1. August 21, 2012, IU 6 Fall In-service Day 2 By: Melissa Austen 1

2. No universal definition currently exists Self-injurious behavior (SIB) : The deliberate harm to one’s body resulting in tissue damage, without a conscious intent to die. (Craigen and Foster, American Counseling Association) Non-suicidal Self-Injury : any physically self-damaging act performed without intent of killing oneself, with intent of inflicting physical harm to one self. (Goldstein and Polling, Western Psychiatric Institute and Clinic, 2012) Self-injury : physically damaging in a response to a psychological crisis and demonstrates a sense of disconnection and alienation from others. (Dallam, 1997 presented by Packard, Center for Behavioral Medicine Forum Health) 2

3. “The intentional destruction of body tissue without suicidal intent and for purposes not socially sanctioned.” -Klonsky (2007) 3

4. Self-cutting Self-burning Self-hitting Self-scratching Self-carving Interference with wound healing Hair pulling Bone breaking Culturally Accepted SIB 4

5. Arms Wrist Legs Abdomen Head Chest Genitals 5

6. Three Factors Extent of the Damage Level of Medical Attention Location of the Wound 6

7. Usually Adolescents to Young Adults Undiagnosed or Untreated adolescents with mental health diagnosis Can have comorbid diagnosis History of abuse No difference between sex, race, or SES status An accurate number is unknown because victims engage in secretive behaviors 7

8. Do not have required coping skills to manage their thoughts and feelings Lack of support from caretakers Self-injurious behaviors is one way to mark events’ “Creating a mark or an injury is a way to make interal, invisible wounds, external and visible.” Form of self-medicating Addictive 8

9. A physical self- punishment Many suffer from a history of trauma in their life Release of anger, pain, emptiness, guilt, or anxiety Seek escape from intense affect Gain a sense of control Achieve some level of focus Ground oneself to reality Feeling physical pain to escape emotional pain Inflict pain on someone who is not available Communicate a need Prevent suicide 9

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11. 1. Experimental Cutter 2. Show-off Cutter 3. Shock Cutter 4. Rebellious Cutter 5. Self-Punishment Cutter 6. Distraction Cutter 7. Coping Skill Cutter 8. Mental Issues and Cutting 11

12. Some think it is brave and cool Most feel shame and repulsive about the behavior Feel alienated and isolated Feel powerless to stop Don’t want to disclose- feel like they have a dirty secret Intense emotions Feel as no on would understand them As the behavior escalates, it increases feelings of alienation, helplessness, and loss of power and control 12

13. Dissociative Not aware of the act until completed Numbness physically and/or psychologically Detaches self from body, environment, and behavior Some of no memory of the SIB, and feel frightened when they discover the wound Very aware of the act Seeking the feeling of pain Feel powerless to stop the SIB Nondissociative 13

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15. After SIB occurs, individuals are reward with feelings of gratification, relief, comfort, and arousal Body releases endorphins– individual feels a “high” Seeing the blood allows some individuals to feel alive and real Some become emotionally frozen and experience no emotions “Self-injurious behaviors is an individuals way of self- medication ( Moninger, 2011 )” 15

16. 55%-85% of SIB have had at least one suicide attempt (Goldstein and Polling, 2012, Western Psychiatric Institute and Clinic) 60% are not trying to end their life (Moninger, 2011) Self injury seeks to feel better while a suicidal ideation seeks to end all feelings 16

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18. Learn to deal with your own feelings and learn about the problem Don’t scold or reprimand or judge Offer Support Individual Counseling with specific treatment therapies Know school policy on reporting SIB individuals Help the individual identify their support system Refer to SAP Encourage communication It is like an addiction, so expect relapses Don’t force them to stop behavior until new coping mechanisms are in place Let them know they deserve to feel better without having to hurt themselves 18

19. Try to see the pain behind the behavior. Offer acceptance and support. Let him or her know that you understand the behavior is an attempt to cope with emotions or stress. Offer observations or statements instead of too many questions (i.e., say something like “You seem to be under a lot of stress lately,” or “I noticed that you have been upset about something.”). Assure the individual that he/she is not bad or insane. Talk about feelings. Try to help the other person find words to express his or her feelings. Seek professional help. Get an evaluation by a mental health professional with expertise in helping persons who injure themselves. Medication may be helpful in treating the underlying cause of the behavior. Your medical doctor should be able to help with referrals. See if your school system or guidance counselor has programs to help self- injuring students. Focus on increasing your teen’s confidence by concentrating on the things he/she does well and offering encouragement in those areas. Generate ideas for other ways to deal with feelings: exercise, do things with a positive group of friends, help someone else. 19

20. American Counseling Association http://counselingoutfitters.com/vistas/vistas05/Vistas05.art66.pdf NYU Child Study Center http://www.aboutourkids.org/files/articles/nov_dec_3.pdf HELPGUIDE.org (helpful for SIB to seek help) http://www.helpguide.org/mental/self_injury.htm University of Tennessee https://utextension.tennessee.edu/publications/Documents/SP681- S.pdf https://utextension.tennessee.edu/publications/Documents/SP681- S.pdf S.A.F.E Alternatives (Self-Abuse Finally Ends) http://www.selfinjury.com 1-800-DON’T-CUT) http://www.selfinjury.com 20

21. Self-Injurious Behavior: Who’s Doing It, What’s Behind it, and How to Treat It http://www.openskywilderness.com/wordpress/wp content/uploads/2012/02/Kirsten-Article-.pdf http://www.openskywilderness.com/wordpress/wp content/uploads/2012/02/Kirsten-Article-.pdf American Academy of Child and Adolescent Psychiatry http://aacap.org/page.ww?name=SelfInjury+in+Adolescents&section= Facts+for+Families http://aacap.org/page.ww?name=SelfInjury+in+Adolescents&section= Facts+for+Families HeartLight Ministries http://www.heartlightministries.org/blogs/markgregston/2007/06/05/ self-mutilation-teens-and-cutting / http://www.heartlightministries.org/blogs/markgregston/2007/06/05/ self-mutilation-teens-and-cutting / American Self-Harm Clearinghouse http://www.selfinjury.org 21

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23. QUESTIONS? Questions 23