Self-Harm/Self-Injurious Behavior

Self-Injury Information:

What Is Self-Injury?

The deliberate mutilation of the body or a body part, not with intent to commit suicide but as a way of managing emotions that seem too painful for words to express. It can include cutting the skin, burning the skin, bruising oneself through a premeditated accident. It can mean scratching or rubbing the skin until it bleeds, interfering with the healing of wounds or pulling hair out. In more extreme cases, self-injurers break their own bones, amputate their own digits, eat harmful substances or inject their bodies with toxins.

How long has this been going on?

This practice has long existed in secrecy. Cuts can be easily hidden under long sleeves. In recent years, movies and TV shows have drawn attention to it prompting greater numbers of teens and tweens (ages 9-14) to try it.

Why do kids do this?

People learn that hurting themselves brings them relief from some kinds of distress and eventually turn to it as a primary coping mechanism. When people who self-injure get emotionally overwhelmed, an act of self-harm brings their levels of tension and arousal back to a bearable level almost immediately. They may feel a strong uncomfortable emotion, don’t know how to handle it (indeed, often do not have a name for it), and know that hurting themselves will reduce the emotional discomfort extremely quickly. They may still feel bad (or not), but they do not have that panicky jittery-trapped feeling; it is a calm bad feeling. Self-injury has an effect similar to endorphins that create a feel-good feeling.

What else is this called?

You will hear it called many things—self-inflicted violence, self-mutilation, self-harm, cutting, or self-abuse.

What are some symptoms of this activity?

Small linear cuts often parallel like railroad ties carved into the forearm, the upper arm and sometimes the legs or abdomen. Words may also be cut into the skin.
Unexplained cuts and scratches, particularly when they appear regularly.
Mood changes like depression or anxiety, out of control behavior, changes in relationships, communication, and school performance. Kids who are unable to manage day-to-day stresses of life are vulnerable to cutting.
Social and emotional isolation and disconnectedness.
Indications of extreme anger, sadness, pain or images of physical harm in class work, journals, art, music, and poetry.
Other extreme risk-taking behaviors that could result in injuries.
Possession of sharp implements (razor blades, thumb tacks or more common items like paperclips and erasers).
Secretive behavior, spending unusual amounts of time in the bathroom or other isolated areas.
Consistent, inappropriate use of clothing designed to cover scars. For example, 100° weather and the individual is wearing long sleeves and pants.
Experimenting with mood altering substances.

Suggestions for the Family

DO’S:

LISTEN. Keep communication open by talking about things that would interest her even if it doesn’t interest you.
Accept your child even though you do not accept the behavior.
Work toward family solutions, there could be a disconnect within your family’s relationships.
Understand that this is his way of coping with the intense pain that she feels inside.
Encourage healthier coping strategies.
Ask open questions (what or how?) to encourage open conversation. Allow conversations to revolve around what your child wants to talk about no matter how silly or crazy it may seem to you.
Allow your child to share feelings with words or in art (drawing, painting, dancing, playing an instrument).
Encourage your child’s personal strengths all the time.
Help your child to get involved in some area of interest, after-school activity, a good cause or other goodwill effort.
If you suspect self-harm, seek professional guidance.
Remain calm and address the behavior with your child.
After getting help, it may take a long time for a person to be ready to give up self-injury. Encourage her and yourself by acknowledging each small step as a major achievement.

DON’T’S:

Don’t say or do anything to cause guilt or shame (e.g., “Why would you do such a thing?” “How could you?”)
Don’t act shocked or appalled by the behavior.
Don’t talk about the behavior in front of friends or with other relatives.
Don’t try to teach them what you think they should feel or do.
Don’t use punishment or negative consequences for self-harming behaviors.
Don’t keep your child from seeing friends, but be aware of their activities.
Don’t blame yourself for your child’s behavior.

Treatment Options for Self-Injury

Crisis Intervention & Problem Solving Therapy
Motivational Interview
Cognitive Behavior Therapy
Dialectical Behavior Therapy
Combined Group Therapy (for coping skills)
Family Therapy

Parental Assessment for Suicidality

S — Specificity of suicide plan
L — Lethality of means
A — Availability of the means
P — Proximity of help

A LCSW/ Psychologist Will

Be the primary therapist
Identify symptoms your child is having
Evaluate your child for health risk behaviors
Do a comprehensive suicide risk evaluation
Evaluate need for hospitalization
Develop a plan of treatment for your child
Work in tandem with psychiatrist

A Psychiatrist Will

Conduct a psychiatric evaluation
Provide diagnosis
Determine medication options
Prescribe and monitor medications

Supporting Your Child’s Treatment

Share observations with the therapist
Learn and implement strategies
Help your child maintain his/her progress
Support his/her ability to Name their feelings, Tame their emotions, & Break down their urges to self-injure through awareness of triggers, thoughts, feelings, and environment.
Stay involved

Websites:
www.selfinjury.org

Self-Directed Violence and Other Forms of Self-Injury— A Resource from the Centers for Disease Control(CDC)
Self-Harm— National Alliance on Mental Illness (NAMI)

Recommended Books:
“When Your Child is Cutting” by Merry E. McVey-Noble, PH.D, et al.

“Helping Teens Who Cut” by Michael Hollander, PH.D

“A Bright Red Scream” by Marilee Strong

“Don’t Let Your Emotions Run Your Life For Teens” – Sheri Van Dijk

Complied By: Marc DeAngelo, MSW (PWC School Social Worker)