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What is There to Gain?Understanding Adolescent

Self-Mutilation

Sheena Smith2009 MSW Colloquium May 5, 2009Baylor School of Social Work

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Overview

Objectives

Statistics

Characteristics

Story

Intervention

Frameworks

Ethics

Questions and Discussion

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Objectives Identify key characteristics of self-mutilating teens

Discuss the purpose behind the behaviors

Explore prevention and intervention techniques

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What are Self-Mutilating Behaviors? Interchangeable terms

Self-mutilation Self-injury Self-harm Self-abuse Cutting

Definition of self-injury “Self-injury is characterized as any sort of self-harm that

involves inflicting injury or pain on one's own body.”

Source: Simpson, 2001

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Common Examples of Self-Injury

Cutting

Scraping

Burning

Bruising

Puncturing

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Stereotypes What perceptions do we have?

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United States Statistics 1 in 5 of U.S. teens self-injure

Highest among teenage females

All races and social classes involved

29 is the average age to stop self-injuring

90% grew up in homes where family problems were ignored and communication was lacking

50% were sexually or physically abused

Frequently associated with additional disorders

50% attempt suicide

Source: http://www.answers.com/topic/self-mutilation

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Characteristics of Self-Mutilation

Torment of different feelings and trauma

Rarely life-threatening

Not part of group rituals or trends

Impulsive-not planned actions

More difficult to stop and more severe with time

Often takes place for years before disclosure

Source: Levenkron, 2006

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Connections to Mental Health Mental and Emotional Desperation

Not recognized disorder in DSM IV

Associated as feature of larger disorders

Neurological Impairments

Medication is not enough

Source: Levenkron, 2006

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Nature vs. Nurture Nature

Effects from birth to age 6-9 Developmental junctures Influence of biologically associated disorders

Nurture Parenting approach Dysfunctional family life Childhood trauma

Source: Levenkron, 2006

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Why Self-Mutilation?

Coping mechanism

Inexpressible rage, emotion, chaos

Dissociation, numbness vs. pain and blood

Release of endorphins

Drown out/divert attention

Intangible emotions are made tangible

Self-punishment

Source: Levenkron, 2006

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What they have to say… “Self-injury is a sign of distress, not madness. We should be congratulated

on having found a way of surviving.” -Cory Anderson

“The great art of life is sensation, to feel that we exist, even in pain.” -Lord Byron

“My skin sheds the tears that I can’t cry.” -Anonymous

Source: http://www.youtube.com/watch?v=tRw8iN11oww&feature=related

13Source: http://www.psyke.org/pictures/t/toxicbex/index.html

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Shila’s Story

Is this an example of nurture or nature?

What actions and feelings led to the behaviors of Shila?

Source: Levenkron, 2006

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The Helping Process Identify team of professionals

Locate support networks

Allow time and patience

Seek behavioral change

Address the scars

Source: Levenkron, 2006

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Social Work Techniques Prepatory empathy

Validation of thoughts and feelings

Positive ideas and strengths

Monitoring and accountability

Conflict and confrontation role-playing

Source: Levenkron, 2006

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Quote

“Routine discussions of the injuries and deciding what to do about

them increases trust, begins to integrate the personality’s sense of

relationship to another person, and replaces self-mutilation with

Attachment.”

Source: Levenkron, 2006,183

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Frameworks

Family Systems Theory

Psychotherapy

Nurturant-Authoritative Therapy

Functional Approach

Solution-Focused

Strengths Perspective

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Remember! Self-injury has a purpose and function

Self-reflection, supervision, and debriefing are necessary

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Ethical Considerations NASW ethics used in intervention

Dignity and worth of a person

Importance of human relationships

Ethical Challenges

Confidentiality

Cultural, religious beliefs

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ReferencesDuperouzel, H., Moores, P. (2009). The good, the bad and the ugly: Experiences of self-injury [Electronic version]. Learning

Disability Practice, 12, 21-23.

Fish, R., Duperouzel, H. (2008). Just another day dealing with woulds: Self-injury and staff-client relationships [Electronic version]. Learning Disability Practice, 11, 12-15.

Hilt, L., Cha, C. Nolen-Hoeksema, S., (2008). Nonsuicidal self-injury in young adolescent girls: Moderators of the distress-function relationship [Electronic version]. Journal of Consulting and Clinical Psychology, 76, 63-71.

Klonsky, E. (2008). Identifying clinically distinct subgroups of self-injurers among young adults: A latent class analysis [Electronic version]. Journal of Consulting and Clinical Psychology, 76, 22-27.

Levenkron, S. (2006). Cutting: Understanding and overcoming self-mutilation. New York: W.W. Norton and Company, Inc.

Nock, M. (2009). Why do people hurt themselves?: New insights into the nature and functions of self-injury [Electronic version]. Current Directions in Psychological Science, 18, 78-83.

Simpson, C. (2001). Self-mutilation. ERIC/CASS Digest, ERIC Clearinghouse on Elementary and Early Childhood Education. Retrieved April 23, 2009, from http://www.athealth.com/Consumer/disorders/selfmutilation.html

Wedge. (2009). Self injury: Self-expression inside out [Electric version]. Healthcare Counseling and Psychotherapy Journal, 9, 22-25.

Psyke.org. Self-injury Information and Support. Retrieved April 28, 2009 from http://www.psyke.org/articles/

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Questions and Discussion