Self-Injurious Behavior in Adolescents Christa Copeland, M.Ed., M.A. Jenna Strawhun, Ph.D. Boone County Schools Mental Health Coalition

Transcription

1 Self-Injurious Behavior in Adolescents Christa Copeland, M.Ed., M.A. Jenna Strawhun, Ph.D. Boone County Schools Mental Health Coalition

2 Overview Define self-injurious behavior Identify common misconceptions associated with self-injury Review the prevalence rates of self-injury Discuss reasons for the occurrence of self-harming behaviors Review evidence-based treatment options Discuss prevention strategies

3 What is self-injurious behavior?...deliberate, self-inflicted destruction of body tissue resulting in immediate damage, without suicidal intent and for purposes not culturally sanctioned (ISSS, 2007) This can include a variety of behaviors, but more commonly: Intentional carving or cutting of skin Sub-dermal tissue scratching Burning oneself Banging or punching objects or oneself with the intention of hurting oneself Embedding objects under the skin

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6 Self-injury is NOT......just simple, attention-seeking behavior Most people who engage in self-injury actually try to hide the evidence...a student attempting to be manipulative Self-injury is more about relieving tension than being manipulative...an enjoyable experience for youth It is most often done to inflict pain on the individual...the same as suicidal behavior It is often done to avoid suicide...only localized to certain subgroups within the overall population Self-injury does not discriminate! There is no typology

7 Suicide and Self-Injury Self-injury is a risk factor for suicidal behavior, but one does not always indicate the presence of the other Distinctions: Self-injury actually tends to reduce arousal and, for many individuals who have considered suicide, is used as a way to avoid committing suicide. Helps the individual to feel better or cope (i.e., preservation of life), rather than removing the capacity to feel at all (i.e., ending one s life) Self-injury is used more regularly to manage stress and other emotions, while suicide-related behaviors occur much less frequently The risk for suicidal behavior is strongest among individuals who: Engage in more severe forms of self-harm (e.g., cutting, carving, burning) vs. less intense forms (e.g., punching, skin picking, self- scratching) chronically self-injure and use multiple methods to injure

8 Other Associated Factors Individual Factors Examples: depression, anxiety, low self-esteem, hopelessness, poor problem-solving, impulsivity, eating disorders, drug or alcohol abuse, bullying (e.g., because of race or sexuality) Family Factors Examples: mental health difficulties in the family, poor parental relationships, drug/alcohol misuse in the family, unreasonable expectations, conflict between young person and parents, excessive punishments or restrictions, family history of self-harm, abuse, neglect Social Factors Examples: difficulties in peer relationships, bullying, peer rejection, abuse, availability of methods of self-harm, friends who self-harm, media and internet influences

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10 How common is self-injury? con t... 25% of those who self-injure, do so only once The majority of those who self-injure stop after 5 years About 6% - 8% of adolescents and young adults report chronic self-injury Most are likely to: use multiple methods injure on several areas of their body Some eye-opening statistics In a longitudinal study following ~4000 adolescents (Stallard et al., 2013): 27% reported thoughts of self-harm over a 12 month period Approximately 50% of those with self-harming thoughts went on to harm themselves Only 18% of these youth actually sought help

11 Early intervention is key Self-harm can become a serious problem Repeated self-harm is common, following a first-time episode Some methods of self-harm can lead to serious physical damage Self-harm is often linked to other concerns, such as depression, anxiety, eating disorders, drug and alcohol use Individuals who have previously self-harmed are at a higher risk of suicide than other young people, although the risk is still low

12 What to look for? If you suspect your child is self-harming, look for these signs: Unexplained cuts, burns or bruises Keeping themselves covered; avoiding swimming or changing clothes around others Being withdrawn or isolated from friends and family Low or depressed mood; lack of interest in life Blaming themselves for problems or expressing feelings of failure, uselessness, hopelessness or anger

13 Tips for talking to your teen about self-harm Ask how they are feeling and if they feel worried about anything (do not abruptly bring up the topic of self-harm) Communicate that you are not judging them or putting them down, and that you love them and that will not change, despite what they tell you Show that you are prepared to listen to what your teen has to say If your child is open about their self-harm... Help them work out feelings and situations that may trigger the behavior Think together of alternative ways to handle strong feelings Help them think through their problems and develop possible solutions Encourage them to think about how things may change (for the better) in the future If they do not want to talk... Respect their decision and offer another communication method (i.e., writing a note, sending an or text message) Offer the opportunity for them to talk to someone else (i.e., a counselor, help-line)

14 Evidence-Based Treatments Types of psychotherapy shown to be effective at improving the outcomes of youth who self-injure: Dialectical Behavior Therapy (DBT) Based on a philosophy of balancing, acceptance and change Teaches skills in emotional regulation, interpersonal effectiveness, distress tolerance, core mindfulness, and self management Cognitive Behavioral Therapy (CBT) Focuses on helping an individual understand the relationship thoughts, emotions, and behaviors Teaches problem solving skills Mentalization-Based Therapy (MBT) Focuses on improving an individual s capacity to mentalize, or think about their own thinking, and the thinking of others Teaches perspective taking and its influence on the thoughts, emotions and actions of ourselves and others

15 Prevention Caregivers and Schools can do the following to prevent the occurence of self-injurious behaviors: Enhance students capacity to experience and regulate difficult emotions Promote strategies to interrupt negative thinking Avoid unintentionally teaching youth too much about forms and practices of self-harm Focus on increasing your (i.e., school staff and/or parents) capacity to recognize distress Promote positive norms related to communication about mental and emotional status/needs Model ways to successfully cope with strong emotions Address sources of stress in the external environment

16 Helpful Resources Online: Cornell Research Program on Self-Injury and Recovery Community Supports: Family Access Center for Excellence (FACE) 105 East Ash Street, Columbia, MO Phone: Crisis Hotline: Burrell Behavioral Health Central Region

17 Contact Information Christa Copeland, M.Ed., M.A. BCSMHC Regional Coordinator