Understanding Understanding

Self-Injurious Self-Injurious BehaviorBehavior

Self Injurious BehaviorSelf Injurious Behavior

Other TermsOther Terms CuttingCutting Self-harmSelf-harm Self-inflicted violenceSelf-inflicted violence Self mutilationSelf mutilation Para-suicidal behaviorPara-suicidal behavior

DefinitionDefinition

““Any socially unacceptable behavior Any socially unacceptable behavior involving immediate, deliberate, direct involving immediate, deliberate, direct and usually repetitive physical injury to and usually repetitive physical injury to one’s own body, resulting in mild to one’s own body, resulting in mild to moderate self harm, usually without moderate self harm, usually without conscious suicidal intent.”conscious suicidal intent.”

Remuda Ranch Treatment CenterRemuda Ranch Treatment Center

Common ExamplesCommon Examples

ScratchingScratching CuttingCutting CarvingCarving BurningBurning Repetitive rubbingRepetitive rubbing AbradingAbrading PunchingPunching

Common Examples, cont.Common Examples, cont.

PinchingPinching BitingBiting Head bangingHead banging Hair pulling or pluckingHair pulling or plucking

Some SIB’s may mimic suicidal behaviors, Some SIB’s may mimic suicidal behaviors, but they serve a different purpose. but they serve a different purpose.

Less Common ExamplesLess Common Examples(Increasing in Popularity)(Increasing in Popularity)

Scarification Scarification Cutting and preventing healing Cutting and preventing healing

Reopening of barely healed woundsReopening of barely healed wounds

BrandingBranding

Excluded BehaviorsExcluded Behaviors

TattooingTattooing Body piercing Body piercing

These are culturally sanctioned behaviors These are culturally sanctioned behaviors and are thus excluded from the SIB and are thus excluded from the SIB definition.definition.

ToolsTools

Razor bladesRazor blades PinsPins Paper clipsPaper clips

(Any object that can be made sharp or cause injury)(Any object that can be made sharp or cause injury)

Cigarettes, matches, candles (burning) Cigarettes, matches, candles (burning)

Body PartsBody Parts

WristsWrists ForearmsForearms LegsLegs Usually hidden areas Usually hidden areas (depends on motivation)(depends on motivation)

StatisticsStatistics

1% of general population1% of general population 1.8% teens 1.8% teens (usually cut with sharp objects)(usually cut with sharp objects)

12% college age12% college age 4.3-13% people with mental disorders4.3-13% people with mental disorders 25-45% people with eating disorders25-45% people with eating disorders Most common in unmarried femalesMost common in unmarried females Positive correlation with sexual traumaPositive correlation with sexual trauma

Variations of SIBVariations of SIB

CompulsiveCompulsive Closely associated with Obsessive Closely associated with Obsessive

Compulsive DisorderCompulsive Disorder Prompted by anxietyPrompted by anxiety Different intention and root than impulsive Different intention and root than impulsive

formsforms

Variations of SIB, cont.Variations of SIB, cont.

Impulsive Episodic TypeImpulsive Episodic Type Not premeditatedNot premeditated Response to emotional triggerResponse to emotional trigger Not self-identified as a “cutter”Not self-identified as a “cutter”

Variations of SIB, cont.Variations of SIB, cont.

Impulsive Repetitive TypeImpulsive Repetitive Type Rumination about SIBRumination about SIB Self-identified as a “cutter”Self-identified as a “cutter” Behavioral response to both positive, Behavioral response to both positive,

negative stressorsnegative stressors Impulse Control Disorder NOS (Axis I)Impulse Control Disorder NOS (Axis I)

Risk FactorsRisk Factors

Early abuse historyEarly abuse history High levels of dissociative defensesHigh levels of dissociative defenses Highly chaotic family environmentsHighly chaotic family environments Lack of sufficient parental controlLack of sufficient parental control Extensive psychosocial stressorsExtensive psychosocial stressors Severe mood disorderSevere mood disorder

