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Understanding Teen Who Self Injure

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Understanding Teens Who Self Injure

Imagine being sixteen years old and taking a razor to your arm because you feel so much pain inside that cutting is the only way to escape it. For a lot of people this idea seems strange and incomprehensible, but for many teenagers this is their reality. In a society with so much abuse, neglect and crime children are facing things that they never had to face in the past. Adolescents who are lacking more positive coping skills are turning to self-injurious behaviors to ease their pain and frustration.

In recent years the issue of self-injurious behaviors or SIB (White Kress, 2003) has increased in popularity. The general public is starting to take a special interest in the issue as more and more people are doing it. The issue of self-mutilation can be found in movies, television and popular literature today. With increasing media attention people want to understand what these behaviors include, who does it and why. Although researchers agree that more research is needed on the topic, much is already known about these behaviors. About 1% of the general population and 4% of the mental health population suffer from a form of SIB (Shoemaker, 2004). Often times people who suffer from SIB have preexisting mental health disorders such as major depression, Dysthymia, dissociate identity disorder, OCD, substance abuse disorders, adjustment disorders, schizophrenia, personality disorders, and eating disorders (Brittlebank et al. as quoted in White Kress, 2003).

Although there is many different definitions of what SIB is, most researchers would agree that ?SIB is defined as a volitional act to harm one?s body without any intention to die as a result of the behavior? (White Kress, 2003). There are also a lot of different terms out there for these behaviors, they include self-inflicted violence, self-injury, self-harm, parasuicide, cutting, self-abuse, and self-mutilation (Martinson, 2001). Without any intention to die as a result is a very important piece of information when understanding SIB. While many people who self injure do have suicidal ideation, most are not in fact suicidal. ?Menninger described self-mutilation as the focusing of suicidal impulse on part of the body instead of the whole body to avoid actual suicide? (Zila & Kiselica, 2001). Someone who is suicidal wants to end his or her life, however someone who is self-injurious uses the behavior as a means of escape. SIB is often triggered by stress and intense emotions (Shoemaker, 2004). ?The object wasn?t to make myself bleed to death, just to let go of the ugly feelings holding me hostage-- feelings that would leave me at the sight of blood? (Pederson, as quoted in Zila & Kiselica, 2001).

SIB includes a wide range of behaviors including head banging, hair pulling, skin cutting, self-hitting, and skin burning. SIB is typically found in early adolescence but can become a chronic behavior that carries on into adulthood. Most research focuses on females who self injure because it is found that, while males do self injure many more females do it. We also need to take into consideration that females tend to be more help seeking than males; so many more males may be self-injuring than we know. Zila and Kiselica define the typical self-mutilator as female, adolescent or young adult, single, usually from upper- middle class family and intelligent. It is found that one in four teenage girls cut (Barnard, 2004).

SIB can be classified into four categories: Stereotypic SIB, Major SIB, Compulsive SIB and Impulsive SIB (White Kress, 2003). Each of the four categories corresponds with and tends to be more prevalent with various DSM-IV mental disorders. The following will describe each of the four categories in detail.

Stereotypic SIB

The kind of behaviors that can be classified under Stereotypic SIB include head banging, self-hitting and slapping, self biting, and hair pulling. These kind of behaviors are most commonly found in individuals with mental retardation, developmental delays, Tourettes, syndrome, Lesch-Nyhan syndrome, autism, temporal lobe epilepsy, and Cornelia de Lange. In this category SIB is seen as organically based, biologically driven behaviors. Stereotypic behaviors tend to be highly repetitive and at times may cause mild to serve tissue damage (White Kress, 2003).

Major SIB

Major SIB is a more serious form of SIB compared to Stereotypic. It can be potentially life threatening and includes such behaviors as castration, eye enucleation and limb amputation (White Kress, 2003). These types of behaviors are not common and usually occur when someone is suffering from severe psychosis, intoxication or character disorder. The person is in such as distorted state that they do not realize that their behavior is harmful and irrational. Many people suffering from Major SIB self injure in response to hallucinations or delusions (White Kress, 2003). People suffering from Major SIB often express that they feel no pain and may experience calmness before, after and during the injury.

Compulsive SIB

Compulsive SIB is a more repetitive form of SIB that includes such behaviors as hair pulling, skin picking, and nail biting. These behaviors range from mild to moderate in severity. Many people suffering from Compulsive SIB feel they need to carry out their impulses to self injure but would rather resist it. People suffering from SIB often have heightened states of anxiety, exhibit obsessive compulsive behaviors and may suffer from trichotillomania and stereotypic movement disorder. These people report that they have no control over their behaviors and they occur automatically. (Simeon & Favazza as quoted in White Kress, 2003).

Impulsive SIB

Impulsive SIB the more commonly known of the four types of SIB. It includes such behaviors as cutting, skin burning, and self-hitting. The behaviors range from mild to moderate and can be isolated or habitual (White Kress, 2003). There are two sub-categories of Impulsive SIB: episodic and repetitive. Episodic Impulsive SIB occurs only a small amount of times in a person?s life. Repetitive Impulsive SIB is more of a reoccurring form of SIB. Repetitive Impulsive SIB can have an addictive like quality to it and can be classified under Impulse Control Disorders in the DSM (White Kress, 2003). Impulsive SIB behaviors tend to be externally triggered and sporadic. This type of SIB is typically formed in early adolescence and by adulthood without proper help can become chronic. Psychological disorders associated with Impulsive SIB include BPD, antisocial, dependent and histrionic personality disorders; eating disorders, posttraumatic stress disorder and dissociative disorders (White



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