Investigating and Understanding Self-

Harming Behaviors in Adolescents

Michael Shufelt Moyer Ph.D, LPC

Brief Overview of Self-Injury

• Major, Stereotypic, and Moderate/Superficial

• Episodic/compulsive

• Significant difference between Self-injury and Suicide.

– Self-injury is the prevention of suicide– Usually done with controlled cuts– “is not a suicide attempt. It certainly is an

expression of disappointment with life – but that’s very different from a suicide attempt” (Levenkron, 1998).

Who is Most At-Risk• Generally begins between the ages of 10-14

(although being seen in younger students)• Most likely to be female• Often continues into 20’s and 30’s or moves to

other self-injurious behavior• Middle to upper class socio-economic status• Has been a victim of sexual or physical abuse• The inability to cope with tension or stressors in a

way manner• Poor ability to regulate emotions• Dysfunctional family unit or chaotic home life• Participates in other self-injurious behavior such as

eating disorders or alcohol or drug use• Frequent peer conflicts• Intimacy problems• Having another self-mutilating family member

Why students self-injure• Every student is different• A way to distract• Helps to clear the mind• Cuts and scars are a way to express

feelings when other ways don’t work (a means of communication)

• Injuries free oneself from negative feelings about self

• Injuries are a way to assert control• Relieves emotional distress• It is a way to maintain a sense of

identity

Myths About Self-Injury

• Self-injury is a sign of madness.• Students will eventually grow out of

it.• Self-harm is a manipulative/attention

seeking act.• It is a girls’ problem.• The best way to deal with those who

self-injure is to make them stop.• Those who self-injure have been

sexually abused.• Self-injury is a failed suicide attempt.

Reasoning Behind the Research• Why Self-injury?

• Conservative estimates say that about 2 million Americans self-injure.

• School Counselors are often times the first to encounter these behaviors and may be the first person a student turns to.

• Purpose of the Study.• Those who self-injure are often

misunderstood.• As adults, we often speak for adolescents

and try to figure out why and how they are acting without asking them.

Research Questions

• What is the experience that an adolescent has when performing self-injurious behaviors?

• What was going on in the student’s life that may have influenced him or her to cut for the first time?

• How did the student decide to hurt him/herself for the first time?

MethodologyData collection

Student Questions1. Tell me about the first time that you self-injured, “cut”

yourself2. What were some things that were going on in your life at

that time?3. How did you decide to self-injure “cut” yourself?4. Please describe the experience of self-injury, and what it

means to you.5. Please describe a recent situation when you participated

in self- injury and any thoughts or feelings that go along with the act.

6. Is there anything else you would like me know about self-injury?

Counselor Questions1. Please elaborate on your experience working with this

population.2. Tell me about what students have told you about self-

injury.3. Tell me about the feelings you see that accompany self-

harming behaviors in students.4. Can you describe any feelings that students have relayed

to you on how they are affected by self-injury?5. Describe what you have come to believe about this

behavior and your opinions about what the behavior means to adolescents.

The Students / CounselorsName Age Gender Ethnicity

Dakkota 12 Female White

Stephanie 15 Female White

Miranda 15 Female White

Destro 17 Male Hispanic/White

Ian 15 Male Hispanic

Tigger 18 Female Hispanic

Interview Case

manager/Counselor

Years Experience

Type of school

Gender Ethnicity

1 Case manager

1 High school

Female Hispanic

1 Counselor 2 High school

Female Hispanic

2 Case Manager

1 High school

Female White

2 Case Manager

1 High school

Female Hispanic

2 Case Manager

2 Middle school

Female Hispanic

3 Counselor 6 Middleschool

Female White

Results

• The 1st cut• Feelings of guilt, shame and regret• Not wanting to hurt others• A tape recorder in the head• A way to handle life situations and

cope with emotions • How they wish to be treated

The First Cut

• “A couple of my friends were doing it at school and they told me about it.”

• “At first, I really wasn’t going to”• “I couldn’t imagine how people

could inflict pain on themselves. And after I did it, instead of hurting, it actually felt, like better, instead of pain.”

Feelings of Guilt, Shame and Regret• everybody wants me to not do it.

• “hurting other people. Making them feel bad. I don’t like doing that.”

• “I’ll see the scar and I’ll be like, ‘God, you know, why did I do that?’”

Not Wanting to Hurt Others• “I still don’t want it (cutting) to hurt my

dad, even though he really doesn’t talk to me anymore. But I don’t know I just don’t want it to like hurt him or anyone else.”

