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Self mutilation

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  • 1. Self MutilationChapter 3Group 02
  • 2. Definition and DescriptionSelf mutilation is defined as intentional, non-lethal, repetitive self bodily harm or disfigurementthat is considered socially unacceptable such ascutting, carving, burning, scalding, punchingoneself, and breaking bones.  Self mutilation is a symptom of several mental disorders such as: borderline personality, bipolar, major depression, anxiety, schizophrenia, and PTSD and it is not a mental disorder of it’s own.  The intent of these acts are not to cause death; it usually begins in late childhood or early adolescence and may continue for +10-15 years. Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA: Pearson Custom Publishing.
  • 3. Categories of Self-MutilationThere are three types of self-mutilation behavior:  Major self- mutilation: extreme acts usually associated with a psychotic state or acute intoxication that cause considerable damage.  Stereotypic self-mutilation: repetitive, rhythmic self- injurious behavior (such as head banging) carried out by individuals who are autistic, mentally retarted, and those with Tourette’s syndrome which has a strong biological component.  Moderate or superficial self-mutilation: more common form of self-mutilation which includes hair pulling, skin scratching, picking, cutting, burning, and carving. Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA: Pearson Custom Publishing.
  • 4. Categories of Self-Mutilation Continued…Moderate or superficial self-mutilation is thenfurther divided into three groups:  Compulsive self-mutilation: repetitive, ritualistic, behavior that occurs several times a day such as hair pulling and insults to the skin.  Episodic self-mutilation: periodical behavior that does not pre-occupy the individual. Is seen in clients who have depression, anxiety, personality disorders, and most commonly in borderline personality disorder.  Repetitive self-mutilation: a major preoccupation and consider it an addiction they can’t stop. Most common in females and appears in late childhood or early adolescence and continues for many years. Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA: Pearson Custom Publishing.
  • 5. Prevalence Is on the rise with young adolescents in middle school. It is expected that 8 million Americans will have one episode of self-mutilation. Most common in young individuals and those who have experienced childhood sexual abuse Prevalence rates in urban and suburban schools were almost the same with an average of 14.3% of students having self-mutilated and females more likely of doing so. Skin cutting is the most common form of self-mutilation followed by self-hitting. Associating with others who self-mutilate is a risk factor due to contagion Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA: Pearson Custom Publishing.
  • 6. Developmental Influences Rootsof this behavior are thought to be in unhappy early childhood experiences which could have included trauma from physical or sexual abuse, loss of a parent due to divorce, witnessing family violence, or illness or surgery. Thefeelings associated with such traumatic events may then intensify in adolescence due to pubertal changes occurring, which may cause further self- loathing. Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA: Pearson Custom Publishing.
  • 7. Reasons for Self-Mutilation It serves as an effective coping mechanism when other strategies are not present when feeling intense emotions. Serves as a release of pressure and relieves tension. The physical pain is the only control they feel they have and is a way to refocus attention from unbearable emotional pain that the individual has no control over (i.e. sexual abuse). It is a way for individuals to express emotional pain that seems inexpressible in words. Because self-mutilation may increase the levels of endorphins, it can become addictive.Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA: Pearson Custom Publishing.
  • 8. Theoretical ViewsDifferent theories seek to explain the origins anddynamics of self-mutilation. Biological Theories: explain that there are low levels of serotonin in the brains of self-mutilators. Additionally, that because endorphins are released during self-mutilation, the person then associates a pleasurable feeling with self-inflicted harm which encourages them to continue. Psychodynamic Theories: explain that real or anticipated loss is a significant antecedent to self- mutilation. It is suggested that when infant development stages are disrupted, self-mutilative behavior emerges when the person experiences a loss later on in life and the pain triggers this behavior.Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA: Pearson Custom Publishing.
  • 9. Theoretical Views Continued… Cognitive Behavioral Theory: explains that self- mutilation is strengthened through positive and negative reinforcements in the individuals life . It suggest that the behaviors is a symptom that can be corrected but are not concerned with the underlying issue. Narrative Theory: explains that individuals who self- mutilate are seeking a way to re-enact the childhood trauma they once experienced to prove that they are incapable of self-protection because they were not protected as children. Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA: Pearson Custom Publishing.
  • 10. Treatment Options and ConsiderationsThere are various treatment options for individualswho self-mutilate, however, not one single one ismore effective than another.Such option are:  Medication  Dialectical Behavior Therapy  Manual Assisted Cognitive-Behavior Therapy  Cognitive Analytic Therapy  Narrative Therapy  Group Therapy  Impatient Treatment Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA: Pearson Custom Publishing.
  • 11. Treatment Options Continued… Manual Assisted Cognitive-Behavior Therapy: This therapy incorporates many of the principles that DBT has but is normally given in no more than six sessions. Can be very practical because it can be given to patients via bibliotherapy. Cognitive Analytic Therapy: used with repeat self- mutilators and can be done in one session. It’s focus is on helping the client understand self-mutilation behavior, teaching problem-solving focus, help the client find alternatives to dealing with stress, and analysis of reciprocal role relationships.Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA: Pearson Custom Publishing.
  • 12. Treatment Options Medication: SSRIs such as Prozac, Paxil, and Luvox are used to reduce self-mutilation in individuals and is most successful in conjunction with other forms of treatment. Therefore, it should never be used as a form of absolute treatment. Dialectical Behavioral Therapy: An outpatient program that includes weekly individual and group therapy for the duration of a year that includes instruction in mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance that will carry over successfully in the individuals world outside of treatment. Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA: Pearson Custom Publishing.
