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”
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.
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Bowman, S. & Randall, K. (2005). See my pain!. Chapin, SC: Youth Light.
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Martinson, D. (2001). What is self-injury. Retrieved March 17, 2006, from Self-Injury Web site: www.focusas.com/Self-Injury.html.
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