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Self Injurious Behavior

Major self-mutilation

Cut off appendages

Much tissue damage

Extreme & Uncommon

Mostly psychotic or intoxicated

Stereotypic self-mutilation

Head banging, finger/arm biting, etc

Autism, severe MR, other disorders

Self Injurious Behavior

(“SI”)

Superficial/moderate self-mutilation

Not highly lethal

Little tissue damage

Not suicidal

May become preoccupation

Identity… (“cutter”, “burner”)

Compulsive, episodic, repetitive

One study

Cutting, 72 %

Burning, 35 %

Self-hitting: 30 %

Interference with wound healing. 22 %

Hair pulling (trichotillomania), 10 %

Bone-breaking, 8 %

Multiple 78%

(Skin-picking)

1986 Study

10%- Great Pain

23%- Moderate pain

67%- Little or no pain

Who does it?

Prevalence

About 1% (.75-1.4%)

Most identified are female

Mostly white, middle class, above average IQ

(May be factor in some males who fight often)

Study: Women with eating disorders- 34.6%

History of

physical, emotional, sexual abuse

Posttraumatic Stress Disorder (PTSD)

Depersonalization

Dissociative Identity Disorder (MPD)

Eating disorders

Characterological traits or disorders

Addison's Disease

Benign intracranial hypertension

Coping mechanism

for extreme emotional stress

Lower levels of serotonin activity

What is the appeal?

Relief from overwhelming emotions

Feeling of control

Physical expression of emotional pain

Unreality, numbness, and dissociation

(Alleviation…bridge back to reality)

Get attention

Self-punishment and self-hate; shame

Self-nurturing

What to do

Premature elimination of SI

May lead to

Suicide or psychotic break

Develop replacement coping mechanisms

Overreaction can

dampen willingness to report

Shame and secrecy go hand in hand:

Don’t ignore what you see!

Indicators/warning signs

Avoiding gym class

Absent: emotionally/physically

Disappear to private space

Flimsy excuses for wounds

Long sleeves/pants when warm

Odd objects in odd locations

(paper clips, glass, razor)

Irritable when asked about it

Socially withdrawn, rejection-sensitive

Poor anger management

Express worthlessness/shame/self loathing

Regulate your own reactions

Avoid being

judgmental and demanding

Avoid “Why”

Be curious/inquisitive… concrete

”How do you make sure you don’t

…get infections?”

… nerve damage …

...share someone else’s disease

... permanent damage

… cut too deep/cut an artery?”

…develop tolerance

(leading to need for more dangerous cuts)

Suicide Screening

ASK!

Thinking about it?

Method chosen?

Method/means available?

Plan? (Time/Place)

Contract

BHR

800-811-4760, 314-469-6644

Life Crisis Services

314-647-4357 (H-E-L-P)

How did people react to your disclosure? (From a SI chat room/Web site)

'They freaked, flipped, were angry, confused, and tried to control me in every way possible, and that just made me more hostile and angry myself. But not everyone reacts that way - that was mainly my doctors, and family. my real life friends were concerned. At the time the people I told on the net didn't understand either, that's why they called my family *sigh* but I have people that understand now and that helps A LOT.'

'My friend told me that she wouldn't talk to me again unless I stopped it. She did that because she cared, but it made everything a lot worse for me'

'When I told my closest friend about the cutting she cried. That upset me in a way but it shocked me because it showed that she really did care. She was very supportive and told me that she would help me in any way that she could. That was everything that I could have wished for. I am very grateful to her and I owe her a lot.'

'My family made me feel very uncomfortable. They just didn't understand when I told them. They thought I was crazy and my Mom thought it was her fault that I was doing all this to myself. She shouted and told me it would get infected. I couldn't believe that she believed that would matter to me...'

'Cutting is me. If people can't take that they can leave it. All of my friends know and some ignored me. They weren't my real friends and I have learnt to deal with that...'

'My father seemed only to care about the fact the scars were there for life.'

'All of my friends knew and a few of them just made fun of it... They thought it was cool. the others didn't do anything about it... they knew I had problems.'

