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Self-injurious Behavior

The Child Advocate is devoted to children and the parents and professionals that work with them and advocate for them. Self-injurious behavior is a major problem for children and their families. Part of this information is presented with the permission of Amy Gedeon, Jill Flemming High and Shilpa Patel of The Penn State College of Medicine. The information presented at this site is for general use only and is not intended to provide personal advice or substitute for the advice of a qualified professional. If you have questions about the information presented here, please consult a physician, the resources listed or other professional in your area.

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Suicide and safety issues

Suicides among young people are a serious problem. Each year in the U.S., thousands of youth commit suicide.  In 2013, suicide was the second leading cause of death for 15-to-24-year-olds, and a major cause of death for 5-to-14-year-olds. More information and resources click...

Self Mutilative Behavior

Understanding Self Mutilative Behavior  Jill Flemming High  Penn State College of Medicine  March 2005 Self Mutilative Behavior (SMB)  definition: -Deliberate damage to one’s own body tissue without suicidal intent -Part of the larger class of self-injurious behavior that includes actions ranging from stereotypic skin-rubbing to completed suicide   Epidemiology: Adults – 4% of general population, 21% or psychiatric inpatients Adolescents – 14%-39% in community, 40%-61% of psychiatric inpatients   The high rate of SMB in adolescents reveals the need for better understanding of how to effectively assess and treat SMB   First need to understand nature of problem by identifying risk factors, associations, methods, frequencies, and how they relate to behavioral functions and theories.   Two experiments by Nock and Prinstein in 2004 and 2005 illustrate a functional approach to assessment of SMB and contextual features and behavioral functions of SMB among adolescents. Both assess SMB in 89 adolescent psychiatric inpatients referred for self-injurious thoughts or   2004 Study by Nock and Prinstein Hypothesis of authors: There are four primary functions of SMB Automatic-Negative Reinforcement: to achieve a reduction in tension or other negative affective state – “to stop bad feelings” Automatic-Positive Reinforcement: to create a desirable physiological state – “to feel something, even if is was pain” Social-Negative Reinforcement: to escape from interpersonal task demands – “to avoid punishment from others”, “to avoid doing something unpleasant” Social-Positive Reinforcement: to gain attention from others or to gain access to materials – “to try to get a reaction out of someone even if it is negative”, “to let others know how unhappy I am” Goal of study: to examine reasons...

Self-Injurious Behavior (SIB) in Adolescents

Self-Injurious Behavior (SIB) in Adolescents: an Important Consideration as a Risk Factor for Suicide  Shilpa Patel Penn State College of Medicine March  2003   I.                   Epidemiology   Adolescent Suicide “Each year, 1 in 5 teens in the US seriously considers suicide; 5 to 8% of adolescents attempt suicide, representing approximately 1 million teenagers, of whom nearly 700,000 receive medical attention for their attempt (Grunbaum et al., 2002); and approximately 1,600 teens die by suicide (Anderson, 2002).”3 According to the U.S. Centers for Disease Control and Prevention (CDC), suicide is the third leading cause of death for those ages 15 to 24. During 1991–2001, significant decreases occurred in the percentage of students who seriously considered suicide (29%–19%), and planned to attempt suicide (18.6%–14.8). The percentage of students who carried a weapon decreased significantly from 1991–1997 (26.1%–18.3%) and then remained constant from 1997–2001 (18.3%–17.4%). 1 From 1991 to 1997, the percentage of students seriously considering suicide and the percentage that made a suicide plan showed significant linear decreases. However, the percentage of students that made an injurious suicide attempt showed a significant linear increase. 2 According to the recently published report by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), three million American teens have thought seriously about or attempted suicide. More than 13 percent of young Americans between 14 and 17 years of age considered suicide in 2000. More than a third of the three million teens aged 12 to 17 thought about suicide in the past 12 months and actually tried it. Girls were twice as likely as boys to say they thought about suicide, but race...

Skin-picking and Self-injurious Behavior

Skin-picking as a form of self-injurious behavior Amy Gedeon Penn State College of Medicine September 2002   Self-Mutilation Intentional infliction of bodily injury to oneself, without intent to die Three types Severe but infrequent – e.g. amputation; associated with psychosis Stereotypic – function as self-stimulation; e.g. head-banging Moderate – episodic and compulsive; e.g. self-cutting, skin picking, and trichotillomania   Clinical Characteristics of Skin Picking Also known as “neurotic excoriation”, “self-inflicted dermatoses”, and “dermatillomania” Most common site is face, but lips, scalp, arms, hands, and legs also affected Fingernails most commonly used, but picking with tweezers, pins, teeth, and other instruments is also described More than half of all individuals who skin pick also report histories of stereotypic behaviors such as body rocking, thumb sucking, knuckle cracking, cheek chewing, and head banging Time spent picking varies from 5 minutes to 12 hours daily Many report increased picking at night, when tired Many affected patients seek dermatology services instead of psychiatric treatment May report sensations such as itching, tingling, burning, or an uncontrollable urge to pick their skin   Prevalence Occurs more often in women than in men Prevalence rate of self-mutilation in US population is 1-2% No published reports of the incidence of skin picking in a psychiatric population   Course of Illness Usually gradual and long-term Mean age of onset reported to be adolescence to early adulthood Uncertain how skin picking is acquired and maintained Many patients report increasing levels of tension prior to skin picking and a sense of relief or satisfaction following the picking, as found in trichotillomania Some patients experience an altered state of consciousness while...

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