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Coping with Self-Injury

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Coping with Self-Injury COPING WITH SELF-INJURY Stephanie Larsen, Psy.D. Clinical Psychologist Palm Beach Behavioral health & wellness DISCLOSURE STATEMENT There is no conflict of interest or commercial support for this presentation. LEARNING OBJECTIVES To be able to identify types of self-injury To understand common reasons for onset of self-injurious behaviors To understand how self-injury is perceived by the injurer as helpful To be able to differentiate between self-injury and suicide attempts To identify potential ways of treating self-injurious behaviors NON-SUICIDAL SELF INJURY (NSSI) Non‐suicidal self‐injury (NSSI) has been defined as the deliberate, self‐inflicted destruction of body tissue without suicidal intent and for purposes not socially sanctioned (ISSS, 2007) DSM-5 SECTION 3: EMERGING MEASURES & MODELS (AREAS OF FURTHER STUDY) (A) In the last year, the individual has, on 5 or more days, engaged in intentional self-inflicted damage to the surface of his or her body, of a sort likely to induce bleeding or bruising or pain for purposes not socially sanctioned (e.g., body piercing, tattooing, etc.), but performed with the expectation that the injury will lead to only minor or moderate physical harm. The behavior is not a common one, such as picking at a scab or nail biting. (B)The intentional injury is associated with at least 2 of the following: (1)psychological precipitant: interpersonal difficulties or negative feelings or thoughts, such as depression, anxiety, tension, anger, generalized distress, or self-criticism, occurring in the period immediately prior to the self-injurious act, (2)urge: prior to engaging in the act, a period of preoccupation with the intended behavior that is difficult to resist (3)preoccupation: thinking about self-injury occurs frequently, even when it is not acted upon (4)contingent response: the activity is engaged in with the expectation that it will relieve an interpersonal difficulty, negative feeling, or cognitive state, or that it will induce a positive feeling state, during the act or shortly afterwards C)The behavior or its consequences cause clinically significant distress or interference in interpersonal, academic, or other important areas of functioning. (This criterion is subject to final approval on the use of criteria that relate symptoms to impairment.) (D)The behavior does not occur exclusively during states of psychosis, delirium, or intoxication. In individuals with a developmental disorder, the behavior is not part of a pattern of repetitive stereotypies. The behavior cannot be accounted for by another mental or medical disorder (i.e., psychotic disorder, pervasive developmental disorder, mental retardation, Lesch–Nyhan syndrome, stereotyped movement disorder with self-injury, or trichotillomania). (E)The absence of suicidal intent has either been stated by the patient or can be inferred by repeated engagement in a behavior that the individual knows, or has learnt, is not likely to result in death COMMON FORMS OF NSSI Cutting (70%) Burning Scratching Hitting/ Punching Self Biting Pulling out hair Choking Interfering with healing of wounds Ingesting harmful toxins or substances WHO IS SELF HARMING? This Photo by Unknown Author is licensed under CC BY-SA-NC It’s very difficult to have clear prevalence due to varying definitions We CAN agree that onset is most frequently between 13 and 15 - 25% before the age of 12 7-8% of children 15% of teenagers 17% of College Students 1-4% of - Ranges: 14-38% -Ranges: 17- 35% Adults - NIMH(2015) estimates 9-16% with increase over last two decades MALE VS. FEMALE Many studies suggest no difference between male versus female Differ in type of self injury Females seen more frequently in treatment Boys seen more comorbidity with substance use 2x to be under influence of alcohol 5x to be under influence of drugs DON’T FALL INTO STEREOTYPES WHY SO POPULAR IN OUR TEENAGERS? Some individuals are contributing the increase in reported self-harm to be related to: Increased violence and self-destructive themes in media Increased choices and adult responsibilities placed on adolescents Demand and intensity of peer groups (effects of social media) Stress Overload Focus on quick fixes, immediate gratification Societal shift to thinking things should be painless and easy Selekman, 2009. (#4) 2:10 TO 3:53 SIB AND CULTURE http://www.selfinjury.bctr.cornell.edu/resources.html#tab6 NEUROBIOLOGICAL MATURATION Prefrontal Cortex, including frontal lobes, goes through significant changes in adolescent Correlated with significant behavioral change: learning to regulate emotions, make plans, and control impulses Animal Studies indicate highest density of dopamine receptors during