1. ADOLESCENT SELF-INJURY BEHAVIOR Rhonda Lesniak, RN, BSN, MA, NCSN Christine E. Lynn College of Nursing Florida Atlantic University

2. Key Terms Self-injury behavior (SIB) Self-inflicted violence (SIV) Self-harm Self-mutilation Cutting Self-abuse

3. Definition Adolescent self-injury behavior is a call for nursing through the deliberate infliction of a wound to oneself in an attempt to seek expression of and immediate relief from intolerable feelings.

4. Self-Injury is A coping mechanism A deliberate act Repetitive Private and personal An act of expression Non verbal communication A survival strategy A cry for help A call for nursing

5. Self-Injury is not Attention seeking For pleasure A group activity A failed suicide attempt Manipulation A tattooing or body piercing trend

6. Who is Self-Injuring? 1 in 10 teenagers More females than males Age of onset pre-teen to teenage May last well into their thirties

7. Types of Self-Injury Cutting Scratching Burning Hair pulling Not allowing wounds to heal

8. Difference Between SIB and Body Decoration Body piercing and tatooing are forms of body decoration which are not used to seek immediate relief from intolerable feelings. Body decoration can originate from a desire for peer approval.

9. High Risk Indicators Childhood history of physical, emotional, mental, verbal, or sexual abuse Lacks validation Feelings of inadequacy Low self esteem Poor self image

10. Calls for Nursing Expression may be realized through: Poetry Creative writing Artwork Frequent school clinic visits Frequent absenteeism Student just wants to talk

11. Antecedents to SIB Feels helpless, powerless Feelings of isolation and abandonment Feelings of worthlessness, emptiness, numbness Depression Frustration Anxiety Anger Tension

12. Why Inflict Physical Pain? Physical pain distracts from emotional pain Means of communicating distress To disassociate from intolerable feelings To transfer emotional pain into physical pain To regain control over self Physical pain is easier to deal with than emotional pain To gain control IT WORKS

13. Immediate Consequences of SIB Feels alive, functioning, able to act Clears the mind, helps to focus Release of endorphins Tension reduction Relief from stress or feelings Calmness Relaxation Sleep

14. Later Consequences of SIB Guilt Shame Stigma Feelings of isolation and abandonment

15. The Cycle of SIB SELF-INJURY RELIEF CALMNESS RELAXATION SHAME STIGMA ABANDONMENT FRUSTRATION TENSION ANGER ANXIETY CALL FOR NURSING

16. ADOLESCENT SELF-INJURY BEHAVIOR DELIBERATE SELF-HARM EXPRESSION INTOLERABLE FEELINGS SHORT-TERM RELIEF CALL FOR NURSING Adolescent Self-Injury Behavior is a call for nursing through the deliberate infliction of a wound to oneself in an attempt to seek expression of and immediate relief from intolerable feelings.

17. What To Look For Unexplained cuts, scratches, burns, or bruises Excuses such as, “my cat scratched me” Clothing inappropriate for the weather Reluctance to dress out for physical education class or swimming Dressing to fit in with the Goth crowd

18. What To Do Once You Have Identified a Student as a Self- Injurer Offer nonjudgmental, unconditional acceptance Provide quiet, private place to talk Assure confidentiality Establish a trusting relationship Above all, listen, listen, listen Do not tell student to stop SIB at this time

19. Implications for Practice Explain to the student that you must notify parents of the SIB Assure student you will provide assistance, encouragement, and support Always keep an “open door” policy Establish your school clinic as a “safe place” Assure that wounds are not infected Teach wound care to student

20. Implications for Practice Encourage the student to come to the clinic as needed (when feelings are beginning to escalate) Intervene at any point during the SIB cycle to disrupt the cycle as needed Encourage healthy coping mechanisms (drama, writing, art, sign language) Keep open communication with parents

21. Referrals Assist parents with referrals to community resources, therapists, counselors, etc. Arrange for parents and students to meet with guidance counselor, if desired. The school nurse is the facilitator of this interdisciplinary approach and is the main resource person for the family.

22. Therapeutic Regimens Diagnosed mental disorders (depression, bipolar, anxiety, compulsive disorder) will be treated traditionally with medication. Implications for school nurse – become familiar with medications and potential adverse reactions Report any adverse reaction to parents

23. Therapeutic Regimens Counseling and talking therapies Psycho-Dynamic therapy Cognitive behavioral therapy Person centered therapy Group therapy, self help, empowerment

24. What About Suicide? Determine if student has suicidal ideations: 1. Are you having suicidal thoughts? Have you ever considered suicide? 2. Are you harming yourself in any way? Have you hurt yourself recently? 3. Do you have the intention to hurt yourself in the future?

25. If Student is Suicidal Use the SLAP method: 1. Does the student have a plan and how Specific is the plan? 2. How Lethal is the plan? 3. How Accessible is the plan or method? 4. In what Proximity could help be found?

26. Suicide Prevention If you believe the student may be of serious harm to self or others, you must notify the school authorities, and follow the policy of your school district.

27. Implications for Research Create an atmosphere of openness and trust. Encourage the student to share his or her story of the lived experience of an adolescent who self-injures.