A matter of beauty…

A matter of beauty…

• A matter of beauty…

• Güzellik konusu…

For thousands of years human beings

• For thousands of years human beings

• have found creative and interesting

• ways of inflicting harm, damage, and

• pain on themselves….usually for the

• purpose of enhancing perceived

• beauty, acceptance, or for tribal,

• cultural or personal identity…..

• Although these acts are often

• injurious, they do not constitute

• “Self-Injury”.

Tattooing…once thought to be “savage” or at least the traditional mark of a sailor….now is increasingly accepted as very normal….

• Tattooing…once thought to be “savage” or at least the traditional mark of a sailor….now is increasingly accepted as very normal….

This form of body ornamentation has existed for thousands of years and can occur in remarkably large number of forms….

• This form of body ornamentation has existed for thousands of years and can occur in remarkably large number of forms….

and may represent tribal

• and may represent tribal

• or clan affiliation…

……or not!

• ……or not!

The intentional scarring of the body by hot irons or by ornamental cutting remains a widely used form of body decoration… for identification or as a mark of loyalty.

• The intentional scarring of the body by hot irons or by ornamental cutting remains a widely used form of body decoration… for identification or as a mark of loyalty.

The process is usually begun early in life with the full consent and participation of parents and the society…..

• The process is usually begun early in life with the full consent and participation of parents and the society…..

With advances in surgical technology and technique has come increased acceptance of body modification that represents positive change..

• With advances in surgical technology and technique has come increased acceptance of body modification that represents positive change..

• Cosmetic Surgery

Individuals have also found creative and interesting ways of inflicting harm, damage, and pain on themselves in an attempt to cope with pain, grief, or even everyday stress.

• Individuals have also found creative and interesting ways of inflicting harm, damage, and pain on themselves in an attempt to cope with pain, grief, or even everyday stress.

Self-injury (SI): the deliberate, direct, and non-suicidal, self-inflicted damage or alteration of one’s body tissues. As the result of these self-inflicted acts the body is left changed…

• Self-injury (SI): the deliberate, direct, and non-suicidal, self-inflicted damage or alteration of one’s body tissues. As the result of these self-inflicted acts the body is left changed…

Self-Injurious Behavior (SIB)

• Self-Injurious Behavior (SIB)

• Self-inflicted violence (SIV)

• Parasuicide

• Self-mutilation

Smoking

• Smoking

• Eating disorders…

• Drinking

• Adopting an unhealthy life style…

• Adopting a “Healthy” lifestyle (running, weight lifting)

• Drug Use

• Only six of millions…..

Stereotypic SIB Stereotipik KY

• Stereotypic SIB Stereotipik KY

• Major SIB Ana /Ciddi KY

• Compulsive SIB Kompulsif KY

• Impulsive SIB Dürtüsel KY

• (APA, 2000)

Head banging

• Head banging

• Self-hitting and face slapping

• Self biting

• Hair pulling

• Associated with organic mental disorders and characterized by highly repetitive and fixed behaviors causing mild to severe tissue damage.

• (APA, 2000)

Fixed, rhythmic patterns

• Fixed, rhythmic patterns

• (belli ve ritmik davranışlar)

• Examples: head-banging, eyeball pressing (örneğin başını vurma, göze baskı uygulama)

• Seen in those with autism or mental retardation (zihinsel engelle ve otizmle birlikte görülür)

• (Bowman & Randall, 2005)

Auto Castration

• Auto Castration

• Eye enucleation

• Limb amputation

• Abdominal self surgery

• Auto cannibalism

This form of SIB is usually

• This form of SIB is usually

• associated with severe psychosis,

• intoxication, or character disorder,

• often performed in response to

• hallucinations or delusions, many

• times with a religious theme.

This form of SIB can be

• This form of SIB can be

• ritualized and associated

• with altered states of

• religious consciousness

Most Extreme and Uncommon

• Most Extreme and Uncommon

• Castration and Amputation

• Often seen in psychotic patients

• (Bowman & Randall, 2005)

Trichotillomania (compulsive hair pulling)

• Trichotillomania (compulsive hair pulling)

• Skin picking

• Nail biting

• This form of SIB is usually associated with

• an impulse to behave as the result of

• increasing anxiety with subsequent

• tension release. The mechanism may be

• similar to that of Obsessive-Compulsive

• Disorder (OCD).

Skin cutting

• Skin cutting

• Burning

• Self hitting

• Digit fracturing

• This form of SIB can be isolated or habitual in nature and can be further

• subdivided into two forms as reported by Favazza (1996):

• Episodic: Limited to discreet periods or situations.

