What is There to Gain? Understanding Adolescent Self-Mutilation

1. What is There to Gain?Understanding Adolescent Self-Mutilation Sheena Smith2009 MSW Colloquium May 5, 2009Baylor School of Social Work

2. Overview • Objectives • Statistics • Characteristics • Story • Intervention • Frameworks • Ethics • Questions and Discussion

3. Objectives Identify key characteristics of self-mutilating teens Discuss the purpose behind the behaviors Explore prevention and intervention techniques

4. 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

5. Common Examples of Self-Injury • Cutting • Scraping • Burning • Bruising • Puncturing

6. Stereotypes • What perceptions do we have?

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

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

15. Shila’s Story • Is this an example of nurture or nature? • What actions and feelings led to the behaviors of Shila? Source: Levenkron, 2006

16. The Helping Process • Identify team of professionals • Locate support networks • Allow time and patience • Seek behavioral change • Address the scars Source: Levenkron, 2006

17. 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

18. 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

19. Frameworks • Family Systems Theory • Psychotherapy • Nurturant-Authoritative Therapy • Functional Approach • Solution-Focused • Strengths Perspective

20. Remember! • Self-injury has a purpose and function • Self-reflection, supervision, and debriefing are necessary

21. Ethical Considerations • NASW ethics used in intervention • Dignity and worth of a person • Importance of human relationships • Ethical Challenges • Confidentiality • Cultural, religious beliefs

22. References Duperouzel, 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/

23. Questions and Discussion