Self-Injurious Behavior: A Bi-Modal Treatment Approach to Working with Adolescent Females
Stone, Judy A., Sias, Shari M., Journal of Mental Health Counseling
The topic of self-injurious behavior (SIB), particularly among female adolescents, has been gaining widespread attention in mainstream culture (Favazza, 1998). However, limited research has been generated examining effective treatment modalities. Given the lack o fin formation concerning treatment models, this article presents a bi-modal treatment approach with a female adolescent SIB client
Approximately 4% of the general population engages in self-injurious behavior (SIB), and 21% of clinical clients self-mutilate (Briere & Gil, 1998). Whereas episodic SIB is observed among normally developing children and teenagers, chronic and severe SIB is more common among people with developmental disabilities, psychiatric disabilities, or other special populations such as prisoners (Milia, 2000). Within the past two decades, mental health professionals, educators, and the general public have recognized many different variatigns of deviant self-harming behavior. SIB may be related to specific biological conditions or syndromes and can be used for attention-seeking, self-stimulation, or for communication (i.e., to get or avoid something; Favazza, 1992; Hyman, 1999; Milia; Strong, 1998). Effective intervention includes identifying and remedying the cause and teaching replacement behaviors. The purpose of this article is to review the extant literature and present a bi-modal approach to treatment of a female adolescent SIB client.
The counseling needs of those who engage in self-injurious behavior are becoming increasingly recognized. For example, the prevalence has been thought to be about 1,400 cases per 100,000 population (Farber, 2000). Mental health professionals have used many different terms to label this behavior. Indeed, one article lists 37 different labels for this type of behavior (Kahan & Pattison, 1984). However, the three most common labels are self-injurious behavior, self-harm, and self-mutilating behavior.
Self-injurious behavior is not new to mental health counselors. For many decades, self-mutilation was seen only as another form of suicidal behavior. The first known author to suggest otherwise was Karl Menninger who, in his 1938 book Man Against Himself, wrote, "Local self-destruction is a form of partial suicide to avert total suicide" (p.271). At the time, this was a significant principle. Nonetheless, it was not until the work of Kahan and Pattison (1983) that self-mutilation began to receive greater attention. Today, more than 300 articles and more than a dozen books have been written on the topic. One of the most prominent researchers within the field, Armando Favazza (1992), has extensive studies on how self-mutilation relates to psychological, sociological, and cultural forces. In addition, he has categorized self-injurious behavior based on the frequency of the behavior and the amount of damage to the body.
CATEGORIZATION OF SELF-INJURIOUS BEHAVIOR
Self-injurious behavior can be divided into two broad categories: culturally sanctioned and deviant self-mutilation. Culturally sanctioned rituals and practices include ear piercing in contemporary U.S. society, ritual dances among Native Americans that involve self-mutilation, and the genital circumcision of Jewish babies. These practices or rituals are widely accepted as normal within the culture in which they commonly occur. They often serve to mark the passage from one life stage to another or to communicate with some form of higher power (Favazza, 1992). The second major category, the one that is the focus of this article, consists of actions that Favazza labeled deviant pathological self-mutilation. Pathological self-mutilation is defined as the deliberate alteration or destruction of body tissue without conscious suicidal intent. For purposes of this article, the words "self-injurious behavior" and "self-mutilation" refer to the actions included within the second category. …