This document provides an overview and introduction to a webinar presentation on non-suicidal self-injury. It welcomes participants and encourages them to submit questions in the comment box to be addressed during the question and answer portion. It then outlines the agenda which will include definitions, history, reasons for self-injury, risk factors, levels of severity, demographics, trends, intervention strategies, case studies and resources. Brief biographies are given for the presenters, who are clinical directors at Sage Day therapeutic schools.

1. Welcome!
Your
,me
is
very
valuable
to
us.
To
ensure
you
are
ge8ng
the
most
out
of
this
Webinar
we
would
like
you
to
submit
a
ques,on
before
we
begin
our
presenta,on
on
Non-­‐Suicidal
Self-­‐Injury,
so
we
can
answer
your
specific
ques,ons
during
our
Q&A
por,on.
Please
type
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ques,on
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presenta,on
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best
to
address
it
at
the
end.
We
will
begin
shortly.

2. • Private,
accredited,
therapeu,c
school
in
Northern,
New
Jersey
• Students
who
need
a
small,
personalized
environment
• Strong
academics
based
on
the
Common
Core
Standards
• Intensive
individual,
group
and
family
therapy
• Provide
NJ
state
approved
In-­‐District
therapeu,c
services
• Three
campuses:
Sage
Day
Lower
and
Middle
School
in
Mahwah,
Sage
Day
High
School
in
Boonton
and
Sage
Day
High
School
in
Rochelle
Park.
• For
more
informa,on,
visit
us
at
www.sageday.com.

3. Agenda
§ Defini,on
of
Self-­‐Injury
§ History
§ Why
People
Self
Injure
§ Risk
Factors
§ Levels
of
Severity
§ Demographics
§ Trends
§ Immediate
Interven,on
§ Case
Studies
§ Resources
§ Q
&
A

4. Meet
The
Presenters
Alison
is
the
Clinical
Director
at
Sage
Day
Lower
&
Middle
School
in
Mahwah,
NJ.
Gail
is
the
Clinical
Director
at
Sage
Day
Boonton
High
School.
Janet
is
the
Clinical
Director
at
Sage
Day
Rochelle
Park
High
School.
Chris
Leonard
is
the
Director
of
Opera,ons
at
Sage
Day
School.

5. What
Is
Self-­‐Injurious
Behavior?
v Self
injury
is
the
inten,onal
harming
of
one's
own
body
in
order
to
relieve
emo,onal
pain
or
stress.
It
is
not
typically
meant
to
end
one's
life.
v Self
Injury
isn’t
a
modern
adolescent
issue.
It
is
an
ancient
disorder,
which
is
best
understood
as
an
aempt
to
relieve
pain.

6. History
v Prior
to
the
nineteenth
century
self-­‐mu,la,on
was
understood
as
a
Chris,an
concept
of
“mor,fica,on
of
the
flesh”.
v First
began
to
appear
in
psychological
literature
in
the
mid
19th
century.
Modern
understanding
of
self-­‐injury
was
made
by
Karl
Menninger.
1930
–
The
Human
Mind
1938
–
Man
Against
Himself
v Menninger
believed
that
“self
injury
was
a
fascina,ng
kind
of
compromise
in
an
ongoing
war
between
aggressive
impulses
and
the
survival
ins,nct."
1960
–
Graff
and
Mallin:
Described
a
“typical
cuer
as
a
young,
highly
intelligent
woman
who
is
prone
to
alcohol
and
drug
abuse
and
has
great
difficulty
in
rela,onships.”
1980’s
–
Landmark
books
:
Self-­‐Mu5la5on
by
Barent
Walsh
and
Paul
Rosen
and
Bodies
Under
Siege
by
Armando
Favazza.
Many
Late
20th
Century
studies
linked
self-­‐injurious
behavior
with
dissocia,on.

7. Why
Do
People
Self
Injure?
v A
way
of
quie,ng
pain
and
anxiety.
v Best
described
as
a
form
of
self-­‐help
for
people
whose
emo,ons
are
hyper-­‐
reac,ve
or
for
those
raised
in
an
emo,onally
chao,c
environment.
v Not
always
a
manifesta,on
of
mental
illness
or
suicidal
idea,on.
v There
is
a
high
correla,on
between
cu8ng
and
childhood
sexual
abuse.

