1. Self-Injury Deliberate Harm to Self Smoking etc… Assessment of Severity Directness (intentionality) Lethality Repetition Tissue Damage Scratch, burn, cut

2. Self-Injurious Behavior Prevalence In a study of 15-16 yo 10.3% reported engaging in self-injurious behavior (SIB) Habitual SIB is estimated at 1%-3% Females 4x more likely to engage in SIB In the early part of this decade the demographic tended to be females age 20-30 (abuse and neglect) Females are socialized to internalize anger whereas men externalize their anger Methods Burning, Scratching, Picking, Head Banging, Breaking Bones, Pills, Cutting (highest at 72%)

3. Etiology Sexual, Emotional, or Physical Abuse A way of being in control A way of repressing feelings (Freud) Stop feeling, feel something, release from tension. A way to punish themselves for being bad Control and predictability Invalidation 1) Self-Attribution (blame, low self-worth) Biological Low serotonin levels are associated with aggression and low impulse control Release of natural opiates (endorphins) when injury occurs Behavioral Operant Conditioning (rewards; e.g. distraction or attention) Classical Conditioning (interoceptive conditioning; e.g. ns=)

4. Why? Affect Regulation Dissociative reconnection Makes it real Communication Expression of things that cannot be said Alexithymia (state of not being able to describe the emotions one is feeling) Control/Punishment Trauma reenactment

5. Risk Factors Mood Disorder (Anxiety/Depression) Low Self-Esteem Withdrawal Few Friends Hypersensitivity to rejection Chronic anxiety Avoidant in their personality Strong dislike for themselves Chronically angry with suppression Abuse and Neglect Mood Disorder

6. Treatment Continuum of Care Outpatient Treatment to Hospitalization Treatment Medication (Depression and Anxiety) Interpersonal Therapy Cognitive Behavioral Therapy Identify Negative Automatic Thoughts Educate about Vicious Cycle and Reinforcement Alternatives Behavioral Contracts Problem Solving Therapy and DBT are most effective