1. Intro to Self Injury Essential Question: How can we identify teenagers with mental disorders and what strategies can we use to help them?

2. Intro to Self Injury Learning Objective: The students will have an understanding of how to recognize warning signs and understand how to proceed with interventions.

3. What is Self Injury When you hurt your body on purpose it is called "self-injury." Other names for self-injury are "cutting", "self- harm", or "self-mutilation." When you hurt your body on purpose it is called "self-injury." Other names for self-injury are "cutting", "self- harm", or "self-mutilation."

4. Types of Self Injury Cutting Cutting Burning (or "branding" with hot objects) Burning (or "branding" with hot objects) Picking at skin or re- opening wounds Picking at skin or re- opening wounds Hair-pulling Hair-pulling Head-banging Head-banging Hitting (with objects) Hitting (with objects) Bone-breaking Bone-breaking

5. Why Do Teenagers Self Injure Themselves??? Teenagers who self- injure often report that there is no adult they could talk to who accepts them for who they are. Teenagers who self- injure often report that there is no adult they could talk to who accepts them for who they are. Could be an effort to make others care or feel guilty or to drive them away. Could be an effort to make others care or feel guilty or to drive them away. Self-injury can be set off by certain events. Self-injury can be set off by certain events.

6. Why Do Teenagers Self Injure Themselves??? To try to get a reaction from someone," "to get control of a situation," and "to stop bad feelings." To try to get a reaction from someone," "to get control of a situation," and "to stop bad feelings." Way to self-regulate feelings and help people cope with overwhelming negative emotions. Way to self-regulate feelings and help people cope with overwhelming negative emotions.

7. Why Do Teenagers Self Injure Themselves??? Children don’t know how to express and deal with anger and sadness, instead turning emotional pain on themselves. Children don’t know how to express and deal with anger and sadness, instead turning emotional pain on themselves. Depression, for example, is often described as anger turned inward Depression, for example, is often described as anger turned inward

8. Why Do Teenagers Self Injure Themselves??? Self-injury makes some people feel part of a group. Self-injury makes some people feel part of a group. Support from internet community. Support from internet community. When they don't want to self-injure anymore, it means they have to leave a community.“ When they don't want to self-injure anymore, it means they have to leave a community.“ Facebook and myspace groups Facebook and myspace groups

9. Why Do Teenagers Self Injure Themselves??? Celebrities, too, have contributed self-injury. Celebrities, too, have contributed self-injury. Confessions of self- injury include the late Princess Diana, Johnny Depp, Angelina Jolie, Nicole Richie, Richie Edwards, Courtney Love and the lead singer on the Garbage band album "Bleed Like Me." Confessions of self- injury include the late Princess Diana, Johnny Depp, Angelina Jolie, Nicole Richie, Richie Edwards, Courtney Love and the lead singer on the Garbage band album "Bleed Like Me."

10. How Often DO Teenagers Self Injure Themselves??? 46% of the high school students reported some form of self- injury within the previous year. 46% of the high school students reported some form of self- injury within the previous year. 17 percent of college students have self- injured 17 percent of college students have self- injured 15 percent of the general adolescent population. 15 percent of the general adolescent population.

11. Symptoms of Self Injury Frequent cuts and burns that cannot be explained Frequent cuts and burns that cannot be explained Self-punching or scratching Self-punching or scratching Needle sticking Needle sticking Head banging Head banging Eye pressing Eye pressing Finger or arm biting Finger or arm biting Pulling out one's hair Pulling out one's hair Picking at one's skin Picking at one's skin

12. Signs of Self Injury Others notice the following: Unexplained and frequent injuries Unexplained and frequent injuries Unexplained blood stains on clothing, bedding Unexplained blood stains on clothing, bedding Individual has tools (i.e., knife, lighter) in possession without explanation Individual has tools (i.e., knife, lighter) in possession without explanation Individual wears long sleeves and pants in warm weather Individual wears long sleeves and pants in warm weather

