Suicidal Thoughts Are Common in Teens From Better Off Dead, 1985, starring John Cusack
Teen Angst is Common (and can be profitable)Band: Suicidal Tendencies, 1983
Deliberate Self-Harm (DSH) is thestrongest risk factor for future suicide.• English study, 2000: 11,583 patients who presented to hospital after DSH between 1978 and 1997• The risk of suicide in the first year of follow-up was 0.7%, which was 66 times the annual risk of suicide in the general population.• The risk after 5 years was 1.7%, at 10 years 2.4%, and at 15 years 3.0%.
Co-Morbidity of DSH• Self-harm is listed in the DSM-IV-TR as a symptom of borderline personality disorder.• However, patients with other diagnoses may also self- harm, including those with depression, anxiety disorders, substance abuse, eating disorders, post-traumatic stress disorder, schizophrenia, and several personality disorders• Evaluation, diagnosis and treatment is essential to prevent progression and escalation
Motivations for Self-HarmMay be used to fulfill a number of different functions.Used as a coping mechanism which providestemporary relief of intense feelings: • Emotional pain • Dissociation from body • Anxiety • Depression • Stress • Emotional numbness • Sense of failure or self-loathing • Wish to feel connection to other cutters
Origins of Self-Harm Behaviors• Often associated with a history of trauma and abuse, including emotional and sexual abuse• Most common in adolescence and young adulthood, usually first appearing between the ages of 12 and 24.• Self-harm in childhood is relatively rare but the rate has been increasing since the 1980s.• Information initially shared by peers, or learned about through music or media• Many teens have little or no perspective, everything is “life or death” to them• Often, teens cannot engage in objective problem-solving
Cutting is not the only method of Self-Harm used
Physiological Markers For Cutting, Other Self- Harming Behaviors By Teenage Girls Found University of Washington psychologists found: • Adolescent girls who engage in behaviors such as cutting themselves have lower levels of serotonin, a hormone and brain chemical, in their blood • They also have reduced levels in the parasympathetic nervous system of what is called respiratory sinus arrhythmia - a measure of the ebb and flow of heart rate along with breathing - characteristic of people who are anxious and depressed, and among boys who are delinquent
DSH Does Not Hurt (Much)• Interestingly, self-injurers report little or no pain during Self-Harm Events.• They show a higher level of pain analgesia on lab-based tests of pain tolerance.• This finding has been reported consistently across studies of DSH and represents one of the most intriguing directions for future research on this topic
Famous Self-InjurersPrincess Diana Angelina Jolie Johnny DeppCourtney Love Marilyn MansonAmy Winehouse
How to tell if a student may be self-mutilating• Long sleeves in warm weather, wrist bands• Resistance to attend or dress in P.E.• Emotionally numb• Signs of repressed anger, irritability• Withdrawal from activities• Unusual interest in things that cut – knives, razor blades, etc.• May be reported to you by their friend
How NOT to Respond to Self-Harm• Don’t react in horror or upset. ("Oh, my God! How can you do that to yourself?" or "Doesnt that hurt?")• Dont be directive or judgmental. ("You must stop that." Or, “How could you do that to yourself?") Reassure them that there is nothing to be ashamed of.• Don’t say, or imply, that some sort of punishment or negative consequence will be imposed.• Don’t agree to keep it a secret. They need to get help, and you must make sure that they get it.• Don’t become a detective or inquisitor. Let them tell about their situation as they feel comfortable doing so.
Best Ways to Respond• Encourage connectedness without invading their space. ("I can see that you are hurting and I’d like to help." Or, "I may not be the right person to talk to, but I can help you find someone who is.")• Acknowledge their feelings. Offer to listen. ("You must be feeling really upset about something. Id like to help.")• Identify the behavior as a coping mechanism, not just a bizarre habit, and preferable to the alternative of suicide. ("I guess hurting yourself seems like the best way you have right now to deal with your feelings.")• Empathize, but don’t pretend to "know" how they feel. (“When I have a problem, I feel better when I talk to someone about it.")• Emphasize hope. ("It is probably hard to imagine giving up this way of dealing with your feelings, but lots of people learn healthier ways to cope. I am sure we can find someone to help.")
Dealing With the Student’s Family• May be in denial• May overreact• Help parents understand context• Assist with referral(s)
Atlanta Area Psychological Associates (770) 953-6401 atlantapsych.com We provide Free Assessments for Fulton County Students and Fulton County School District Employees