  • 13. Treatment Options Continued… NarrativeTherapy: sees symptoms of self mutilation as “stories”, in which the problem is located outside the individual. Three stages:  Outer: The counselor inquires about the context of the client’s life with no focus on the self-mutilation.  Middle: The counselor inquires about the client’s trauma and symptoms and encourages client to build a support system.  Inner: The counselor focuses on identifying the aspects of the client that were internalized as a way to cope with the trauma or abuse. Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA: Pearson Custom Publishing.
  • 14. Treatment Options Continued… Group Therapy: used simultaneously with individual therapy. It allows the client to feel that they are not alone in this problem. However, caution should be used with self-mutilation groups because of contagion and members becoming too involved in the other patients’ recovery which can become counterproductive. Inpatient Treatment: usually for those who are not benefiting from outpatient therapy and their behavior is escalating. Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA: Pearson Custom Publishing.
  • 15. Dos Counselor Dos for working with clients who self- mutilate are:  Show that you care  Show concern for the injury and offer compassion  Help client recognize and understand the function and origin of the behavior  Help client learn other ways of expressing difficult feelings or memories and to ask for support  Encourage client to create and strengthen support systems  Encourage and acknowledge any gains made by the client, no matter how small  Encourage patients to seek help online with individuals also struggling with this behavior because it might encourage disclosure of feelings and emotions which can be healthy.Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA: Pearson Custom Publishing.Richardson, B. G., Surmitis, K.A., & Hyldahl, R. S. (2012). Minimizing social contagion in adolescents who self-injure: Considerations for group work, residential treatment, and the internet. Journal Of Mental Health Counseling, 34(2), 121-132.
  • 16. Don’ts Counselor Don’ts when working with clients who self-mutilate  Encouraging detailed verbal descriptions of the self-mutilation rather than focusing on the underlying emotional issues  Suggesting substitute behaviors that “re-enact” the feeling of cutting  Encouraging techniques that release anger such as punching objects, rather than encouraging verbal expression.  Hypnosis  Reinforcing the behavior by being the clients “hero” and excessively going above and beyond to try to maintain the clients safety . Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA: Pearson Custom Publishing.
  • 17. Issues of Diversity Self-mutilation is known to cross the lines of culture, race, and socioeconomic status It is suggested that females self-mutilate at higher rates than males across all age levels Individuals who are more likely to come forth and admit to self-mutilation behaviors are female, bisexual, or questioning their sexual orientation  Persons with Disabilities  Self-mutilation is a common behavior among individuals with developmental disabilities (stereotypic type)  The degree of developmental impairment is related to the level of risk that individual has to self-mutilate, with individuals who have a more severe disability likely to show more self-mutilation behavior.  Treatment for individuals who have developmental disabilities and self-mutilate are preferred to be medication and behavior modification programs Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA: Pearson Custom Publishing.
  • 18. Assessment There is no particular profile associated with people who self-mutilate nor is there one specific assessment test designed to test for self-mutilation Self- report inventories are more common Observation and direct questioning are the best ways to assess an individuals level of self- mutilation behavior When self-mutilation behavior is acknowledged, then it is important for the counselor to follow up with more in depth questioning Counselors should refer patients to a physician to treat any possible infections to sightBauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA: Pearson Custom Publishing.
  • 19. Counselor Issues It is difficult for counselors to accept the possibility that they may not be able to stop their client from engaging in self-mutilation behavior. Counselors should refrain from excessive sympathy for the behavior because it can reinforce it and should focus on the emotions behind the behavior instead Counselors should not overreact to non- suicidal self- mutilation and should refrain from seeking unnecessary medical intervention. Counselors need to be aware of the commitment required to work with this population Counselors should caution not letting their frustration become an impediment in the therapeutic process Counselors should use good judgment and realize when they must make a referral to a more qualified professional. When pertaining to adolescents, counselors need to determine whether the injury is severe enough to breach confidentiality and inform the adolescent’s parents. Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA: Pearson Custom Publishing. Hoffman, R. M., & Kress, V. E. (2010). Adolescent nonsuicidal self-injury: Minimizing client and counselor risk and enhancing client care. Journal of Mental Health Counseling, 32(4), 342-347.
  • 20. Ethical Concerns Counselors should always provide informed consent that covers the clients limits of confidentiality; which should include duty to protect. It is important for counselors not to overreact to self- mutilation behavior due to their own level of fear and seek extreme measures (i.e. hospitalization) It is also important that counselors to not disregard such behavior either and make the appropriate referral if the situation is beyond their level of competence. Counselors should aim at seeking supervision from another mental health professional who is experienced when working with clients who self- mutilateBauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA: Pearson Custom Publishing.
  • 21. ReferencesBauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA: Pearson Custom Publishing.Hoffman, R. M., & Kress, V. E. (2010). Adolescent nonsuicidal self-injury: Minimizing client and counselor risk and enhancing client care. Journal of Mental Health Counseling, 32(4), 342-347.Richardson, B. G., Surmitis, K.A., & Hyldahl, R. S. (2012). Minimizing social contagion in adolescents who self-injure: Considerations for group work, residential treatment, and the internet. Journal Of Mental Health Counseling, 34(2), 121-132.