galleryofpain.self-injury.net

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

Notify Parents or Appropriate Personnel

Issue of confidentiality Parent’s 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 student’s parents or local authorities in helping the student

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 student’s treatment process (safe person)

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

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

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

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

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.

Self-Injury is the injurer’s 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

Elizabeth Rose, Counselor

Searcy High School

301 N. Ella

Searcy, AR 72143

Phone: 501.278.2243

erose@searcyschools.org