1. Mary Seitz & Erin Nobile Old Dominion University

2. Self-Injury  Non-suicidal self-injury is the intentional destruction of body tissue without suicidal intent and for purposes not socially sanctioned.  Intentional act with the objective to do harm to the body without leading to a result of death. (Klonsky & Muehlenkamp 2007)

3.  Typical age of onset: 13-14 years old ◦ Occurs most often in adolescents and young adults as compared to adults  Common forms: cutting, severe scratching, burning, and banging or hitting ◦ Typical areas injured: arms and wrists, legs, abdomen, head, chest and genitals (Kress, Gibson, & Reynolds, 2004)

4. ◦ Feeling concrete pain when emotional pain is too overwhelming ◦ Reducing numbness, feeling real ◦ Keep traumatic memories away ◦ Affect Modulation ◦ Receiving support and caring from others ◦ Discharge of anger/anxiety/despair ◦ Sense of Control ◦ Self-Punishment ◦ Enhancement of Self-Esteem (Kress, Gibson, & Reynolds, 2004)

5.  Psychiatric Patients ◦ Occurs in about 20% of adult psychiatric patients, 40–80% of adolescent psychiatric patients.  General Population ◦ 4% of adults in the general population report a history of self-injury. ◦ 46% of 9 th and 10 th graders performed at least one self-injurious behavior within the past year. (Klonsky & Muehlenkamp 2007)

6.  Life experiences that correlate with self- injurious behavior: ◦ losing a parent, family violence, childhood sexual abuse or rape, a childhood illness, and a history of self-injury in the family  Two of the best predictors of self-injury are childhood sexual abuse and/or family violence. (White Kress, Drouhard, & Costin 2006)

7.  DSM Controversy  Link between self-injury and eating disorders, anxiety and depression.  Suicide  Assess the intent or motivation underlying the self-injury as well as pay careful attention to the psychiatric symptoms being reported throughout treatment. (Klonsky & Muehlenkamp 2007)

8.  Most cultures have forms of culturally acceptable and sanctioned self-injurious behavior  Gender Differences ◦ Similar overall rates in men and women ◦ Differences occur in the methods  Ethnicity ◦ Rates of self-injury are higher in Caucasians than non- Caucasians  Socio-Economic Status ◦ More prevalent in middle and upper class (Klonsky & Muehlenkamp 2007); (Kress, Gibson, & Reynolds, 2004)

9.  Be aware ◦ Know your student population ◦ Recognize those who may be at risk  Educate yourself ◦ Get to know the resources available in your community  Offer a safe place for students who self- injure (Caperton, 2004)

10.  Multimodal Approach  Cognitive Behavior Therapy  Dialectal Behavior Therapy  Medication (Caperton, 2004)

11.  Questions to consider: ◦ How do you think this cycle of self injury could have been caught early on? ◦ As a school counselor what should you look for to identify a student who may be exhibiting these behaviors? ◦ What is the best way to confront a student, like the one in this example if you suspect they may be hurting themselves? ◦ How can you respect the student’s privacy while also protecting them from harm? www.psyke.org

12.  Questions to consider: ◦ Did the counselor break confidentiality? ◦ Did the counselor have a duty to warn others because the student was a danger to herself? ◦ What additional information might the school counselor have gathered to more adequately assess the situation, and to have engaged in appropriate ethical decision- making? ◦ Suppose the counselor decided that Jennifer was not in danger of seriously harming herself, does the school counselor still have a responsibility to contact the student's parents? (White Kress, Drouhard, & Costin 2006)

13.  School counselors are ethically obligated to keep student-reported information confidential unless disclosure is required to prevent clear and imminent danger to the counselee or others (ASCA, 2004).

14.  Thorough assessment: ◦ Severity ◦ When a student self-injures ◦ Age of onset ◦ Frequency ◦ Course of injuries (increased or decreased) ◦ Medical complications (stitches or treated for injuries) ◦ Tools used to injure (Used? Clean? Rusty?) ◦ Injure with anyone? ◦ Wound care ◦ Emotional state when injuring ◦ Who knows about the cutting ◦ Recent life experiences or past traumas. ( White Kress, Drouhard, & Costin 2006)

15.  Ethical Decision Making Model  Apply Moral Principles  Consult  Document  Community Resources that specialize in Self- Injury ◦ www.selfinjury.com ( White Kress, Drouhard, & Costin 2006)

16.  Leadership  Collaboration  Advocacy  Systemic Change

18.  American School Counselor Association. (2005) The ASCA National Model: A Framework for School Counseling Programs, Second Edition. Alexandria, VA: Author.  Caperton, Barbara (2004). What school counselors should know about self injury among adolescents: A literature review. University of Wisconsin Stout Graduate Guidance and Counseling. 25.  Focus Adolescent Services. (2008). http://www.focusas.com/SelfInjury.html. http://www.focusas.com/SelfInjury.html  Klonsky, D.E., & Muehlenkamp, J.J. (2007). Self-Injury: A Research Review for the Practitioner. Journal of Clinical Psychology: In Session, 63(11), 1045-1056.  Kress, V.E., Gibson, D.M., & Reynolds, C.A. (2004). Adolescents who self-injure: Implications and strategies for school counselors. Professional School Counseling, 7, 195-201.  S.A.F.E. Alternatives. (2007). http://www.selfinjury.com.http://www.selfinjury.com  Self Injury Information and Support. (2006). www.Psyke.org.www.Psyke.org  White Kress, V.E., Drouhard, N. & Costin, A. (2005). Students who self-injure: School counselor ethical and legal considerations. Professional School Counseling, 10(2), 203-209.