• Repetitive: Habitual and addictive in nature.

• Typically this type of behavior begins in adolescence and often

• develops into chronic behavior by adulthood.

Typically not highly lethal

• Typically not highly lethal

• Little tissue damage

• Occurs sporadically and repetitively

• Examples: cutting (with razor blades or glass), skin carving, burning, interference with wound healing, needle sticking, self-punching and scratching

• (Folmer & Lukomski, 2005)

Cutting seems to be one of the most

• Cutting seems to be one of the most

• commonly reported forms of SIB among

• adolescents…..

72% of reported SIB

• 72% of reported SIB

be used as a coping mechanism;

• be used as a coping mechanism;

• help release built up emotions (i.e. anger, anxiety);

• release tension;

• re-enact abuse;

• increase endorphin production (inhibits pain and tension); and,

• be a form of self-punishment

Self-injury, in its most simplistic form, is

• Self-injury, in its most simplistic form, is

• nothing but a highly destructive and

• maladaptive but generally very effective

• response to stress….it’s drive reducing!

Assist in gaining “control”

• Assist in gaining “control”

• To physically express pain (easier to handle psychological pain)

• Means of dissociating

• To externalize internal pain

• (Alderman, 1997)

It is difficult to determine because self-injurers are so secretive.

• It is difficult to determine because self-injurers are so secretive.

• 1% of the US population was thought to self-injure in early

• studies (Lester, 1972) .

More recent studies suggest that 4% of the

• More recent studies suggest that 4% of the

• general population may self-injure (Briere & Gill, 1998).

• Poll of 850 “tweens” published in the summer of 2006 reported that 1 in 4 had engaged in self-harm behaviors (www.nahec.org/kidspoll)

SIB is reported in 13%-53% of patients diagnosed with Tourette’s Syndrome (Robertson, 1989; Robertson, Trimble, & Lees, 1989).

• SIB is reported in 13%-53% of patients diagnosed with Tourette’s Syndrome (Robertson, 1989; Robertson, Trimble, & Lees, 1989).

• SIB is reported in 3%-46% of a population diagnosed with mental retardation or developmental delay (Bodfish, Crawford, & Powell, 1995).

• SIB is reported in 75% of hospital patients diagnosed borderline personality disorder (Clarkin, Widiger, & Frances, 1983).

In recent studies, 13% of adolescents reported self-mutilation

• In recent studies, 13% of adolescents reported self-mutilation

• Most common among teenage girls

• Average to high intelligence

• (Bowman & Randall, 2005) (Warner, 2002)

In a recent study of undergraduate college students revealed that:

• In a recent study of undergraduate college students revealed that:

• 18% reported harming themselves more than 10 times in the past…

• 10% reported harming themselves more than 100 times….

• 38% reported a history of self-injury

• (Gratz, Conrad, & Roemer, 2002)

• SIB seems to correlate with: KY şunlarla ilişkili görünüyor

Gender differences in SIB

• Gender differences in SIB

• KY da cinsiyet farklılıkları

Greatest risk factors En büyük riskler

• Greatest risk factors En büyük riskler

A study of 862 Turkish high school students revealed that 21.4% had engaged in self-mutilative behaviors.

• A study of 862 Turkish high school students revealed that 21.4% had engaged in self-mutilative behaviors.

• Female (21.5%) male (21.3%).

• Source: Zoroglu,Tuzun, Sar, Tutkun, Savaş, Ozturk, Alyanak and Erocal

• Kora (2003)

The sample used in this research consists of the adolescents (194) under the age of 21 who were being accommodated in the protection and rehabilitation centers in Istanbul.

• The sample used in this research consists of the adolescents (194) under the age of 21 who were being accommodated in the protection and rehabilitation centers in Istanbul.

• 20.6% of them have reported self injuring behavior (SIB)

• The average age of starting SIB found to be 16.3±2.4 ages.

• The percentage of SIB among boys found to be 38.7%, but the proportion found to be 15.4% among girls.

• Aksoy and Ögel (2005 )

Typically NOT a sign of suicidal behavior

• Typically NOT a sign of suicidal behavior

• Those who self-injure may be at a slightly higher risk of suicide

• (Folmer & Lukomski, 2005)

8 out of 10 who are suicidal give advanced warning of suicidal intentions. Rarely is this true with those who self-injure.

• 8 out of 10 who are suicidal give advanced warning of suicidal intentions. Rarely is this true with those who self-injure.

