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Self-Injury Kellie Szerlag, M.Ed. School Psychology Intern

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1 Self-Injury Kellie Szerlag, M.Ed. School Psychology Intern
University of Massachusetts, Boston

2 What’s Happening: Adolescence
Time of transition and change. Maturing bodies and minds Combination of Thoughts/Feelings: center of attention, but alone in experiences. Early Adolescence: world is more black and white. Later Adolescence: better able to understand self. Learning How to: Establish and maintain relationships. Define self and purpose. Understand themselves and the world.

3 Why discuss Self-Injury?
Nonsuicidal self-injury (NSSI): is a growing public health concern among adolescents. Self-injury is often identified in schools

4 What is Self-Injury? Terms: self-harm, cutting, self-mutilation, & non-suicidal self-injury (NSSI) NSSI: “the deliberate destruction of one’s own body tissue without the intent of death” (Taylor, Peterson, & Fischer, 2012).

5 Self-Injury vs. Suicide Attempts
Self-injurers are typically not attempting suicide. Connection to thoughts of suicide later in life. Physically harmful and dangerous Related to impulsiveness Dysfunctional/Maladaptive coping strategy

6 Most Common Forms of Self-Injury
Skin cutting Burning People who Self-Injure might: Pick or interfere with wound healing Engage in behavior secretively Bathrooms or other secluded areas.

7 Identifying Self-injury
Frequent unexplained scars/burns Non-dominant arms, forearms, hands Can be anywhere on body “Covering-up” with clothing Constant wearing of wrist bands, long sleeves, multiple bracelets

8 Who is at-risk? Victims of abuse Family Conflict Mental illness
Higher rates among: Females LGBTQ

9 Who is at Risk? Impulsivity Low self esteem Low levels of resiliency
Poor problem-solving skills Difficulty regulating emotions Often related drug and alcohol abuse

10 Adolescents who self-injure reported they do it to:
Self-soothe Reduce severe distress “Feel good” Express negative feelings Hopelessness, worthlessness, depression, anxiety or distress  Fight feelings of numbness  Feel a sense of control

11 Why Adolescents Self-Injure
Belief: self-injury achieves emotional equilibrium when they can’t regulate or control emotions (self-soothe). To relieve intolerable emotional pain To communicate a deep sense of anguish. A cry for help

12 Self-Injury in Social Groups
Sometimes considered “contagious” among groups of friends. Importance of protocols for dealing with self-injury in schools. Parent involvement and communication with children.

13 Protective Factors Connectedness Access to mental health services
Spiritual life Stable families

14 Roles of the School Communication is important between school-home-outside clinician. Support Staff and Medical Professionals School should be involved in the reinforcement of coping strategies and communication skills.

15 Responding to Self-Injury
Medical attention Outside counseling or therapy Have a strong support system, treatment can be long and tough for parents. Support siblings

16 Responding to Self-Injury
Understand self-injury as a way to cope or handle intense feelings. Encourage them to share feelings through journaling or in art (drawing, painting, creating). Remove tools After-school activities or hobby/interest. Community outreach

17 Things to Avoid Avoid statements that might cause guilt or shame
Try not to appear shocked by this behavior. Avoid talking about their self-injury in front of friends or with other relatives. Try to teach them what you think they should do Avoid punishment for self-injurious behaviors. Overprotecting might be harmful, but try to be aware of what’s going on. Don’t blame yourself for your child’s behavior.

18 Communication and Bonds as Protective Factors
Family connectedness is a protective factor. Reduced likelihood of harmful or dangerous behaviors (e.g., drugs, alcohol, or sex, etc.) Fewer mental health problems Increased likelihood of making “right” choices and standing up for believes. Predicts more constructive coping skills and social skills Difficult topics are better discussed when connectedness and communication are in place.

19 But my child pulls away…
Searching for own identity. Time spent with family drops an estimated 21% More times with friends, work, or dating relationships. Does not mean there is not a secure bond or good relationship Conflicts happen Not a sign of poor relationship Important that parents and adolescent maintain understanding and empathy while disagreeing Confidently state opinion  show empathy/understanding of other point of view.