8. Risk
Factors
Childhood
sexual
abuse
and
or
family
violence
(Dieter
et
al)
Maltreatment
during
childhood
People
who
experience
dissocia>on
Those
who
have
experienced
childhood
trauma
People
who
suffer
from
other
mental
health
issues
(impulse
control,
ea>ng
disorders)
Excessive
alcohol
or
drug
abuse
Loss
of
a
parent
or
separa>on
from
a
caregiver
in
childhood
There
are
many
factors
that
may
contribute
to
self
injury
Difficulty
expressing
strong
nega>ve
emo>ons
such
as:
pain,
hurt
and
anger

9. Levels
of
Severity
v To
determine
level
of
severity,
consider
how
frequently
self-­‐harming
occurs,
the
number
of
methods
one
u>lizes
and
the
loca>on
on
the
body
that
is
injured.
v Most
olen
those
who
self-­‐injure
do
not
wish
to
expose
their
wounds.
v The
most
common
areas
of
the
body
on
which
self-­‐harming
is
performed
are:
the
arms,
wrists
and
legs.
Other
areas
may
include:
the
breasts,
thighs,
stomach
and
genitals.
(Conterio
et
al,
1998)
v Typically
those
who
self-­‐harm
private
areas
of
the
body
do
so
out
of
shame.

10. Demographics:
Female
vs.
Male
9
percent
of
girls
engage
in
NSSI.
6.7
percent
of
boys
engage
in
NSSI.
Primary
behavior
for
females
is
cu8ng.
Primary
behaviors
for
males
is
burning
or
self-­‐hi8ng.
cu8ng
is
viewed
as
“feminine.”
17-­‐28%
of
teens
report
having
par,cipated
In
NSSI.
Nearly
50%
of
those
who
engage
in
NSSI
have
been
sexually
abused.
NSSI
behaviors
for
all
genders
typically
begin
between
11-­‐15.
When
treated,
most
NSSI
resolves
by
the
,me
both
males
and
females
begin
young
adulthood..
Untreated,
NSSI
can
con,nue
throughout
adulthood
especially
in
Females.

11. Trends
Self
Injury
Trends
Since
2007
reports
of
NSSI
have
doubled
Many
who
self
injure
report
learning
how
to
do
so
are
from
friends
or
pro
self-­‐injury
websites.
NSSI
is
frequent
in
high
income
countries.
NSSI
behaviors
by
males
are
increasing.
Self
harm
is
a
risk
factor
for
suicide
although
suicide
is
a
rare
effect.
Brain
research
indicates
that
there
an
incomplete
connec,on
between
the
cortex
and
amygdala
contribute
to
the
deregula,on
of
mood.
Approximately
2
million
cases
are
reported
annually
in
the
US.
Collec,on
of
data
remains
difficult
as
behaviors
go
unreported.

12. Immediate
Interven,on
Remain
calm
and
caring
Administer
first
aid
if
necessary
Do
not
be
cri>cal
or
judgmental
even
if
you
disagree
with
behavior
Listen
with
compassion
Do
not
overreact,
show
shock
or
fear
Do
not
use
threats
to
stop
behavior
Follow
school/clinic
procedures
to
no,fy
administra,on/clinical
team
Note:
Students
and
staff
may
be
the
“first
responders”
to
NSSI.

13. Sage
Day
Interven,on
Protocol
CuMng,
Self-­‐Mu>la>on
or
other
Self-­‐Injurious
Behavior
Reported
Outside
of
Therapy
Teachers:
v If
a
student
discusses
or
reveals
cu8ng
during
class
they
must
be
accompanied
to
the
office.
v Inform
Clinical
Director
and
Therapist.
Administrators:
v Check
and
administer
first
aid
if
needed.
v Access
immediacy
of
risk.
v Based
on
assessment
retrieve
all
student
possessions.
Have
student
empty
out
belongs
and
confiscate
any
items
that
could
be
used
to
self-­‐harm.
v If
student
refuses,
contact
parent.
Call
police
if
student
aempts
to
leave.
The
student
should
not
return
to
school
un,l
a
follow
up
mee,ng
with
parents
(and
district)
is
held
and
safety
plan
is
in
place.
Review
policy
with
student
Consider
No-­‐
Harm
Contract
Consider
suspension
of
privileges
Inform
parents
Inform
therapist
Inform
teachers
When
we
[Sage
Day]
make
a
decision
to
refer
a
student
for
evalua,on
for
hospitaliza,on

