SELF MUTILATION AND DESTRUCTIVE BEHAVIORS By Alexandra Kolupa and Lindsey Dolin

SELF MUTILATION AND DESTRUCTIVE BEHAVIORS Self mutilation and destructive behaviors are prevalent in society, especially among teens. “Acts of self-mutilation include, but are not limited to, cutting, burning, carving, hair pulling, inserting objects under the skin or in body orifices, and skin picking or scratching.” Common areas of this are the distal extremities (McDonald, 2006). These behaviors can be avoided. Self mutilation and destructive behaviors are separate from suicide.

CATEGORIES OF SELF MUTILATION Self mutilation is divided into three categories: Major self mutilation Stereotypic self mutilation Moderate/superficial self mutilation (McDonald, 2006)

PREVALENCE Self mutilation is the main method of self-harm at 59.2% of all instances. In the U.S., the prevalence of self harm is 17%. (Rissanen, Kylma, & Laukkanen, 2011). “The incidence of self-mutilations among adolescents has increased during the past 10 years.” Results of the few studies that have been done in the U.S. on self-mutilation show that 4-38% of the people who participated engage in some act of self-injurious behavior. (Williams & Bydalek, 2007).

MANAGEMENT The first thing that always needs to be done if a person is self mutilating is to address the wound and prevent infection. Until this is done, therapy cannot begin (McDonald, 2006). After the wound is addressed, measures should be taken to identify the current stressors in the person’s life in order to discover why the person is feeling the need to self mutilate. Therapy, in the form of individual therapy, group therapy, or family therapy, will be used. In conjunction with therapy, pharmacologic therapy can be used. (Williams & Bydalek, 2007)

MULTIDISCIPLINARY TEAM A multidisciplinary team is important in providing care to adolescents that self mutilate. The team should be coordinated by a psychiatrist or other psychiatric provider, and include the adolescent’s “school counselor, school nurse, psychologist, and therapist.” (Williams & Bydalek, 2007).

RELEVANCE TO NURSING Self mutilation is relevant to nursing because often, nurses are the first to notice or be told that the person is self mutilating or engaging in destructive behaviors. School nurses are important in both the prevention and the recognition of self mutilating behaviors (McDonald, 2006). Nurses also have the opportunity to prevent further harm to the person by providing a person to talk to and being able to recognize when the person is upset enough to self mutilate.

GROWTH AND DEVELOPMENT The way a person is brought up, and their home environment during childhood, are great influences on how the child grows up to act. “Some proposed risk factors for self-mutilation include sexual or physical abuse; parental alcoholism or depression; history of chronic illnesses with childhood hospitalization; lack of coping mechanisms associated with stress; depression; violence in society; and curiosity and peer pressure to ‘try it out’” (McDonald, 2006).

FUTURE IMPLICATIONS “Self-mutilation by an adolescent can escalate over time in both frequency and intensity, leading to not only disfigurement, but also an inability to control impulses and behavior (Favazza, 1998). If not treated, self-mutilation can develop into a debilitating and dangerous chronic behavior that persists in adult-hood” (McDonald, 2006).

S.A.F.E. ALTERNATIVES This organization is dedicated to prevention of self abuse. S.A.F.E. stands for self abuse finally ends. They talk about how there is no healthy amount of self-injury, and self-injury is something that can be stopped and prevented. They believe that the self-injurer should take control and learn to keep themselves safe; it shouldn’t be the responsibility of the helper. They also help clients to discover healthier cope mechanisms. “Quality of life is a choice.” (“About us,” 2007)

OUR NCLEX STYLE QUESTIONS An adolescent reports to the school nurse that she has been cutting herself by stating “I cut my wrists at night when I’m feeling upset or overwhelmed.” What is the most appropriate intervention for the school nurse to do at this time? A) Tell her parents. B) Question her further by asking if she has done this in an attempt to end her life. C) Assess the wounds. D) Refer her to a therapist.

OUR NCLEX STYLE QUESTIONS (CONTINUED) You are an advanced practice nurse in a community clinic. An adolescent is in for treatment of a cut on his arm, accompanied by his mother, and you note that the adolescent has a mark on his inner forearm that you estimate looks to be about 4 weeks old. When you question the adolescent about the cut, he states that he was skateboarding the other day and fell, scraping his arm. What is an appropriate intervention during this visit? Select all that apply. A) Assess the wound. B) Clean and dress the wound. C) Tell the adolescent that he shouldn’t be self-mutilating because it is bad. D) Ask the mother to leave the room, then question the adolescent on if he has ever self- mutilated. E) Inform the adolescent that there is no way that he fell skateboarding the other day because the wound is obviously at least 4 weeks old.

REFERENCES About us. (n.d.). Retrieved from McDonald, C. (2006). Self-mutilation in adolescents. Journal of School Nursing (Allen Press Publishing Services Inc.), 22(4), doi: / Rissanen, M. Kylma, J., & Laukkanen, E. (2009). Helping adolescents who self-mutilate: Parental descriptions. Diagram. Journal of Clinical Nursing, 18(12), doi: /j x Rissanen, M., Kylma, J., & Laukkanen, E. (2011). A systematic literature review: Self- mutilation among adolescents as a phenomenon and help for it – What kind of knowledge is lacking? Issues in Mental Health Nursing, 32(9), doi: / Williams, K., & Bydalek, K. (2007). Adolescent self-mutilation: Diagnosis and treatment. Journal of Psychosocial Nursing & Mental Health Services, 45(12),