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The scope of self-injury in adolescence

The scope of self-injury in adolescence. Stephen P. Lewis, PhD Assistant Professor, University of Guelph. Questions we’ll answer today. ?. What is self-injury. Who self-injures. Why do youth self-injure. What are the risks. What is the role of social media. What can we do.

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The scope of self-injury in adolescence

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  1. The scope of self-injury in adolescence Stephen P. Lewis, PhD Assistant Professor, University of Guelph

  2. Questions we’ll answer today ? What is self-injury Who self-injures Why do youth self-injure What are the risks What is the role of social media What can we do

  3. What is self-injury?

  4. Defining self-injury Non-suicidal Self-injury (NSSI) Refers to the intentional destruction of one’s body tissue in the absence of conscious suicidal intent and for purposes that are not socially or culturally sanctioned or accepted (Nock & Favazza, 2009)

  5. Self-injury vs. suicide Key differences… Suicide NSSI Nonlethal Intent Lethal Intent Lower Severity Higher Severity Higher Frequency Lower Frequency Muehlenkamp, 2005; Nock & Favazza, 2009

  6. What isn’t self-injury? Accidental cuts or bruises Tattooing, Body piercing Binging/purging, self-starving Smoking Drug/alcohol abuse Overdosing/self-poisoning Nock & Favazza, 2009

  7. How people self-injure: Methods Most commonly cited: Cutting, carving, scratching, scarping Cutting itself RARELY results in suicide Hitting/Bruising Burning Skin-picking Wound Interference Biting Self-embedding Nock & Favazza, 2009; Whitlock et al. 2006

  8. Who self-injures?

  9. 14-24% of youth and young adults have self-injured Many of these repeatedly self-injure Lewis & Santor, 2008; Klonsky & Lewis, 2010; Rodham & Hawton, 2009; Whitlock et al., 2006

  10. Prevalence: Adolescence Canada/ US 12-15% Many of these will repeatedly self-injure 1 in 7 A recent Canadian study Some studies report higher rates (up to 48%) Lloyd-Richardson et al., 2008; Muehlenkamp & Gutierrez, 2004; Nixon et al., 2008; Ross & Heath, 2002

  11. Sex differences Mixed evidence; girls may self-injure more frequently Consensus: Boys & girls self-injure; boys seek help less Methods Females: scratch, pinch & cut Males: punch objects/hit Body Location Females: wrists, thighs Males: hands Whitlock et al., 2006

  12. Why do youth self-injure?

  13. How will you know I am hurting, If you cannot see my pain? I wear it on my body To say what words cannot explain -Teenager on an online forum

  14. Why do youth self-injure? It’s NOT about attention-seeking…but, rather… To cope with difficult feelings Emotion Regulation Self-punishment Expressing self-hate/punish self Anti-Dissociation To feel real or less numb

  15. Why do youth self-injure? Tell others how one feels Interpersonal Communication To set boundaries Expressing self as distinct Anti-suicide To avoid suicide urges Functions may co-exist (& this is a non-exhaustive list)

  16. What are the risks?

  17. Risks FOR self-injury There is nosingle ‘path’ to self-injury Mental Illness (e.g., depression, eating disorders) Difficulty coping with negative feelings Substance Abuse Interpersonal difficulties, maltreatment See Nock, 2009; Skegg, 2005; Walsh, 2006

  18. Risks OF self-injury Self-injury may lead to the following… Difficulty talking to others/feeling connected Repeated self-injury, scarring & more severe self-injury Worsening of symptoms (e.g., depression, anxiety, stress) Sometimesit can lead to suicidality See Nock, 2009

  19. NSSI & Suicidality: A closer look

  20. What is the role of social media?

  21. Self-injury online… Searching for ‘self-injury’ or ‘self-harm’ In Google yields millions of hits This is not a bad thing…. Though, it may be (sometimes)…

  22. Self-injury online: Personally-made sites Many sites are shared via self-injury e-communities Descriptions of self-injury Addictive, hard to stop, helpful (to cope) & not always painful (at the time) Graphic descriptions of different episodes Pictures of self-injury Graphic, and typically of cutting Lewis & Baker in press

  23. Self-injury online: Personally-made sites NSSI Messages Mixed/ambivalent messages Fewpro-self-injury messages Triggering Material Direct reports that material is triggering (imagery & text-based content) This has been based on clinical assumption Lewis & Baker in press