20 Communicating with your Child
Ask open questions (what or how) to encourage him/her to open up. Allow conversations to revolve around what interests your child. Spend time together, with their choice of activity. Dinner time and Cooking together Connections with other family members

21 Safety Independence but still developing good decision making skills.
Peer approval is important. Discuss Safety and dangerous consequences of: Motor vehicles Substance abuse Protective Gear in sports Healthy Relationships Internet Safety

22 What helps your family stay connected?
Approaches to discussing difficult or sensitive topics that have worked for your families?

23 Local Resources & Support Lines
Wayside Youth & Family Support (508) http:// Advocates, Inc (508) National Suicide Prevention Lifeline TALK (8255) Samaritans Statewide Befriending Line HOPE (4673)   (24 hrs) Samariteens Helpline TEEN (8336) 3pm-9pm weekdays/9am-9pm weekends

24 Additional Resources American Self Harm Information Clearinghouse
National Mental Health Association (fact sheet) National Association of School Psychology (NASP)

25 Questions? Thank you!

26 References Bakken, N. W., & Gunter, W. D. (2012). Self-cutting and suicidal ideation among adolescents: Gender differences in the causes and correlates of self-injury. Deviant Behavior, 33(5), doi: / Brock, S. E. (2002). Crisis Theory: A Foundation for the Comprehensive School Crisis Response Team. In S.E. Brock, P.J. Lazarus, % S.R. Jimerson (eds.), Best Practices in School Crisis Prevention and Intervention (pp. 5-17). Bethesda, MD: National Association of School Psychologists. Brock, S. E., Nickerson, A. B., Reeves, M. A., Jimerson, S. R., Lieberman, R. A., & Feinberg, T. A. (2009). School Crisis Prevention and Intervention: The PREPaRE Model. Bethseda: National Association of School Psychologists. Bubrick, K., Goodman, J. & Whitlock, J. (2010). Non-suicidal self-injury in schools: Developing and implementing school protocol. [Fact sheet] Cornell Research Program on Self-Injurious Behavior in Adolescents and Young Adults. Retrieved from

27 Cromer B. Adolescent Development
Cromer B. Adolescent Development. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011: chap 104 Gonzales, A., & Bergstrom, L. (2013). Adolescent non‐suicidal self‐injury (NSSI) interventions. Journal Of Child And Adolescent Psychiatric Nursing, 26(2), Guan, K., Fox, K. R., & Prinstein, M. J. (2012). Nonsuicidal self-injury as a time-invariant predictor of adolescent suicide ideation and attempts in a diverse community sample. Journal Of Consulting And Clinical Psychology, 80(5), doi: /a Klonsky, E., May, A. M., & Glenn, C. R. (2013). The relationship between nonsuicidal self-injury and attempted suicide: Converging evidence from four samples. Journal Of Abnormal Psychology, 122(1), doi: /a Lieberman, R. (2004) Understanding and Responding to Students Who Self-Mutilate. Principal Leadership Magazine, Vol. 4, No. 7, March 2004, Produced in cooperation with the National Association of School Psychologists.

28 Muehlenkamp, J. , Brausch, A. , Quigley, K. , & Whitlock, J. (2013)
Muehlenkamp, J., Brausch, A., Quigley, K., & Whitlock, J. (2013). Interpersonal features and functions of nonsuicidal self-injury. Suicide And Life-Threatening Behavior, 43(1), doi: /j X x Radovic, S., & Hasking, P. (2013). The relationship between portrayals of nonsuicidal self-injury, attitudes, knowledge, and behavior. Crisis: The Journal Of Crisis Intervention And Suicide Prevention,34(5), doi: / /a000199 Self-harm in young adults. National Alliance on Mental Illness. Accessed Oct. 11, 2010. Sornberger, M. J., Smith, N., Toste, J. R., & Heath, N. L. (2013). Nonsuicidal self‐injury, coping strategies, and sexual orientation. Journal Of Clinical Psychology, 69(6), doi: /jclp.21947 Walsh, B. (2012). Treating Self-Injury: A Practical Guide (2 ed.). New York, New York: Guilford Publications.

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