• Typically the intent of self-injury is to not stop living….just get some relief.

• (Folmer & Lukomski, 2005)

SIB is most strongly correlated with

• SIB is most strongly correlated with

• Borderline Personality Disorder

• En fazla Borderline kişilik bozukluğu ile ilişkili

Medication is often prescribed to address the issues of:

• Medication is often prescribed to address the issues of:

• DEPRESSION, ANXIETY, RACING THOUGHTS

• (All of which are sometimes associated with self-injuring)

• İlaç vermeye temel olan tanılar depresyon, kaygı ve sürekli düşüncelerdir ve bunlar da KY ile bağlantılıdır.

• Counselors are encouraged to seek medical support in

• the treatment of clients with severe SIB patterns.

Get comfortable with self-harm

• Get comfortable with self-harm

Show unconditional acceptance

• Show unconditional acceptance

• Goal: to understand the causes

• Provide coping strategies

Convey it’s “ok” to talk about self-injury

• Convey it’s “ok” to talk about self-injury

• Help client to discover his/her identity

• Encourage open communication

Do Not be afraid to ask a student if he/she self-injures

• Do Not be afraid to ask a student if he/she self-injures

• Do Not make the student stop

Do Not make a behavioral or safety contract

• Do Not make a behavioral or safety contract

• Do Not be the only support

• (Bowman & Randall, 2005)

Do Not leave the family out of the healing process

• Do Not leave the family out of the healing process

• Do Not consider SIB as “attention seeking” behavior

• (Bowman & Randall, 2005)

• Be supportive

• Don’t convey disappointment

• Don’t remove all sharp objects

• Don’t give ultimatums

• Seek personal counseling

Encourage child to seek better coping mechanisms

• Encourage child to seek better coping mechanisms

• Don’t blame yourself or consider yourself a “bad parent”

• Know you are not alone

• Accept your child, not the behavior

Give unconditional love

• Give unconditional love

• Do fun activities together

• Encourage your child to use his/her strengths

• Provide opportunities for your child’s interests

• Don’t deny there is a problem

• (Bowman & Randall, 2005) (“Family & friends factsheet”, 2006)

Self-injurers typically are fully aware of their behavior and societal prohibitions….hence:

• Self-injurers typically are fully aware of their behavior and societal prohibitions….hence:

• Shame and embarrassment frequently prevent them from seeking help.

• They often will hide their self-injurious behaviors from others and are very reluctant to admit the need for psychological or even medical treatment….

It helps to regard SIB as a coping mechanism, hurtful and disturbing perhaps, but a coping mechanism all the same.

• It helps to regard SIB as a coping mechanism, hurtful and disturbing perhaps, but a coping mechanism all the same.

It is important that you first understand that self- harm is an attempt to gain relief from something.

• It is important that you first understand that self- harm is an attempt to gain relief from something.

• Öncelikle bilinmelidir ki KZV davranışı bir şeyden kurtulma çabasıdır

There probably is not one best mode of treatment…

• There probably is not one best mode of treatment…

• but it can help if you:

• know what you are good at doing… are you the best person to work with this client?;

• can view SIB as a response to stress;

• can teach alternative coping skills and;

• can remain flexible, tolerant, and never give up on a client.

Cognitive Behavioral Therapy

• Cognitive Behavioral Therapy

• Rational Emotive Therapy

• Dialectical Behavioral Therapy

• Group Therapy

• Art Therapy

• (Bowman & Randall, 2006) (“Health care professional factsheet”, 2006)

It’s about like arguing whether it is better to make a trip in a Ferrari, Mercedes,

• It’s about like arguing whether it is better to make a trip in a Ferrari, Mercedes,

• or Ford. It is not so much the car you drive, but the skill with which you can

• drive it and having a clear goal or destination in mind when you leave.

• Actually, you’re going to have to go in the client’s Ford Fiesta anyway!

OK: The “Brand” of golf club you swing is not as important as your skill in using it.

• OK: The “Brand” of golf club you swing is not as important as your skill in using it.

• It’s more about keeping your eye on the ball.

• Understanding that self-harm is an attempt to respond to threat and stress is essential.

• Reducing that threat/stress and providing for a more effective response should be the goal regardless of the “theory” used.

