2. Self Injury 1. Who self injures? 2.Why do they do it? 3.What
it is and is not. 4.How can we help? 3. I needed to cut the way
your lungs scream for air when you swim the length of the pool
underwater in one breath. It was a craving so organic it seemed to
have risen from my skin itself. Caroline Kettlewell 1 4.
Self-Injury Terms Self Inflicted Violence Cutting Self Harm Self
Mutilation 5. SI Behaviors Cutting Scratching Abrading Burning Some
forms of hair pulling Biting Inserting foreign objects into the
body Interference with wound healing Ingesting toxins 6. Warning
signs Unexplained frequent cuts or burns Wearing long sleeves or
pants in warm weather Avoiding swimming pools or the beach Wearing
thick bracelets to cover wrists Having sharp objects in purse, book
bag, or bedroom Difficulty expressing feelings Withdrawal from
close relationships 7. Self injury is the intentional harm of ones
own body without conscious suicidal intent. (Aldeman, 1998,
Favazza, 1998, van der Kolk, et al., 1991) 8. What Self Injury is
NOT It is not a suicide attempt (attempting to feel better, not
escape all feelings) It is not usually attention seeking It is not
a danger signal to others 9. Who? Roughly 2% (1-4%) of the
population. In some studies reported as high as 8 million Americans
self-mutilate. 30 times the rate of suicide attempts 140 times the
rate of completed suicides May also suffer from eating disorders
90% who cut began as teenagers 10. Who? Typical profile Female Mid
20s to early 30s Began cutting as a teen Middle to upper class
Intelligent, well educated Perfectionist 11. Who? Males and females
All races and socio-economic levels Ages 15-50s Not easily
identifiable 12. Characteristics are often depressed, feel
powerless or anxious have low self esteem /negative body image have
difficulty expressing their emotions verbally experience difficulty
with relationships aim for perfection often have negative body
image lack impulse control/suppressed anger do not have a
repertoire of coping skills may have serotonin dysfunction possible
trauma 13. Abuse? Many who self-injure did not suffer childhood
abuse (Zweg-Frank, et.al, 1995, Brodsky, et. al., 1998) 50-60%
suffered childhood abuse or trauma. That means that 40-50% did not
(Favazza,1998) 14. Then Why? Invalidating environments (Lineham,
1993) Expression of private experiences and feelings are not
validated Feelings are trivialized, punished or ignored Experience
of painful emotions are disregarded. Childs interpretation of his
or her behavior is dismissed 15. In their own words . . . There are
times when I hurt too deep for tears, so I cut and it lets out some
of the hurt. Its like when you see the blood flowing out, the pain
and fear are flowing with it. Watching the blood flow out makes me
feel clean, purified. It feels like something bad or dirty is
leaving with the blood. 2 & 3 16. In their own words . . . The
stopped voice becomes a hand lifting knife, razor, broken glass to
cut, burn, scrape, pop, gouge. The skin erupts in a mouth, tongue
less, toothless. A voice drips out, liquida voice sears itself for
a moment, in the flesh. This is a voice emerging on the skin, a
mouth appearing on the skin. The body which could not be air on the
larynx becomes the stroke of a razor on the breastbone or of a
red-hot-knife-tip upon the wrist . Janice McLane (1996) 4 17. Why
do they harm themselves? To release intense feelings The physical
pain may be easier to deal with than the emotional pain To feel
real, alive To exert some control Acting out self punishment 18.
Cycle of Cutting Shame, guilt, remorse, disgust Mounting anxiety,
anger or self hatred, alienation Disassociation Cutting Relief Into
the Void Panic Muller 2005 19. Why? I felt like I was isolated from
the world, dead, with no emotions at all. The blood told me I was
alive, that I could feelAlso I couldnt cry, and bleeding was a
different form of crying. (Lindsay in Strong, p.57) 7 20. SI is
often associated with: Borderline Personality Disorder
Obsessive-Compulsive Disorder Post-Traumatic Stress Disorder
Dissociative Identity Disorder Eating Disorders Substance Abuse
Depression 21. Therapeutic Goals Encourage communication about
self- injury and relevant aspects of the childs life. Improve the
quality of clients life as it relates to self-injury. Explore
themes of guilt and shame. Diminish use of self-injury as the
coping skill when client desires to make changes. (Conners, Rubin,
et, al,2002). 22. Helping: What to Do (Alderman, 1997) Learn about
self-injury. Talk about SI. Ask about it. Be supportive. Show you
care. Acknowledge the effort to cope with very difficult emotions
Set limits Be available, but refer when appropriate Dont discourage
self-injury Recognize the severity of the distress 23. What Not to
Do Be afraid to ask the question, Do you self- injure? Make
eliminating the behavior the primary goal Make a safety contract or
use contracts as a reward or punishment Visibly monitor their
injuries Make him or her feel ashamed or guilty about the behavior
24. This is yet another secret I must hold to myself because my
therapist has given me an ultimatum, either no more hurting myself
or we will have to discontinue our therapy. So a little distance
comes between us now, a secret that hold great importance which we
could both learn from, if I was able to tell herJML 25.
Interrupting the Cycle Dispute irrational thoughts, feelings
Triggering event Unbearable tension, anxiety Dissociation Self
injury Relapse 26. Expressive Arts Journals Poetry Music Art 27.
Self-Injury Group Respond to the following statements by writing A
for agree if you mostly agree with the statement or D for disagree
if you mostly disagree. Be ready to explain your responses.
___Self-injurers are survivors. ___Self-injurers are weak people.
___Self-injurers are harming themselves to get attention.
___Self-injurers are perfectionists. ___Self-injury is a type of
suicidal behavior. ___Self-injurers are proud of their scars.
___Self-injury helps people cope. ___Self-injurers are more
sensitive than most other people. Muller 2006 28. Self-Injury If my
wound could talk it would
say_______________________________________________
__________________________________________________
________________________________________________
__________________________________________________
_________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________ Muller 2006 29.
Taking Care of Yourself Monitor your own horror and confusion
Broaden your perspective past the behavior to the intent behind it
Seek consultation Get support for yourself 30. Care and Concern The
capacity to derive comfort from another is the single biggest
predictor of whether traumatized patients are able to give up their
self- destructive habits. (van der Kolk) 31. Care and Concern The
development of a safe and trusting relationship is vital for the
child to learn to sooth and care for him or herself in a healthy
manner by internalizing their therapists care and concern. (Strong,
1988) 32. Care and Concern _____ was the first to acknowledge that
maybe I was in pain, as opposed to doing it for attention . This
affirmation of my inner pain was a healing force. Shelley 10 33.
Discussion Why the upsurge in self-injurious behavior? Students who
look for fist fights? Tattoos and piercing? Addictive?
