Self MutilationSelf Mutilation

ByBy

Karen FackrellKaren Fackrell

FACT:FACT:

Approximately 1% of the US population Approximately 1% of the US population uses physical self injury as a way of uses physical self injury as a way of

dealing with overwhelming feelings or dealing with overwhelming feelings or situations, often using it to speak when no situations, often using it to speak when no

words will comewords will come

What is Self MutilationWhat is Self Mutilation

It goes by many names, self inflicted It goes by many names, self inflicted violence, self injury, self-harm, parasuicide, violence, self injury, self-harm, parasuicide, delicate cutting, self-abuse, and self delicate cutting, self-abuse, and self mutilationmutilation

Broadly speaking self harm is the act of Broadly speaking self harm is the act of attempting to alter a mood state by inflicting attempting to alter a mood state by inflicting physical harm serious enough to cause physical harm serious enough to cause tissue damage to one’s bodytissue damage to one’s body

Self Harm’s Different FormsSelf Harm’s Different Forms

Can IncludeCan IncludeCutting or BurningCutting or BurningTaking Overdoses of medicinesTaking Overdoses of medicinesPunching selfPunching selfThrowing self against somethingThrowing self against somethingPulling out hair or eyelashesPulling out hair or eyelashesScratching, picking, tearing at skinScratching, picking, tearing at skinInhaling or sniffing harmful substancesInhaling or sniffing harmful substancesInserting objects into bodyInserting objects into body

FactFact

Researchers found that 53% of a social Researchers found that 53% of a social worker’s teen case load includes some form of worker’s teen case load includes some form of

self destructive behavior, with 14 to 16 year self destructive behavior, with 14 to 16 year olds comprising the largest group. Out of a olds comprising the largest group. Out of a

143 sampled high school students, 39% 143 sampled high school students, 39% participated in some form of self mutilation in participated in some form of self mutilation in

the past year.the past year.

Psychological CharacteristicsPsychological Characteristics

Strongly dislike/invalidate Strongly dislike/invalidate themselvesthemselves

Are hypersensitive to Are hypersensitive to rejectionrejection

Are chronically angry, Are chronically angry, usually at themselves; tend usually at themselves; tend to suppress their angerto suppress their anger

High levels of aggressive High levels of aggressive feelingsfeelings

More impulsive and may More impulsive and may lack impulse controllack impulse control

Do not see themselves Do not see themselves skilled at copingskilled at coping

Do not think they have Do not think they have control over how they control over how they copecope

Tend to be avoidantTend to be avoidant Do no see themselves as Do no see themselves as

empoweredempowered Tend to not plan for the Tend to not plan for the

futurefuture Suffer chronic anxietySuffer chronic anxiety

Stereotypical Self MutilatorsStereotypical Self Mutilators

Typically the self injurer is female, in Typically the self injurer is female, in her mid 20s to early 30s and been her mid 20s to early 30s and been

hurting herself since her teens. hurting herself since her teens. She tends to be middle or upper She tends to be middle or upper class, intelligent, well educated, class, intelligent, well educated,

and from a background of physical and from a background of physical and/or sexual abuse or a home and/or sexual abuse or a home

with at least one alcoholic parent. with at least one alcoholic parent. Eating disorders are often reportedEating disorders are often reported

??Why Do People Self Harm????Why Do People Self Harm??

Reduces physiological and psychological Reduces physiological and psychological tension rapidlytension rapidly

May have learned at young age that their May have learned at young age that their feelings were not allowed or interpretation feelings were not allowed or interpretation of environment were always wrongof environment were always wrong

Can have a hard time communicating in Can have a hard time communicating in words the anguish they feel insidewords the anguish they feel inside

To punish themselvesTo punish themselves To feel realTo feel real

BUT THE FIX IS ONLY TEMPORARY SO A CYCLE DEVELOPS

Risk FactorsRisk Factors

Being femaleBeing female History of childhood History of childhood

sexual abusesexual abuse History of childhood History of childhood

physical abusephysical abuse Parental Substance Parental Substance

AbuseAbuse Emotional NeglectEmotional Neglect Insecure AttachmentInsecure Attachment Prolonged separation Prolonged separation

from caregiversfrom caregivers

Borderline Personality Borderline Personality DisoderDisoder

Substance AbuseSubstance Abuse PTSDPTSD Eating DisordersEating Disorders Antisocial PersonalityAntisocial Personality High levels of High levels of

disassociationdisassociation Low self esteemLow self esteem

*Look at Precipitating Factors*

Quotes from Former CuttersQuotes from Former Cutters““The objective was not to make myself bleed to The objective was not to make myself bleed to death, just to let go of the ugly feelings holding me death, just to let go of the ugly feelings holding me hostage, feelings that would leave at the sight of hostage, feelings that would leave at the sight of

blood.”blood.”