• “Just think of all the people you are hurting. You’re going to have to stop sooner or later.”

• “I don’t take my anger out on other people. Like some people fight to let out their anger. I don’t do that. I hurt myself.”

• “Instead of, you know, going up to someone else, I can, you know, just do it to myself instead of doing it to someone else.”

A tape Recorder in the head• “I just get everything going through my head,

and then just think about it and then I just cut myself.”

• “I usually think about all the problems and all the anger I have, and then that drives me to do it. I usually think about all the problems and all the anger I have.”

• “I mean, everything that’s going on, it goes over – It’s like, I guess, a tape recorder going over in my head, just over and over and over.”

• “if you want to do it good while you’re cutting yourself, you have to think about all the things that are driving you crazy at the time. The more you think about it, the less it hurts.”

A way to handle life situations and cope with emotions• “It (cutting) was an easy way out. Some

people, they just won’t listen to your problems.”

• “It just makes me feel better. I guess it’s my way out.”

• “clear my mind and get everything else out. It just like blocks the whole world so it’s just me.”

• “cleansing, just getting rid of it (the pain). Every feeling you feel is going into your cut. The pain you feel goes into that (cutting).”

• “gives me something else to think about.” • “so much anger and stuff built up inside me

that I would just – I would just do it (cut).”

How they wish to be treated• “people call me freak and they, like,

talk about me behind my back.”• “It makes me mad when other people

get mad about it.”• “pretend like they don’t see it. It just

bothers me when people like ignore it.”

• “Teachers, they don’t really say anything. They just stay out of it. It’s like they look at them (the cuts), they don’t bother asking.”

Counselors Response

• “parents are scared to death,”• “had no idea that their child does this.”• “staff members and teachers need to

be more educated on how to handle a situation.”

• Teachers and administrators are not trained at all. It’s a total abomination. I have seen it handled so badly. I just think it’s absolutely horrendous how little the teachers and the principals, security officers, even the nurses

Implications for School Counselors• Increased training and educational

opportunities for parents, administrators, counselors, and students.

• Guidance Curriculum focused on healthy coping skill and building support networks starting at an early age.

• Individual counseling emphasizing basic counseling skills and simply listening

• Parent and faculty education that provides accurate information.

Parent and faculty education that provides accurate information.

• Provide accurate factual information to parents and families.

• Listen to concerns and worries.• Advocate for your students with

other faculty members.• Find appropriate referral

sources

Individual counseling emphasizing basic counseling skills and simply listening

• Informing students about Confidentiality and limits.

• Be aware of your own reactions and immediate responses

• Your first response is probably the most important one

• Treat the student and show that you care about them more than the behaviors.

• How to inform parents???

Helpful Responses

• Treat student as an individual and remember that this is an extremely private issue and one they are trusting you with.

• Some students may not believe they need help.

• Ultimatums do not work• Provide a therapeutic environment

in which the student feels comfortable talking about self-injury.

Activities and Resources

• Having a plan of action at your school

• Suggestions for alternate coping strategies

• The Safe Kit• http://selfinjury.com/• http://www.psyke.org/• http://www.palace.net/~llama/p

sych/injury.html

References

• Alderman, T. (1997). The scarred soul: Understanding and ending self-inflicted violence.

Oakland, CA: New Harbor Publishing Inc.• Conners, R.E. (2000). Self-injury: Psychotherapy with people who engage in self-

inflictedviolence. Northvale, NJ: Jason Aronson Inc.

• Conterio, K. & Lader, W. (1998). Bodily harm. New York: Hyperion Publishing. • Favazza, A. R. (1996). Bodies under siege: Self-Mutilation and body modification in

culture and psychiatry. Baltimore: Johns Hopkins Press.• Froeschle, J. & Moyer, M. (2004). Just cut it out: Legal and ethical challenges in

counseling students who self-mutilate. Professional School Counseling, 74,

231-235.• Levenkron, S. (1999). Cutting: Understanding and overcoming self-mutilation. New

York: W.W. Norton and Company.• Strong, M. (1998). A bright red scream: Self-mutilation and the language of pain.

New York, New York: Penguin Books.

• Walsh, B.W. (2006). Treating self-injury: A practical guide. New York: The Guilford Press.

• White Kress, V. E. (2003). Self-injurious behaviors: assessment and diagnosis. Journal of

Counseling and Development, 81, 490-495.• Zila, L. M. & Kiselica, M. S. (2001). Understanding and counseling self-mutilation in

female adolescents and young adults. Journal of Counseling and Development, 79, 1, 46-53.