Detection, Intervention, & Treatment
Detecting and intervening in self-injurious behavior can be difficult since the practice is often secretive and involves body parts which are relatively easy to hide. Although experienced therapists can offer advice based on experience, few studies which actually test detection, intervention and treatment strategies have been done. The suggestions which follow are those which evolve naturally from existing literature and from interviews with practitioners with significant experience in self-injurious behavior.
- Unexplained burns, cuts, scars, or other clusters of similar markings on the skin can be signs of self-injurious behavior. Arms, fists, and forearms opposite the dominant hand are common areas for injury. However, evidence of self-injurious acts can and do appear on pretty much every body part possible. Other signs include: inappropriate dress for season (consistently wearing long sleeves or pants in summer), constant use of wrist bands/coverings, unwillingness to participate in events or activities which require less body coverage (such as swimming or gym class), frequent bandages, odd or unexplainable paraphernalia (e.g. razor blades or other implements which could be used to cut or pound), and heightened signs of depression or anxiety. When asked, individuals who self-injure may offer stories which seem implausible or which may explain one, but not all, physical indicators such as "It happened while I was playing with my kitten." It is important that questions about the marks be non-threatening and emotionally neutral. Evasive responses are common. Not knowing how to broach the subject is often what restrains concerned individuals from probing. However, concern for their well-being is often what many who self-injure most need and persistent but neutral probing may eventually elicit honest responses.
- Schools, parents, medical practitioners, and other youth serving professionals all have an important role to play in identifying self-injury and in assisting youth in getting help. Unfortunately, lack of information on self-injury has hampered the creation of informational materials and/or treatment options. The S.A.F.E. Alternatives program in the Linden Oaks Hospital in Edward, Illinois is one of the only existing inpatient treatment program specific to self-injury in the U.S. (see www.selfinjury.com). Moreover, while a small but growing body of evidence exists to assist those helping individual self-injurers, little literature exists to explain and address the environmental factors that contribute to adoption of the practice. For those who encounter self-injurious adolescents, creating a safe environment is critical. This can be difficult with youth who have suffered trauma or abuse. Drawing from a number of studies in this area, Kress, Gibon & Reynods (2004) maintain that structure, consistency, and predictability are important elements in forming relationships with self-injurious youth.