'Confessing to my friend was the hardest thing I have ever done. I didn't know why I wanted to confess, but I kinda needed to. He just shook his head at me and ran out of the room. I should have expected that, but for years it stayed in my mind - from that day on I vowed I would never tell a soul about it...'

'My friend encouraged me to talk to her about it, but one day it must have become too much for her. She couldn't cope. She told me that if I didn't stop hurting myself then she would tell my parents. I never talked to her after that.'

'Someone found out about the cutting before I really told anyone. I confessed to a friend that day, because I needed some help in dealing with people knowing, and cause I didn't want her finding out another way. That was a long time ago now, and at first she was wonderful - concerned, worried, and supportive. She told me she was there for me. Along the road she had problems dealing with it, and there were times I thought I would die because she just didn't want to be anywhere near me - she was trying to handle my problems as well as her own. It was unfair on her. When I started to see a therapist it helped, and now we are friends again. The cutting is a sore subject, and I don't tell people about it now. It's not a big part of my personality, it is just a part of the inner me rebelling against the outer me.'

'All I wanted was a shoulder to cry on and someone to tell me they would help me. What I got was panic about my health. Everyone seemed to take it that the cutting itself was the issue, and what it was doing to my health... the scars would always be there. No one asked me why, or what I was feeling. No one seemed to care. After that the cutting got worse. All I wanted was someone to listen to me and tell me that they understood, instead of telling me that they were worried about what I was doing to myself. No one understood...'

How do you want people to react?

'I wish my parents would have left me alone. They followed me everywhere when they found out - and it made me want to cut even more.'

'I guess I want understanding.. but then no one seems to understand.'

'My friend told me we would get through it together. I was lucky. He helped me through it every step of the way - just by being there and letting me know that he cared'

Alternatives suggested by someone on SI web site

It seems that the name of the game is distraction. I find that the following things have been mentioned by many people I know, and/or have helped me:

- Anything that keeps your hands busy - writing, drawing, typing, gluing... (word of advice: stapling/cutting paper etc may not be quite so effective!!!)

- Keep your mind busy - read, write, sing at the top of your voice, watch a soppy romance or a silly children's movie, learn to play patience.

- Phone/E-mail someone - for those times when nothing else seems to work, a friend is the best support system you can hope for. Join the list (http://health.groups.yahoo.com/group/Self_Injury/join)

and write to us when you feel like hurting yourself, keep a list of friend's phone numbers with you as emergency back-up. Write e-mails to friends - whether you send them or not.

- Set yourself targets - goals to see you through difficult parts of the day/week/month, with rewards for each one, can be extremely rewarding to you and can help take your mind of self injury. Try and set yourself goals that you can reach - don't be too hard on yourself!

- Exercise! - It will do you good health wise as well as taking your mind off things. Pushing yourself hard in exercise can often help soften the desire to self injure.

- Rubber bands - Many people suggest keeping a rubber band around your wrist (not too tight!) - pinging it against your skin when you feel the urge to cut can produce a little bit of pain that works for some and not for others.

- Draw in red pen in the areas you wish to self injure - this, again, works for some and not for others. Many people like to see the sight of their own blood when cutting, and this can help to soften that need.

Resources

http://www.healthyplace.com/Communities/Self_Injury

Bass, E. & Davis, L. 1994. The Courage To Heal. New York:Harper & Row Publishers.

Dr. Wendy Lader and Karen Conterio. , Bodily Harm

Alderman, T. (1997). The Scarred Soul: Understanding and Ending Self-Inflicted Violence. Oakland: New Harbinger.

About Self Injury Links http://depression.about.com/od/selfinjury/
From the About.com Depression site, links to even more information about self injury. Not just for teens, but very important information is covered here.

About Self Injury Explained http://mentalhealth.about.com/cs/familyresources/a/selfinjury.htm
From the About.com Mental Health site, a look at self injury, it's causes and the efects it has on sufferers and their loved ones.