““I was actually one of the most popular kids in I was actually one of the most popular kids in school… People would look at me like they wanted school… People would look at me like they wanted

to be me and I thought if they found out who I to be me and I thought if they found out who I really was, they would leave me alone.”really was, they would leave me alone.”

MOVIE TIMEMOVIE TIME

Treatment for Self InjuryTreatment for Self Injury

Evaluation or assessment is the first step, followed Evaluation or assessment is the first step, followed by a recommended course of treatmentby a recommended course of treatment

The diagnosis for someone who self-injures can The diagnosis for someone who self-injures can only be determined by a licensed psychiatric only be determined by a licensed psychiatric professional. Self-harm behavior can be a symptom professional. Self-harm behavior can be a symptom of several psychiatric illnesses: Personality of several psychiatric illnesses: Personality Disorders (especially Borderline Personality Disorders (especially Borderline Personality Disorder); Bipolar Disorder; Major Depression; and Disorder); Bipolar Disorder; Major Depression; and Anxiety Disorders.Anxiety Disorders.

Treatment options can include weekly Treatment options can include weekly appointments with a therapist, outpatient treatment, appointments with a therapist, outpatient treatment, and inpatient hospitalization. and inpatient hospitalization.

Effective Therapeutic ApproachesEffective Therapeutic Approaches

Cognitive Therapy: teaches a client how certain thinking Cognitive Therapy: teaches a client how certain thinking patterns are causing their symptoms by giving them a patterns are causing their symptoms by giving them a distorted picture of what’s going on in their life.distorted picture of what’s going on in their life.

Behavioral Therapy: helps a client weaken the connections Behavioral Therapy: helps a client weaken the connections between troublesome situations and their habitual reactions to between troublesome situations and their habitual reactions to them. It also teaches a client how to calm their mind and body them. It also teaches a client how to calm their mind and body in order for them to think more clearly and make healthier in order for them to think more clearly and make healthier decisions.decisions.

Approaches (con)Approaches (con) Interpersonal Therapy: is an active therapy that focuses on Interpersonal Therapy: is an active therapy that focuses on

four general areas: grief, role disputes, role transitions, and four general areas: grief, role disputes, role transitions, and interpersonal deficits. It is present-oriented and emphasizes interpersonal deficits. It is present-oriented and emphasizes clients’ exploring their options and increasing their activities clients’ exploring their options and increasing their activities and social life.and social life.

Dialectical Behavioral Therapy: is a therapy that includes Dialectical Behavioral Therapy: is a therapy that includes once-weekly psychotherapy sessions in which a particular once-weekly psychotherapy sessions in which a particular problematic behavior or event from the past week is explored problematic behavior or event from the past week is explored in detail, beginning with the chain of events leading up to it, in detail, beginning with the chain of events leading up to it, going through alternative solutions that might have been going through alternative solutions that might have been used, and examining what kept the client from using more used, and examining what kept the client from using more adaptive solutions to the problem. This therapy also includes adaptive solutions to the problem. This therapy also includes weekly group therapy sessions.weekly group therapy sessions.

Approaches (con)Approaches (con)

Antidepressants or anti-anxiety medication is sometimes Antidepressants or anti-anxiety medication is sometimes recommended for self-injurers. recommended for self-injurers.

Additional recommendations may be made if the self Additional recommendations may be made if the self injurer has a coexisting condition such as an eating injurer has a coexisting condition such as an eating disorder or chemical dependency issues.disorder or chemical dependency issues.

What Therapists Need to KnowWhat Therapists Need to Know

Have a clear safety plan and review it Have a clear safety plan and review it during every session during every session

This is a procedure to use when a client This is a procedure to use when a client feels the urge to self-injurefeels the urge to self-injure

Focuses on clients strengths and abilitiesFocuses on clients strengths and abilities Identifies client as active agent in therapyIdentifies client as active agent in therapy Works as a motivator and delay Works as a motivator and delay

mechanismmechanism

In Therapy:In Therapy:

Convey understanding that self-injury has been a Convey understanding that self-injury has been a vital coping strategy that has helped the client vital coping strategy that has helped the client survive.survive.