  24. Self-injury online: Discussion Boards Motives for discussing self-injury Acceptance, support, validation, connection/communication What is discussed? Self-injury experiences, questions shared, etc What’s also discussed? Sharing self-injury methods, how to hide it Whitlock et al. 2006

  25. Self-injury online: YouTube Over 5,000 videos Various forms of video content We examined the top 100 (based on views) Highly Viewed Over 2 million at the time of analysis Favourably Viewed Over 12,000 “favorites” Average rating: 4.6 out of 5 Lewis et al., 2011

  26. Self-injury online: YouTube 50 Character Videos 28% had in-action self-injury (mostly cutting) 50 Non-character Videos Over 90% had graphic self-injury photographs (mostly cutting) Most common video themes/tones Educational/Informative & Melancholic (followed by Hopeful) Lewis et al., 2011

  27. Self-injury online: Yahoo! Answers Yahoo Answers! Most popular Q&A Website online Functions like an e-community Questions examined by self-injury disclosure status: Disclosure: Sought validation/acceptance, concerns re: scars No disclosure: Asked general questions, how to help others Lewis et al. under review

  28. Self-injury online: Yahoo! Answers Most self-injury questions are not questions per se Most youth/young adults seek acceptance & validation Do people actually get validation in this e-community? Sometimes… But not always… Lewis et al., under review

  29. Risks & Benefits of self-injury e-content Key Benefits Decreased isolation, acceptance, validation & support from others (but NOT in all forums) We have an opportunity here… Key Risks Triggering content, normalization/reinforcement of self-injury, thwarted help-seeking, encouraging self-injury, etc. Lewis & Baker in press; Lewis et al. under review; Lewis et al., 2011; Whitlock et al., 2006

  30. What can we do?

  31. Enhance your self-injury literacy www.cares.psy.uoguelph.ca www.crpsib.com

  32. Identifying self-injury… Many students will not tell anyone But, if the do, they are apt to tell a friend (66%)… Fewer tell a romantic partner (43%)… Even fewer (less than 30%) tell a teacher or health professional

  33. Know what to look for… Unexplained scars, cuts, injuries Significant mood changes Difficulty regulating mood Changes in academics, socially Withdrawal & isolation High self-criticism Long-sleeves, covering limbs in warm weather Finding razor blades, sharps

  34. Know how to discuss self-injury… It’s not just what you say It’s how you say it

  35. Talking to students about self-injury Interpersonal style is highly important… • Approaches that do NOT work: • Intense concern/effusive support • Anguish/fear • Recoil/shock/avoidance • Condemnation & threats Klonksy & Lewis, 2010; Klonsky & Weinberg, 2009; Walsh, 2006, 2007

  36. Talking to students about self-injury What does work…. A calm, empathic style with a respectful curiosity Use their ‘self-injury language’ Klonksy & Lewis, 2010; Klonsky & Weinberg, 2009; Walsh, 2006, 2007

  37. Talking to students who self-injure

  38. Discussing self-injury: Summary Be open & understanding Be mindful of your reaction Don’t ignore it Show you want to genuinely understand what’s going on Express concern & to listen…attend to how the student feels Encourage, and refer to, professional help

  39. Other issues: reporting… By talking to teens, you can better understand WHY they self-injure If they report suicidal thinking or plans immediate action is needed Do I contact caregivers if a teen is self-injuring? Unclear at this time…varies by school board

  40. Some types of professional help Cognitive Behaviour Therapy (CBT) Promotes realistic (less negative) thought patterns & Promotes re-engaging in activities, including social activities Dialectical Behaviour Therapy (DBT) Integrates CBT components but also… Interpersonal effectiveness/communication skills, mindfulness, emotion-regulation skills (including distress tolerance), etc. Gratz & Chapman, 2009; Klonsky & Muehlenkamp, 2007; Muehlenkamp, 2007; Walsh, 2006

  41. Emotion Regulation Strategy: Example The Stress Bucket Examples of coping strategies: Mindful/relaxing Breathing Play some loud music Yoga Physical Exercise (go for a run!) Writing (e.g., story, poem, letter) Doing art Playing or listening to music Talking with others MANY other techniques

  42. Summarizing what we can do… Awareness Enhance OUR literacy about self-injury Respond Learn how to respond effectively (be supportive, direct to professional help) Referring to school’s designated mental health worker Promote Professional Help

  43. Thank you Contact Information Email: stephen.lewis@uoguelph.ca

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