Mary Seitz & Erin NobileOld Dominion University

Self-Injury

Non-suicidal self-injury is the intentional destruction of body tissue without suicidal intent and for purposes not socially sanctioned.

Intentional act with the objective to do harm to the body without leading to a result of death.

(Klonsky & Muehlenkamp 2007)

Typical age of onset: 13-14 years old◦ Occurs most often in adolescents and young

adults as compared to adults

Common forms: cutting, severe scratching, burning, and banging or hitting ◦ Typical areas injured: arms and wrists, legs,

abdomen, head, chest and genitals

(Kress, Gibson, & Reynolds, 2004)

◦Feeling concrete pain when emotional pain is too overwhelming

◦Reducing numbness, feeling real◦Keep traumatic memories away◦Affect Modulation◦Receiving support and caring from others◦Discharge of anger/anxiety/despair◦Sense of Control◦Self-Punishment◦Enhancement of Self-Esteem

(Kress, Gibson, & Reynolds, 2004)

Psychiatric Patients◦ Occurs in about 20% of adult psychiatric patients,

40–80% of adolescent psychiatric patients.

General Population◦ 4% of adults in the general population report a

history of self-injury.◦ 46% of 9th and 10th graders performed at least one

self-injurious behavior within the past year.

(Klonsky & Muehlenkamp 2007)

Life experiences that correlate with self-injurious behavior:◦ losing a parent, family violence, childhood sexual

abuse or rape, a childhood illness, and a history of self-injury in the family

Two of the best predictors of self-injury are childhood sexual abuse and/or family violence.

(White Kress, Drouhard, & Costin 2006)

DSM Controversy

Link between self-injury and eating disorders, anxiety and depression.

Suicide

Assess the intent or motivation underlying the self-injury as well as pay careful attention to the psychiatric symptoms being reported throughout treatment.

(Klonsky & Muehlenkamp 2007)

Most cultures have forms of culturally acceptable and sanctioned self-injurious behavior

Gender Differences◦ Similar overall rates in men and women ◦ Differences occur in the methods

Ethnicity◦ Rates of self-injury are higher in Caucasians than non-

Caucasians

Socio-Economic Status◦ More prevalent in middle and upper class

(Klonsky & Muehlenkamp 2007); (Kress, Gibson, & Reynolds, 2004)

Be aware◦ Know your student population◦ Recognize those who may be at risk

Educate yourself◦ Get to know the resources available in your

community

Offer a safe place for students who self-injure

(Caperton, 2004)

Multimodal Approach

Cognitive Behavior Therapy

Dialectal Behavior Therapy

Medication

(Caperton, 2004)

Questions to consider:◦ How do you think this cycle of self injury could

have been caught early on?◦ As a school counselor what should you look for

to identify a student who may be exhibiting these behaviors?

◦ What is the best way to confront a student, like the one in this example if you suspect they may be hurting themselves?

◦ How can you respect the student’s privacy while also protecting them from harm?

www.psyke.org

Questions to consider:◦ Did the counselor break confidentiality?◦ Did the counselor have a duty to warn others because

the student was a danger to herself?◦ What additional information might the school

counselor have gathered to more adequately assess the situation, and to have engaged in appropriate ethical decision-making?

◦ Suppose the counselor decided that Jennifer was not in danger of seriously harming herself, does the school counselor still have a responsibility to contact the student's parents?

(White Kress, Drouhard, & Costin 2006)

School counselors are ethically obligated to keep student-reported information

confidential unless disclosure is required to prevent clear and imminent danger to the counselee or others (ASCA, 2004). 

Thorough assessment: ◦ Severity◦ When a student self-injures◦ Age of onset◦ Frequency◦ Course of injuries (increased or decreased)◦ Medical complications (stitches or treated for

injuries)◦ Tools used to injure (Used? Clean? Rusty?)◦ Injure with anyone?◦ Wound care◦ Emotional state when injuring◦ Who knows about the cutting◦ Recent life experiences or past traumas.

(White Kress, Drouhard, & Costin 2006)

Ethical Decision Making Model Apply Moral Principles

Consult

Document

Community Resources that specialize in Self-Injury

◦ www.selfinjury.com

(White Kress, Drouhard, & Costin 2006)

Leadership

Collaboration

Advocacy

Systemic Change

American School Counselor Association. (2005) The ASCA National Model: A Framework for School Counseling Programs, Second Edition. Alexandria, VA: Author.

Caperton, Barbara (2004). What school counselors should know about self injury among adolescents: A literature review. University of Wisconsin Stout Graduate Guidance and Counseling. 25.

Focus Adolescent Services. (2008). http://www.focusas.com/SelfInjury.html.

Klonsky, D.E., & Muehlenkamp, J.J. (2007). Self- Injury: A Research Review for the Practitioner. Journal of Clinical Psychology: In Session, 63(11), 1045-1056.

Kress, V.E., Gibson, D.M., & Reynolds, C.A. (2004). Adolescents who self-injure: Implications and strategies for school counselors.

Professional School Counseling, 7, 195-201. S.A.F.E. Alternatives. (2007). http://www.selfinjury.com. Self Injury Information and Support. (2006). www.Psyke.org. White Kress, V.E., Drouhard, N. & Costin, A. (2005). Students

who self-injure: School counselor ethical and legal considerations. Professional School Counseling, 10(2), 203- 209.