13. Signs of Self Injury Individual has difficulty with the following: Self-esteem Self-esteem Handling and/or expressing strong feelings Handling and/or expressing strong feelings Interpersonal relationships Interpersonal relationships Functioning at work, school, and/or home Functioning at work, school, and/or home

14. Signs of Self Injury Individual does the following: Makes excuses for injuries Makes excuses for injuries His/her own laundry (won’t let others help) His/her own laundry (won’t let others help) Isolates himself/herself for long periods of time Isolates himself/herself for long periods of time Becomes defensive when asked questions Becomes defensive when asked questions

15. Self Injury-Quotes "I feel relieved and less anxious after I cut. The emotional pain slowly slips away into the physical pain." "I feel relieved and less anxious after I cut. The emotional pain slowly slips away into the physical pain." "It's a way to have control over my body because I can't control anything else in my life.“ "It's a way to have control over my body because I can't control anything else in my life.“ ---Alicia Moore ---Alicia Moore Cutting Story: CBS Cutting Story: CBS

16. Self Injury-Quotes "It expresses emotional pain or feelings that I'm unable to put into words." "It expresses emotional pain or feelings that I'm unable to put into words." "I usually feel like I have a black hole in the pit of my stomach. At least if I feel pain it's better than nothing." "I usually feel like I have a black hole in the pit of my stomach. At least if I feel pain it's better than nothing."

17. Intervention and Treatment Find ways to soothe or focus yourself when you feel like self- injuring. Find ways to soothe or focus yourself when you feel like self- injuring. Make a list of non- harmful things that help you feel relaxed and real. Make a list of non- harmful things that help you feel relaxed and real. Keep this list where you can see it so when you feel like hurting yourself. Keep this list where you can see it so when you feel like hurting yourself.

18. Intervention and Treatment How do I stop hurting myself in the moment? Here are some ways to use up nervous energy: go for a long walk go for a long walk dance to loud music dance to loud music shoot hoops or kick soccer goals shoot hoops or kick soccer goals go jogging go jogging clean your room clean your room Here are some ways to relax and de-stress: take a bath or a hot shower take a bath or a hot shower listen to music listen to music write in a journal write in a journal talk to a friend talk to a friend read a good book read a good book

19. Intervention and Treatment How can I help a friend who self injures? Suggest to your friend that they talk to an adult they trust,, like a parent, school counselor, or their health care provider. Suggest to your friend that they talk to an adult they trust,, like a parent, school counselor, or their health care provider. Second, support your friend by listening to them, and letting them know you care about them. Second, support your friend by listening to them, and letting them know you care about them. Lastly, print out this guide, or some other information on self-injury, and give it to them. They can read it when they feel ready. Lastly, print out this guide, or some other information on self-injury, and give it to them. They can read it when they feel ready.

20. Intervention and Treatment What should I do if my friend won't talk to an adult, and refuses help? Find a trusted adult who knows your friend, and talk to that person. Find a trusted adult who knows your friend, and talk to that person. Tell an adult even if your friend asked you to keep their self-injury a secret! Tell an adult even if your friend asked you to keep their self-injury a secret! Remember your friends safety is of the most importance. Remember your friends safety is of the most importance.

21. Cutting-Nathalie's Story I Cut When The Pain Gets To Be Too Much Nathalie calls her self a "cutter." She is 15 years old. She doesn't have many friends in real life. Her best friends are from the Internet. On the Internet she can be totally honest. She can talk about why she cuts herself and why she doesn't eat. She has never had a boyfriend and she can not remember the last time anyone hugged her or told her they loved her. She lives with her grandparents because her step-father and mother didn't want her to live with them anymore. I Cut When The Pain Gets To Be Too Much Nathalie calls her self a "cutter." She is 15 years old. She doesn't have many friends in real life. Her best friends are from the Internet. On the Internet she can be totally honest. She can talk about why she cuts herself and why she doesn't eat. She has never had a boyfriend and she can not remember the last time anyone hugged her or told her they loved her. She lives with her grandparents because her step-father and mother didn't want her to live with them anymore.