adolescence Correlated with significant responsiveness to reward signals Risky choices and processing emotional information create much higher activation in amygdala and dopamine receptors than children or adults Adolescents display exaggerated stress response due to increased steroid hormone, cortisol, released from the Hypothalamic-Pituitary-Adrenal (HPA) axis Increased activity in the HPA and increased cortisol contributes to high emotional reactivity Ballard, E., Bosk, A., & Pao, M. (2010) Invited Commentary: Understanding brain mechanisms of pain processing in adolescents’ non-suicidal self injury. Journal of Youth and Adolescence, 29 (4) WHAT WERE YOU DOING AT 15? WHAT DO TEENS HAVE TO WORRY ABOUT? Homework College Frenzy (2016) 1 to 5 hours a night for middle 69% high school seniors enroll AND high school students directly into college 65% acceptance rate at a “typical school”. 71% in Average high school student 2001 with 5 classes= 17.5 hours per week 19.9 million students projected (2018) > 15.3 million students in fall 2010 Ivy League school acceptance rates fell approximately .5-1% from last year Bullying (CDC, 2015) • 35% of 12-18 –year-olds report traditional bullying • 15% have been cyber-bullied in last year Sex and Relationships (CDC,2015) • 41% of high school students have had sexual intercourse • 30% have had sexual intercourse in the last three months; 43% of these individuals did not use a condom • (2013) 15% of high sexually active high school students have had sex with four or more partners • (2014) 22% of girls and 18% of boys have sent nude pictures or semi-nude pictures to others • (2014) anonymous online undergraduate study indicates over 50% reported sending nude pictures during high school 24 Hour Media Exposure Importance of Peer Acceptance/ Interpersonal Relationships • Self Identity is developed by peer feedback in early adolescents Sport Performance or Extracurricular Activities • 66% of students LOGIC- 1-800-273-8255 • September 24, 2018 = 292, 114,170 YouTube views • 50% increase in calls following VMA performance • In the last year it has remained 25% higher usage • https://www.youtube.com/watch?v=Kb24RrHIbFk DESENSITIZATION IN MEDIA CONTINUED… YouTube 8.5 million “Cutting” videos (two year’s presentation) 19.6million “cutting” videos (last years presentation) 1.2 million “self harm” Suicide Prevention hotline and text line provided - FACEBOOK YOU CAN FLAG PICTURES OR STATUSES THAT SUGGEST SUICIDAL IDEATION OR SELF HARM BEHAVIORS AND FACEBOOK WILL PROVIDE OPTIONS FOR RESOURCES FOR BOTH INDIVIDUALS INCREASING THE ODDS… Being Female (for cutting) Being an ‘early teen’ Having friends that self-harm Traumatic Life Events Death, abuse, questioning identity, unstable home Mental Health Issues Use of Alcohol or Illicit Substances Less Parental Supervision/ Involvement ATTEMPTING TO UNDERSTAND… HTTP://WWW.YOUTUBE.COM/WATCH?V =ZVB3M4Z8ZHC FUNCTION OF SELF INJURY Primarily, an attempt to COPE and a physical expression of being OVERWHELMED It is continued because to many it is an effective coping mechanism AFFECT REGULATION Many adolescents report anxiety, depression, feeling “sad,” “lonely,” and “alone” prior to engaging in self-harm 63-78% for emotional distress Attempt to escape from trapped feelings of psychological and emotional distress which they cannot find a way to solve or cope with Temporary distraction from anxiety, depression, rejection, or distress PAIN Our brains use the same two areas to sense physical and emotional pain the anterior insula and the anterior cingulate cortex. Pain relievers also act in these two areas seamlessly: Tylenol will relieve distress associated with emotional distress and physical pain. Pain causes inhibition of the amygdala and emotional centers of the brain. Physical pain acts as an emotional regulation mechanism since emotional and physical pain are interpreted in the same area SOCIAL DISTRESS AND PAIN “Social Pain” primarily perceived by adults demonstrates significant activation of the ACC and decreased activation of Prefrontal Cortex. In adolescents activation in the insula and Prefrontal Cortex AND differential activation in the subgenual ACC and ventral striatum Decoded: Adolescents experience social pain in different regions of the brain than adults Pain causes inhibition of the amygdala and emotional centers of the brain. PAIN AND SELF INJURY Those that engage in NSSI experience heightened emotional distress Heightened activation of limbic circuitry to both positive and negative emotions Heightened amygdala activation correlating to more emotion regulation problems Experience higher physiologic reactivity Higher pain threshold under both stress and non-stress conditions Less sensitive to thermal stimuli and laser radiant heat pulses Pain thresholds increase
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