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Why do children and young adolescents self injure? View our webinar presentation led by Sage Day's top Clinical Directors .
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Welcome! Your ,me is very valuable to us. To ensure you are ge8ng the most out of this Webinar we would like you to submit a ques,on before we begin our presenta,on on Non-‐Suicidal Self-‐Injury, so we can answer your specific ques,ons during our Q&A por,on. Please type your ques,on in the comment box on the right hand side of your screen at this ,me or at any point throughout the presenta,on and we will do our best to address it at the end. We will begin shortly.
• Private, accredited, therapeu,c school in Northern, New Jersey • Students who need a small, personalized environment • Strong academics based on the Common Core Standards • Intensive individual, group and family therapy • Provide NJ state approved In-‐District therapeu,c services • Three campuses: Sage Day Lower and Middle School in Mahwah,
Sage Day High School in Boonton and Sage Day High School in Rochelle Park.
• For more informa,on, visit us at www.sageday.com.
Agenda § Defini,on of Self-‐Injury § History § Why People Self Injure § Risk Factors § Levels of Severity § Demographics § Trends § Immediate Interven,on § Case Studies § Resources § Q & A
Meet The Presenters Alison is the Clinical Director at Sage Day Lower & Middle School in Mahwah, NJ.
Gail is the Clinical Director at Sage Day Boonton High School.
Janet is the Clinical Director at Sage Day Rochelle Park High School.
Chris Leonard is the Director of Opera,ons at Sage Day School.
What Is Self-‐Injurious Behavior? v Self injury is the inten,onal harming of one's own body in order
to relieve emo,onal pain or stress. It is not typically meant to end one's life.
v Self Injury isn’t a modern adolescent issue. It is an ancient
disorder, which is best understood as an a\empt to relieve pain.
History v Prior to the nineteenth century self-‐mu,la,on was understood as a Chris,an
concept of “mor,fica,on of the flesh”. v First began to appear in psychological literature in the mid 19th century. Modern understanding of self-‐injury was made by Karl Menninger. 1930 – The Human Mind 1938 – Man Against Himself v Menninger believed that “self injury was a fascina,ng kind of compromise in
an ongoing war between aggressive impulses and the survival ins,nct." 1960 – Graff and Mallin: Described a “typical cu\er as a young, highly intelligent woman who is prone to alcohol and drug abuse and has great difficulty in rela,onships.” 1980’s – Landmark books : Self-‐Mu5la5on by Barent Walsh and Paul Rosen and Bodies Under Siege by Armando Favazza. Many Late 20th Century studies linked self-‐injurious behavior with dissocia,on.
Why Do People Self Injure?
v A way of quie,ng pain and anxiety. v Best described as a form of self-‐help for people whose emo,ons are hyper-‐
reac,ve or for those raised in an emo,onally chao,c environment.
v Not always a manifesta,on of mental illness or suicidal idea,on. v There is a high correla,on between cu8ng and childhood sexual abuse.
Risk Factors
Childhood sexual abuse and or family violence (Dieter et al) Maltreatment during childhood
People who experience dissocia>on
Those who have experienced childhood trauma
People who suffer from other mental health issues (impulse control, ea>ng disorders)
Excessive alcohol or drug abuse
Loss of a parent or separa>on from a caregiver in childhood
There are many factors
that may contribute to self injury
Difficulty expressing strong nega>ve emo>ons such as: pain, hurt and anger
Levels of Severity v To determine level of severity, consider how frequently self-‐harming occurs,
the number of methods one u>lizes and the loca>on on the body that is injured.
v Most olen those who self-‐injure do not wish to expose their wounds. v The most common areas of the body on which self-‐harming is performed are:
the arms, wrists and legs. Other areas may include: the breasts, thighs, stomach and genitals. (Conterio et al, 1998)
v Typically those who self-‐harm private areas of the body do so out of shame.
Demographics: Female vs. Male
9 percent of girls engage in NSSI.
6.7 percent of boys engage in NSSI.
Primary behavior for females is cu8ng.
Primary behaviors for males is burning or self-‐hi8ng. cu8ng is viewed as “feminine.”
17-‐28% of teens report having par,cipated In NSSI. Nearly 50% of those who engage in NSSI have been sexually abused. NSSI behaviors for all genders typically begin between 11-‐15. When treated, most NSSI resolves by the ,me both males and females begin young adulthood.. Untreated, NSSI can con,nue throughout adulthood especially in Females.
Trends
Self Injury Trends
Since 2007 reports of NSSI have doubled
Many who self injure report learning how to do so are from friends or pro self-‐injury websites. NSSI is frequent in high income countries.
NSSI behaviors by males are increasing.
Self harm is a risk factor for suicide although suicide is a rare effect.
Brain research indicates that there an incomplete connec,on between the cortex and amygdala contribute to the deregula,on of mood.
Approximately 2 million cases are reported annually in the US.
Collec,on of data remains difficult as behaviors go unreported.
Immediate Interven,on Remain calm and caring Administer first aid if necessary Do not be cri>cal or judgmental even if you disagree with behavior Listen with compassion Do not overreact, show shock or fear Do not use threats to stop behavior Follow school/clinic procedures to no,fy administra,on/clinical team Note: Students and staff may be the “first responders” to NSSI.