14. No
Harm
Contract

15. Resources
Conterio,
K.,
Lader,
W.,
&
Bloom,
J.K.
(1998).
Bodily
harm:
The
breakthrough
healing
program
for
self
injurers.
New
York:
Hyperion.
Deiter,
P.J.
Nicholls,
S.S.,
&
Pearlman,
L.A.
(2000).
Self
injury
and
self-­‐capaci,es:
Assis,ng
an
individual
in
crisis.
Journal
of
Clinical
Psychology,56,1173-­‐1191.
Levenkron,
S.
(1998).
Cu8ng:
Understanding
and
Overcoming
Self-­‐Mu,la,on.
New
York:
W.
W.
Norton
&
Company.
American
Psychiatric
Associa,on.
(1994).
Diagnos,c
and
Sta,s,cal
Manual
of
Mental
Disorders,
Fourth
Edi,on(DSM-­‐IV)
Washington,
DC:
American
Psychiatric
Associa,on.
Gluck,
Samantha
(2012).
Self
Injury,
Self
Harm
Sta,s,cs
and
Facts.
Retrieved
from:
hp://healthyplace.com/abuse/self-­‐injury/self-­‐harm.
Claassen,
Cindy
and
M.
Kasner.
(2012).
Self
Harm
in
the
United
States:
What
We
Can
Learn
from
Na,onal
and
State-­‐Level
Medical
Datasets.
Washington,
DC:
Na,onal
Center
for
Health
Sta,s,cs.
Interna,onal
Associa,on
for
Child
and
Adolescent
Psychiatry
and
Mental
Health.
(2012).
IACCP
Textbook
of
Child
and
Adolescent
Mental
Health.
Belgium:
Interna,onal
Associa,on
for
Child
and
Adolescent
Psychiatry
and
Mental
Health.

16. Resources
Con,nued
Levenkron,
Steven.
(2006).
Cu8ng:
Understanding
and
Overcoming
Self-­‐Mu,la,on.
New
York:
W.W.
Norton.
Favazza,
A.R.
1996.
Bodies
Under
Siege,
Self-­‐Mu3la3on
and
Body
Modifica3on
In
Culture
and
Psychology.
Bal,more:
The
John
Hopkins
University
Press.
Graff,
Harold
and
Mallin,
Richard.
1967.
The
Syndrome
of
the
Wrist
Cuer.
American
Journal
of
Psychiatry,
124
:
36-­‐42.
Levenkron,
Steven.
2006.
CuAng:
Understanding
and
Overcoming
Self-­‐Mu3la3on.
New
York/London
,
W.W.
Norton
and
Company.
Menninger,
K.A.
1938.
Man
Against
Himself.
New
York,
Harcourt,
Brace
and
World,.
Strong,
Marilee.
1999.
The
Bright
Red
Scream:
self-­‐mu3la3on
and
the
language
of
pain.
New
York,
Penguin
Putnam
Books.
Walsh,
B.W.,
Rosen,
P.
1988,
Self
Mu,la,on:
Theory,
Research
and
Treatment.
New
York,
The
Guilford
Press.
Levenkron,
S.
CuAng,
Understanding
and
Overcoming
Self-­‐Mul3la3on.
New
York/London:1998

17. Suggested
Reads
Kelewell,
Caroline.
(2000).
Skin
Game:
A
Memoir.
NY:
St.
Mar,n's
Press.
Leatham,
Victoria.
(2004).
Bloodle8ng:
A
Memoir
of
Secrets,
Self-­‐Harm
and
Survival.
Australia:
Allen
&
Urwin.
Strong,
Marilee.
(1998).
A
Bright
Red
Scream:
Self-­‐Mu,la,ons
and
a
Language
of
Pain.
NY:
Penguin
Group

18. Q&A
“CuMng
may
be
a
way
to
reclaim
control
over
one’s
body,
as
with
anorexia
and
bulimia.
Or
it
may
allow
the
tortured
individual
to
play
out
the
roles
of
vic>m,
perpetrator,
and
finally
loving
caretaker,
soothing
self-­‐inflicted
wounds
and
watching
them
heal.
For
others,
the
sight
of
blood,
is
literal
proof
that
they
are
alive,
drawing
them
out
of
terrifying
dissocia>ve
states.”
-­‐Marlee
Strong-­‐

19. Final
Steps…
Thank
you
for
your
>me
this
a[ernoon.
We
hope
that
you
gained
some
new
knowledge
on
the
topic
of
Non-­‐Suicidal
Self-­‐Injurious
Behavior
and
that
we
answered
all
of
your
ques>ons.
You
can
now
refer
to
the
link
in
the
comment
box
that
will
direct
you
to
our
brief
survey.
Once
you
have
completed
the
survey,
you
will
be
redirected
to
a
Sage
Day
web
page
where
you
can
print
out
your
cer>ficate.
Survey
Link:
https://www.surveymonkey.com/s/K9NGXJC
If
you
have
any
further
ques>ons,
feel
free
to
visit
us
at
www.sageday.com
If
you
have
specific
ques>ons
geared
towards
one
of
our
presenters
today,
you
can
contact
them
via
email:
Alison
Hipscher-­‐
ahipscher@sageday.com
Gail
D’Aurelio
–
gdaurelio@sageday.com
Janet
Bertelli
–
jbertelli@sageday.com

20. Disclaimer:
The
informa>on
and
interven>ons
discussed
today
are
supported
by
research.
However
abendees
are
urged
to
inves>gate
provided
resources
and
their
own
resources
to
confirm
research
findings.