Reinforce phone calls that come before self-injury. Reinforce phone calls that come before self-injury. Limit support if call comes directly after self-injury:Limit support if call comes directly after self-injury: Establish if there is a need for medical attention Establish if there is a need for medical attention

only.only. Save exploring underlying feelings or reasons for Save exploring underlying feelings or reasons for

next session.next session. Avoid gratifying harmful behaviorAvoid gratifying harmful behavior

Developing Coping StrategiesDeveloping Coping Strategies Develop at least five alternative coping strategies.Develop at least five alternative coping strategies. Choose activities that client can use to sooth self in non-violent Choose activities that client can use to sooth self in non-violent

ways.ways. Encourage positive distractions that draw from client’s reservoir Encourage positive distractions that draw from client’s reservoir

of talents or interests.of talents or interests. Examples of coping strategies can include:Examples of coping strategies can include:

JournalingJournalingListening to musicListening to music

Taking a walkTaking a walkPrayingPraying

Calling a friendCalling a friendReadingReadingNappingNappingDrawingDrawing

Taking a bathTaking a bathCalling your therapistCalling your therapist

Don’t Forget!Don’t Forget! Teach client to identify:Teach client to identify:

Warning signs of escalation (heart rate, respiration, Warning signs of escalation (heart rate, respiration, muscle tension)muscle tension)Warning signs of dissociation (emotional numbing, Warning signs of dissociation (emotional numbing, disconnectedness)disconnectedness)

Help client make a list of typical stressors and emotional Help client make a list of typical stressors and emotional triggers so client can learn to identify the causes of the triggers so client can learn to identify the causes of the urge to self-injure.urge to self-injure.

If client shares that she has self-injured since last clinical If client shares that she has self-injured since last clinical contact:contact:

Find out if there is any need for medical attentionFind out if there is any need for medical attentionReview, revise and reinforce safety planReview, revise and reinforce safety planExplore feelings and fantasies that triggered self-Explore feelings and fantasies that triggered self-

injuryinjuryHelp client become more aware of how self injury Help client become more aware of how self injury damages herself and her relationships with othersdamages herself and her relationships with others

Resources for Self-InjuryResources for Self-Injury Butler Hospital Butler Hospital

345 Blackstone Boulevard 345 Blackstone Boulevard Providence, RI 02906 Providence, RI 02906 (401) 455-6200(401) 455-6200

Adolescent Psychiatric Adolescent Psychiatric Services at Fairfax Hospital Services at Fairfax Hospital

10200 N.E. 132nd Street 10200 N.E. 132nd Street Kirkland, Washington Kirkland, Washington 98034 98034 Telephone: 425-821-2000 Telephone: 425-821-2000 Toll free: 800-435-7221 Toll free: 800-435-7221 Fax: 425-821-9010Fax: 425-821-9010

Behavioral Technology Behavioral Technology Transfer Group Transfer Group 4556 University Way NE, 4556 University Way NE, Ste 222 Ste 222 Seattle, WA 98105 Seattle, WA 98105 Phone: 206/675-8588 Phone: 206/675-8588 Fax: 206/675-8590Fax: 206/675-8590

The Menninger Clinic The Menninger Clinic PO Box 829 PO Box 829 Topeka, KS 66601-0829 Topeka, KS 66601-0829 General 1-800-288-0317 General 1-800-288-0317 Admissions/Care Admissions/Care Coordination 1-800-351-Coordination 1-800-351-9058 9058 Karl Menninger School of Karl Menninger School of Psychiatry & Mental Health Psychiatry & Mental Health Sciences Sciences 1-800-288-0317 Ext 58331-800-288-0317 Ext 5833

Resources for Self InjuryResources for Self Injury Frederick County Mental Frederick County Mental

Health AssociationHealth Association 357-359 W. Patrick Street 357-359 W. Patrick Street

Frederick, MD 21701 Frederick, MD 21701 301-663-6135 301-663-6135 24-hour Hotline: 24-hour Hotline: 301-662-2255301-662-2255

The Healing HouseThe Healing House5435 Balboa Blvd.5435 Balboa Blvd.Encino, California 91316Encino, California 91316Andrew Levander, M.A., Andrew Levander, M.A., M.A.C.M.A.C.Clinical DirectorClinical Director213-470-7730213-470-7730

River Oaks Hospital River Oaks Hospital Compulsive Behaviors Compulsive Behaviors programprogram1525 River Oaks Road 1525 River Oaks Road WestWestNew Orleans, LA 70123New Orleans, LA 70123Phone: (504) 734-1740Phone: (504) 734-1740Toll-free: (800) 366-1740Toll-free: (800) 366-1740

SAFE Alternatives SAFE Alternatives Program Program MacNeal Hospital MacNeal Hospital Berwyn, IL Berwyn, IL 1-800-DONT CUT 1-800-DONT CUT

Any QuestionsAny Questions