Professional Documents
Culture Documents
Deliberate SelfHarm
By: Susan Alejandre, Liliana
Barajas,
Alexander Lacey, David
Leftwich, and Kristalyn Obtera
Table of Contents
What is Deliberate SelfHarm1
Understanding and
Responding.2
Warning
Signs.3
School Wide Intervention/Training
........4
Dialectical Behavioral
Therapy.6
Cognitive Behavioral
Therapy.10
Self-Injury
Contagion13
NASP...
Deliberate Self-
2
.
Deliberate Self Harm (DSH) is also known has Non-suicidal selfinjury (NSSI), which is defined as the deliberate, self-inflicted
destruction of body tissue without suicidal intent and for purposes
not socially sanctioned. DSH is commonly misperceived as a
deliberate attempt to commit suicide. Experts have shown that
the opposite seems to be true. DSH is a reoccurring failure to
resist impulses to harm oneself physically without suicidal intent.
These students are engaging in deliberate self-harm so they do
not kill themselves. The inflicted wounds usually are not life
threatening and appear on the inner thighs, forearms, and torsos
as opposed to more well known method of fully slitting the wrists.
For many students, DSH occurs at a time of crisis when their
Warning Signs!
There are various ways in which
individuals who engage in DSH
are detected. Students my self
disclose that he or she is selfharming. Peers may notify staf
members of another student
engaging in DSH. In some
cases staf members may
notice signs and symptoms
suggesting that a student is
self-harming.
Signs and symptoms of selfinjury may not be obvious to
detect. Arms, hands and
forearms on the non-dominant
side are common areas to find
evidence of DSH. However,
evidence of self-harm may
appear anywhere on the body.
Other signs include:
Inappropriate dress for the
environment (long sleeves
or pants in warm weather)
Use of wrist
band/coverings, avoidance
of activities/events that
require less body coverage
(swimming, or gym class)
Frequent use of bandages,
possession of odd
paraphernalia (razor
blades, or other objects
that can be used to cut or
School Wide
Don't:
Overreact and scare them away
Respond with panic, disgust, shock, or aversion
Try to stop the behavior with threats or ultimatums
Show excessive interest in their behavior
Permit the students to relive their NSSI experiences in
detail (can be triggering to repeat the behavior)
Talk about their behavior in front of peers
Say that won't tell anyone about their NSSI (you may legally
Quick Links
*Currently, there are no evidenced-based
prevention programs for NSSI, but there are
two prevention programs that can be used in
schools:
1. Signs of Self-Injury
www.mentalhealthscreening.org
This program teaches students to find
signs of distress in themselves and in
peers.
2. Safe Abuse Finally Ends (S.A.F.E.)
www.selfinjury.com
This program is for school professionals
to be ready to work with at-risk youth. 7
(Toste & Heath, 2010)
Dialectical Behavioral
What is DBT?
DBT is a therapy that has many aspects from Behavior Therapy
but is unique to itself because it emphasizes on acceptance.
Dialectical Behavior Therapy (DBT) is an intervention that can
work with adolescents who part take in deliberate self-harm.
When using DBT it is important to remember that the core
feature of this therapy is the balance between acceptance and
change. Self-injury is most often motivated by an inability to
tolerate aversive thoughts or feelings and so learning to accept
and tolerate ones current experience or circumstances rather
than trying to change them, can be quite useful (p.1084).
DBT helps clients accept or at least tolerate their situation and
environments they find themselves in, instead of trying to
change them right away and feeling they cannot handle what
they are experiencing. The term dialectic refers to a
philosophical approach in which truth is obtained by combining
contradictory points (thesis and antithesis) into a new whole
(synthesis) (p. 1084). Clients are helped in creating a new
story for themselves, one in which they understand their
situation and feelings and find the balance between accepting
and changing their situation.
History of DBT
This therapy was first started to help suicidal women who
sufered from Borderline Personality Disorder (Hollander, Nock,
& Teper, 2007). However, it has been demonstrated that DBT
reduces the occurrence of suicidal and non-suicidal self-injury
and has been adapted for use with adolescents (p. 1083).
8
7
Main targets of DBT
Decreasing lifethreatening behaviors
Decreasing therapyinterfering behaviors
Decreasing quality-oflife interfering
behaviors
Main skills taught
Mindfulness
Emotional regulation
Interpersonal
efectiveness
Distress tolerance
Walking the middle
path
Critical elements
Enhancing capabilities
Generalizing
capabilities
Improving motivation
and reducing
dysfunctional behavior
Enhancing and
maintaining therapist
capabilities and
motivation
(Champman,
Background information:
11
1
0
Cognitive Behavioral
Therapy
Therapeutic
Relationships
1
1
Functional Behavioral
Analysis
Conduct extensive behavioral analysis of each incident or the
Behavior Interventions
Identifying and eliminating the positive and negative
reinforcements of self-harm
Rewarding reductions in the frequency, severity, or type of selfinjury.
Address potential deficits in problem solving, communication
skills, identification, labeling, verbalization of emotions, training in
intimacy, conflict resolution, and adaptive coping since selfinjuring individuals tend to have weak skills in these areas.
Emotion Regulation
Cognitive Restructuring
12
Relapse Prevention
Before therapy is
terminated the therapist
may help the patient to
identify problems that
could possibly trigger
relapse of DSH.
People are not discharged
until they are able to deal
efectively with their
feeling and thoughts that
Multiculturalism and
CBT emphasizes on understanding the DBT
clients belief and values (Corey, 2012
Limitations
CBT doesn't apply to
persons with limited
intelligence and some
learning disabilities (Corey,
2012).
CBT focuses on the present
that can fail to take into
consideration the past that
has influenced their child
development (Corey, 2012).
Therapists also need to be
aware of not imposing their
beliefs and not being overly
14
Self-Injury Contagion
13
What is Self-Injury
Contagion?
When acts of self-injury
occur in two or more
persons within the same
group within a 24-hour
period.
When acts of self-injury
occur within a group in
statistically significant
Four Categories of Behavior
Interpersonal aspects play a central role in contagion episodes.
These interpersonal factors include at least four categories of
behavior:
1) Limited communication skills
2)Attempts to change the behavior of others
3)Response to caregivers, family members, or significant
others
Limited Communication
Desire for Acknowledgement
o Walsh (2012) states that students will engage in selfharm because they lack efective communication skills so
they will self-injure to let others know they are angry,
sad, anxious, or depressed.
Desire to Punish
o Students who self-injure may have intentions to attack or
accuse. Others in the immediate environment are
15
expected to react to the self-harm with fear or guilt.
14
15
17
1
6
18
1
7
-Self-Injury Meetu
http://www.c
http://www.
1-800-273-TALK A 24-h
To Write Love On Her Arms (http://www.TWLOHA.com) - A non-profit m
1-8
1-800-33
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Referen
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Appendix A1
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Appendix A2
23
Appendix
A-3
24
Appendix A4
25
Appendix
A-5
26
Appendix
A-6
27
Appendix A7
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