Levitt, Sansone, Cohn 2004Levitt, Sansone, Cohn 2004

Function OverviewFunction Overview

Relief from overwhelming painful emotionsRelief from overwhelming painful emotions Stopping/preventing dissociative stateStopping/preventing dissociative state Addiction to euphoric endorphins releasedAddiction to euphoric endorphins released Voice for emotional painVoice for emotional pain Self-punishment for behaviors, feelings or Self-punishment for behaviors, feelings or

needs needs (likely to hide evidence of SIB)(likely to hide evidence of SIB)

Re-enactment of abuse to gain a sense of Re-enactment of abuse to gain a sense of controlcontrol

Function Overview, cont.Function Overview, cont.

““When I could not find the words, cutting had When I could not find the words, cutting had become the language to describe the pain, become the language to describe the pain, communicating everything I felt.” communicating everything I felt.” A clientA client

““Youth who self-mutilate may choose this behavior Youth who self-mutilate may choose this behavior because it meets a multitude of needs at one because it meets a multitude of needs at one time. The most common functions….are time. The most common functions….are expressing and controlling overwhelming expressing and controlling overwhelming emotions, and maintaining a coherent sense of emotions, and maintaining a coherent sense of self when threatened with the loss of identity.”self when threatened with the loss of identity.”

Suyemoto and Kountz, 2000Suyemoto and Kountz, 2000

Function SpecificsFunction Specifics

StimulationStimulation Escape dissociation through an intentional gesture to Escape dissociation through an intentional gesture to

feel one’s bodyfeel one’s body Self-grounding techniqueSelf-grounding technique

PunishmentPunishment Self-imposed response toSelf-imposed response to

GuiltGuilt

ShameShame

WeaknessWeakness

Function Specifics, cont.Function Specifics, cont.

Punishment, cont.Punishment, cont.AngerAngerLack of disciplineLack of discipline

RelaxationRelaxation Pleasure response to warmth of bloodPleasure response to warmth of blood

and/or physical sensation of painand/or physical sensation of pain Form of tension reductionForm of tension reduction Endorphin releaseEndorphin release

Function Specifics, cont.Function Specifics, cont.

DiversionDiversion Inducing a trance-like state to avoid Inducing a trance-like state to avoid

attending toattending to

An emotional triggerAn emotional trigger

Specific issueSpecific issue

Specific subjectSpecific subject

Suicidal thoughtsSuicidal thoughts

Function Specifics, cont.Function Specifics, cont.

Social Motives/AttentionSocial Motives/Attention Obtaining self-affirmationObtaining self-affirmation

Showing self and others one’s strengthShowing self and others one’s strength

Achieving nurturing and protection through the Achieving nurturing and protection through the response of othersresponse of others

AlterationAlteration Making one’s body unattractive to others through Making one’s body unattractive to others through

scarringscarring

What clients say…What clients say…

Perceived loss and/or abandonment precedes Perceived loss and/or abandonment precedes the actthe act

Experience of shame is high prior to SIBExperience of shame is high prior to SIB

Self-anger and/or sadness are common feelings Self-anger and/or sadness are common feelings both before and afterboth before and after

Isolation almost always occurs before SIBIsolation almost always occurs before SIB

What clients say… cont.What clients say… cont.

Frequently reported goalsFrequently reported goals Diminish negative feelingsDiminish negative feelings Self-punishmentSelf-punishment Avoidance of painful memoriesAvoidance of painful memories Induction of trance-like stateInduction of trance-like state

70% report release of tension and anxiety, 70% report release of tension and anxiety, and a sense of satisfaction following SIBand a sense of satisfaction following SIB

Therapeutic InterventionTherapeutic Intervention

Therapist must understandTherapist must understand Risk factorsRisk factors VariationsVariations FunctionFunction

Approaches to treatmentApproaches to treatment Assessment (initial and ongoing)Assessment (initial and ongoing) EducationEducation MedicationMedication Family therapyFamily therapy Individual and group therapyIndividual and group therapy Experiential therapyExperiential therapy

Therapeutic Intervention, Therapeutic Intervention, cont.cont.