Aksoy A.,and Ögel K. (2005 ). Drug abuse and self injuring behavior (SIB) among the adolescents who live on the streets . Anadolu Psikiyatri Dergisi 2005;6(3):163-169

• Aksoy A.,and Ögel K. (2005 ). Drug abuse and self injuring behavior (SIB) among the adolescents who live on the streets . Anadolu Psikiyatri Dergisi 2005;6(3):163-169

• Alderman, T. (1997). The scarred soul. Oakland, CA: New Harbinger.

• American Self-Harm Information Clearinghouse, (n.d.). About self-harm. Retrieved Apr.2,2006, from ASHIC Web site: http://selfinjury.org.

• Bowman, S. & Randall, K. (2005). See my pain!. Chapin, SC: Youth Light.

• Briere, J. & Gill, E., (1998). Self-mutilation in clinical and general population samples: Prevalence, correlates, and functions. American Journal of Orthopsychiatry, 68,609-620.

• Conn, L.M. & Lion, J.R., (1983). Self-mutilation: A review. Psychiatric Medicine, 1, 21-33

• Dunkle, T. (1990). Health: Dissecting causes of self-mutilation. Insight 6(22), 48-51.

• Family & friends factsheet. (2006). Retrieved March 17, 2006, from Self Injury Guidance & Network Support Web site: www.lifesigns.org.uk.

Favazza, A.R., (1996). Bodies Under Siege: Self-mutilation and body modification in culture and psychiatry, 2nd.ed., Baltimore: The John Hopkins University Press.

• Favazza, A.R., (1996). Bodies Under Siege: Self-mutilation and body modification in culture and psychiatry, 2nd.ed., Baltimore: The John Hopkins University Press.

• Folmer, T. & Lukomski, J. (2005, October). Self-mutilation: information and guidance for school personnel. Guidance Channel Ezine, Retrieved March 11, 2006 from www.guidancechannel.com/default.aspx?index=1328&cat=13.

• Frey, R. (2002, December). Self-mutilation. Gale Encyclopedia of Medicine, Retrieved February 12, 2006, from www.healthatoz.com/healthatoz/Atoz/ency/self-mutilation.jsp.

• Gratz, K.L., Conrad, S.D., & Roemer, L. Risk factors for deliberate self-harm among college students. American Journal of Orthopsychiatry, 72, 128-140.

• Health care professional factsheet. (2006). Retrieved March 17, 2006, from Self Injury Guidance & Network Support Web site: www.lifesigns.org.uk.

Martinson, D. (2001). What is self-injury. Retrieved March 17, 2006, from Self-Injury Web site: www.focusas.com/Self-Injury.html.

• Martinson, D. (2001). What is self-injury. Retrieved March 17, 2006, from Self-Injury Web site: www.focusas.com/Self-Injury.html.

• Simeon, D. & Favazza, A.R. (2001). Self-injurious behaviors: Phenomenology and assessment. In D. Simeon & E. Hollaoder (Eds.), Self-Injurious Behaviors: Assessment and treatment, 1-28, Washington, DC, American Psychiatric Press.

• Soloff PH, Lis JA, Kelly T, Cornelius J, Ulrich R. (1994). Self-mutilation and suicidal behavior in borderline personality disorder. Journal of Personality Disorders, 8(4), 257-67.

• Teachers’ self injury factsheet. (2006). Retrieved March 17, 2006, from Self Injury Guidance & Network Support Web site: www.lifesigns.org.uk.

• Warner, J. (2002, Nov. 21). Cutting and other dangerous acts becoming new cries for help.

• WebMD Medical News, Retrieved March 17, 2006 from www.webmd.com/content/article/53/61375.htm.

Zlotnick, C., Mattia, J.I., & Zimmerman, M., (1999). Clinical correlates of self-mutilation in a sample of general psychiatric patients. The Journal of Nervous and Mental Disease, 187, 296-301.

• Zlotnick, C., Mattia, J.I., & Zimmerman, M., (1999). Clinical correlates of self-mutilation in a sample of general psychiatric patients. The Journal of Nervous and Mental Disease, 187, 296-301.

• Zlotnick, C., Shea, M.T., Pearlstein, T., Simpson, E., Costello, E., & Begin, A. (1996). The relationship between dissociative symptoms, alexithymia, impulsivity, sexual abuse, and self-mutilation. Comprehensive Psychiatry, 37, 12-16.

• Zoroglu S.S.,Tuzun, U., Sar, V., Tutkun, H., Savaş, H.A., Ozturk, M., Alyanak, B., and Erocal-Kora, M. (2003). Suicide attempt and self-mutilation among Turkish high school students in relation with abuse, neglect and dissociation. Psychiatry and Clinical Neurosciences, ,57, 119–126