Sage Day Interven,on Protocol CuMng, Self-‐Mu>la>on or other Self-‐Injurious Behavior Reported Outside of Therapy Teachers: v If a student discusses or reveals cu8ng during class they must be accompanied to the office. v Inform Clinical Director and Therapist. Administrators: v Check and administer first aid if needed. v Access immediacy of risk. v Based on assessment retrieve all student possessions. Have student empty out belongs and confiscate
any items that could be used to self-‐harm. v If student refuses, contact parent. Call police if student a\empts to leave. The student should not
return to school un,l a follow up mee,ng with parents (and district) is held and safety plan is in place. Review policy with student Consider No-‐ Harm Contract Consider suspension of privileges Inform parents Inform therapist Inform teachers When we [Sage Day] make a decision to refer a student for evalua,on for hospitaliza,on
No Harm Contract
Resources Conterio, K., Lader, W., & Bloom, J.K. (1998). Bodily harm: The breakthrough healing program for self injurers. New York: Hyperion. Deiter, P.J. Nicholls, S.S., & Pearlman, L.A. (2000). Self injury and self-‐capaci,es: Assis,ng an individual in crisis. Journal of Clinical Psychology,56,1173-‐1191. Levenkron, S. (1998). Cu8ng: Understanding and Overcoming Self-‐Mu,la,on. New York: W. W. Norton & Company. American Psychiatric Associa,on. (1994). Diagnos,c and Sta,s,cal Manual of Mental Disorders, Fourth Edi,on(DSM-‐IV) Washington, DC: American Psychiatric Associa,on. Gluck, Samantha (2012). Self Injury, Self Harm Sta,s,cs and Facts. Retrieved from: h\p://healthyplace.com/abuse/self-‐injury/self-‐harm. Claassen, Cindy and M. Kasner. (2012). Self Harm in the United States: What We Can Learn from Na,onal and State-‐Level Medical Datasets. Washington, DC: Na,onal Center for Health Sta,s,cs. Interna,onal Associa,on for Child and Adolescent Psychiatry and Mental Health. (2012). IACCP Textbook of Child and Adolescent Mental Health. Belgium: Interna,onal Associa,on for Child and Adolescent Psychiatry and Mental Health.
Resources Con,nued Levenkron, Steven. (2006). Cu8ng: Understanding and Overcoming Self-‐Mu,la,on. New York: W.W. Norton. Favazza, A.R. 1996. Bodies Under Siege, Self-‐Mu3la3on and Body Modifica3on In Culture and Psychology. Bal,more: The John Hopkins University Press. Graff, Harold and Mallin, Richard. 1967. The Syndrome of the Wrist Cu\er. American Journal of Psychiatry, 124 : 36-‐42. Levenkron, Steven. 2006. CuAng: Understanding and Overcoming Self-‐Mu3la3on. New York/London , W.W. Norton and Company. Menninger, K.A. 1938. Man Against Himself. New York, Harcourt, Brace and World,. Strong, Marilee. 1999. The Bright Red Scream: self-‐mu3la3on and the language of pain. New York, Penguin Putnam Books. Walsh, B.W., Rosen, P. 1988, Self Mu,la,on: Theory, Research and Treatment. New York, The Guilford Press. Levenkron, S. CuAng, Understanding and Overcoming Self-‐Mul3la3on. New York/London:1998
Suggested Reads Ke\lewell, Caroline. (2000). Skin Game: A Memoir. NY: St. Mar,n's Press. Leatham, Victoria. (2004). Bloodle8ng: A Memoir of Secrets, Self-‐Harm and Survival. Australia: Allen & Urwin. Strong, Marilee. (1998). A Bright Red Scream: Self-‐Mu,la,ons and a Language of Pain. NY: Penguin Group
Q&A “CuMng may be a way to reclaim control over one’s body, as with anorexia and bulimia. Or it may allow the tortured individual to play out the roles of vic>m, perpetrator, and finally loving caretaker, soothing self-‐inflicted wounds and watching them heal. For others, the sight of blood, is literal proof that they are alive, drawing them out of terrifying dissocia>ve states.”
-‐Marlee Strong-‐
Final Steps… Thank you for your >me this a[ernoon. We hope that you gained some new knowledge on the topic of Non-‐Suicidal Self-‐Injurious Behavior and that we answered all of your ques>ons. You can now refer to the link in the comment box that will direct you to our brief survey. Once you have completed the survey, you will be redirected to a Sage Day web page where you can print out your cer>ficate. Survey Link: https://www.surveymonkey.com/s/K9NGXJC If you have any further ques>ons, feel free to visit us at www.sageday.com If you have specific ques>ons geared towards one of our presenters today, you can contact them via email: Alison Hipscher-‐ [email protected] Gail D’Aurelio – [email protected] Janet Bertelli – [email protected]
Disclaimer: The informa>on and interven>ons discussed today are supported by research. However abendees are urged to inves>gate provided resources and their own resources to confirm research findings.