Coping with Self Injury http://bipolar.about.com/cs/selfharm/a/sfe_si_coping.htm
Taken from the About.com Bipolar Forum, some real life discussions about coping and living with self injury.

Are you a cutter?

http://teenadvice.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2Fwww.angelfire.com%2Fks%2FCutters%2Findex.html
A personal web page on Angefire. From one cutter to another an important message, "you are not alone". Find out how one person recovered and how you can get help too.

Diary of a Self Harmer

http://teenadvice.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2Fwww.geocities.com%2FHotSprings%2FBath%2F2620%2Fme.html
Another GeoCities personal page. This one is in diary form and is very easy to read. Compelling insights. Lots of helpful information for anyone who is harming themselves.

15 more Articles & Resources below

Alternatives to Self Injury

http://teenadvice.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2Fwww.geocities.com%2FFebruaryDove%2Furges.html
A list of some alternatives to self injury that worked for one person. Not a medical analysis, but a personal sharing of information one person found helpful - you may find it helpful too.

Distracting Yourself from Self Injury

http://teenadvice.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2Fwww.palace.net%2F%7Ellama%2Fpsych%2Fthing.html
Some tips to help you stay focused on the issues in your life and to avoid self injury as an escape.

Reasons People Self Injure

http://teenadvice.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2Fwww.geocities.com%2FFebruarydove%2Freasons.html

A good look at the motivations behind self injury, from the most common to the most difficult to accept. Find out why this happens. A GeoCities page.

Personal Experiences with Self Injury

http://bipolar.about.com/cs/selfharm/a/sfe_si_personal.htm
Taken from the About.com Bipolar Forum, some real life discussions about experiences with self injury.

Safety Tips to Avoid Self Injury

http://teenadvice.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2Fwww.geocities.com%2FHotSprings%2F1872%2Fsafety.html
From "MollyKat" a cutter, some suggestions to help you safety proof your life while recovering from self injurious behavior.

Self Injury - A Struggle

http://teenadvice.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2Fwww.self-injury.net%2F
An online network started by a 16 year old former cutter. A well presented site with lots of useful information. If you hurt yourself, you'll want to see this site.

Online Support Group

http://teenadvice.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2Fwww.supportpath.com%2Fsl_s%2Fself_injury.htm
A great online support board for people dealing with self injury. Free with weekly all inclusive chats. From Support-Group.com.

Self Injury - You're Not Alone

http://teenadvice.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2Fmembers.tripod.com%2F%7Efuschia9%2Fsi.htm
A Tripod site. A good source of support and information from a recovered self injurer. Get help and learn that you are not alone.

The Way it Was - Then and Now

http://teenadvice.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2Fwww.angelfire.lycos.com%2Fjournal%2FThewayitwas%2Findex.html
Another diary from a person struggling with self injury. A good source of self awareness and a way to feel less alone for those who harm themselves.

Secret Shame - Self Injury Support

http://teenadvice.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2Fwww.palace.net%2F%7Ellama%2Fpsych%2F
A great place to find information and support on self injury. Dealing with things like; cutting, scarring, branding, burning, bone breaking, eye pressing and other harmful acts. Very good site.

Self Harm - A Safe Place

http://teenadvice.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2Fwww.areti.com%2Ftigger%2Fself.htm
An excellent site with two sections - one for people who hurt themselves, and one for people who want to help someone who hurts themselves. An excellent resource and support network.

"Self-Mutilation" in Psychiatry -- One Patients View

http://teenadvice.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2Fwww.bme.freeq.com%2Fnews%2Fselfmutp.html
A personal account of cutting and how it was handled by Psychiatric medicine. A good story for anyone who is self injurious to read.

Self Injury - Getting Help

http://teenadvice.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2Fwww.mirror-mirror.org%2Fselfinj.htm
Some good advice about self injury; what causes it and how you can overcome it. From Mirror Mirror.

Wounded

http://bipolar.about.com/cs/selfharm/a/0007_wounded.htm
From the About.com Bipolar site, a look at the wounds, external and internal, that are caused by self injury.