22. Cutting-Nathalie’s Story She gets one hour three times a week on the Internet. If she goes one minute over, she loses it for two weeks. She said she can't talk to her grandparents. She said they come from another era. Nathalie told me she cuts when the pain gets to be too much. She has 23 scars. When she was 10 she would sit in the class and stare out the window. When the teacher would call out her name and tell her to stop looking out the window and pay attention it would frighten and embarrass her. She said the other children in the class would laugh at her. They called her the Nathalie the daydreamer. She gets one hour three times a week on the Internet. If she goes one minute over, she loses it for two weeks. She said she can't talk to her grandparents. She said they come from another era. Nathalie told me she cuts when the pain gets to be too much. She has 23 scars. When she was 10 she would sit in the class and stare out the window. When the teacher would call out her name and tell her to stop looking out the window and pay attention it would frighten and embarrass her. She said the other children in the class would laugh at her. They called her the Nathalie the daydreamer.

23. Cutting-Nathalie’s Story Sometimes she would get punished for not knowing the answers to the teacher's questions. She said once she had to write "I will not stare out the window" 500 times. I asked her what she would think about when she was staring out the window. She said she was usually trying to figure out why she was such a horrible person. I asked her why she thought of herself as a horrible person. She said, "I thought I must be horrible if my mother doesn't want me to live with her and my father never wanted to see me." I asked her if her mother had hit her. She said, "Yes. Sometimes." I asked her if she thought that her mother was abusive. She said, "No, I wouldn't say that. Sometimes she would get punished for not knowing the answers to the teacher's questions. She said once she had to write "I will not stare out the window" 500 times. I asked her what she would think about when she was staring out the window. She said she was usually trying to figure out why she was such a horrible person. I asked her why she thought of herself as a horrible person. She said, "I thought I must be horrible if my mother doesn't want me to live with her and my father never wanted to see me." I asked her if her mother had hit her. She said, "Yes. Sometimes." I asked her if she thought that her mother was abusive. She said, "No, I wouldn't say that.

24. Cutting-Nathalie’s Story She only hit me when I made her angry. So I guess I deserved it.“ Then I asked her why she thought her father never wanted to see her. She said, "I really don't know. Isn't it normal for a father to want to see his own daughter? What could I have done to make him hate me so much?" She said he moved away when she was 6. She said she has written him letters but he has never written back. She said she lays awake at night wondering if he ever reads the letters or if he even gets them. She said he must get them because they never get returned to me by the post office. She only hit me when I made her angry. So I guess I deserved it.“ Then I asked her why she thought her father never wanted to see her. She said, "I really don't know. Isn't it normal for a father to want to see his own daughter? What could I have done to make him hate me so much?" She said he moved away when she was 6. She said she has written him letters but he has never written back. She said she lays awake at night wondering if he ever reads the letters or if he even gets them. She said he must get them because they never get returned to me by the post office.

25. Cutting-Nathalie’s Story I asked her if she ever told anyone that her mother was hitting her. She said once she did but then they talked to her mother and the mother said Nathalie was a "compulsive liar." They believed her mother over Nathalie, so Nathalie was afraid to ever tell anyone else again. When we talked about her feelings she always said she learned that people didn't want to hear her true feelings. So she kept to herself. When they got too much for her, she would reach for her razor I asked her if she ever told anyone that her mother was hitting her. She said once she did but then they talked to her mother and the mother said Nathalie was a "compulsive liar." They believed her mother over Nathalie, so Nathalie was afraid to ever tell anyone else again. When we talked about her feelings she always said she learned that people didn't want to hear her true feelings. So she kept to herself. When they got too much for her, she would reach for her razor