Goals of treatmentGoals of treatment Safety first Safety first (validate emotion, but not behavior, thoughts)(validate emotion, but not behavior, thoughts)

Skill training Skill training (DBT works well)(DBT works well) Self-sootheSelf-soothe Manage emotionsManage emotions

Resolve psychological schemasResolve psychological schemas Replace lies with truth aboutReplace lies with truth about

GodGod

SelfSelf

OthersOthers

Therapeutic Intervention, Therapeutic Intervention, cont.cont.

Goals of treatment, cont.Goals of treatment, cont. Make connections between thoughts, Make connections between thoughts,

feelings, behaviorsfeelings, behaviors Identify triggersIdentify triggers

EmotionsEmotions SituationsSituations PeoplePeople Other external stimuliOther external stimuli

Behavior chain analysisBehavior chain analysis

Miscellaneous NotesMiscellaneous Notes

BaalBaal I will go before you and will level the mountains; I will I will go before you and will level the mountains; I will

break down the gates of bronze and cut through the bars break down the gates of bronze and cut through the bars of iron. I will give you the treasures of darkness, riches of iron. I will give you the treasures of darkness, riches stored in secret places, so that you will know I am the stored in secret places, so that you will know I am the Lord, God of Israel who summons you by name.Lord, God of Israel who summons you by name.

Isaiah 45:2, 3Isaiah 45:2, 3

For the word of God is full of living power. It is sharper For the word of God is full of living power. It is sharper than the sharpest knife, cutting deep into our innermost than the sharpest knife, cutting deep into our innermost thoughts and desires. It exposes us for what we really thoughts and desires. It exposes us for what we really are. Nothing in all creation can hide from Him. are. Nothing in all creation can hide from Him. Everything is naked and exposed before His eyes.Everything is naked and exposed before His eyes.

Hebrews 4:12, 13Hebrews 4:12, 13

Miscellaneous Notes, Miscellaneous Notes, cont.cont.

God’s unconditional love knows each of God’s unconditional love knows each of us to the depths of our pain, shame and us to the depths of our pain, shame and joy. Only He can truly understand what joy. Only He can truly understand what that excruciating sorrow is like. Through that excruciating sorrow is like. Through and with Him we have a hope and a and with Him we have a hope and a future. Bringing this to those who self-future. Bringing this to those who self-injure can provide them a new way of injure can provide them a new way of thinking.thinking.

Helpful websitesHelpful websites

www.selfinjury.comwww.selfinjury.com or SAFE (Self-Abuse Finally Ends) - 800-366- or SAFE (Self-Abuse Finally Ends) - 800-366-8288 8288

http://secured.nmha.org/mpower/411Cutting.htmhttp://secured.nmha.org/mpower/411Cutting.htm

http://http://dmlive.com/index.htmldmlive.com/index.html

http://groups.google.com/group/Fading-Scarshttp://groups.google.com/group/Fading-Scars

http://www.selfmutilatorsanonymous.orghttp://www.selfmutilatorsanonymous.org

http://www.Focusas.com/SelfInjury.htmlhttp://www.Focusas.com/SelfInjury.html

http://www.self-injury.org/index.htmlhttp://www.self-injury.org/index.html

Contact InformationContact Information

Catherine Jantzen, MS, LMHCCatherine Jantzen, MS, LMHCLead Therapist, Family Care CenterLead Therapist, Family Care Center2821 Hillegas Road2821 Hillegas Road

Fort Wayne, IN 46808Fort Wayne, IN 46808

260-471-1950 260-471-1950

cathyj@familycarectr.orgcathyj@familycarectr.org