Dealing with Students Who Self-Injure

In this article in Principal Leadership, Mary Beer, a clinical social worker in the Austin Independent School District, examines issues around non-suicidal self-injury. This is when students (usually adolescents) engage in deliberate, repetitive, impulsive, non-lethal self-harm – for example, cutting, scratching, picking scabs or interfering with wound healing, burning, punching self or objects, infecting oneself, inserting objects in the skin, bruising or breaking bones, and some forms of hair-pulling. Studies suggest that between 12 and 24 percent of adolescents engage in self-harm, with the typical onset between 11 and 15 and similar patterns among males and females. 

“The majority of students who self-injure are trying to get relief from either overwhelmingly intense emotions or from lack of emotion,” says Beer. “They share an inability or reluctance to ask for help using traditional means of communication. Some studies suggest that students may be punishing themselves, and others suggest that self-injury prompts students to care for physical rather than emotional wounds. Students who self-injure regularly experience a sense of relief, which not only is comforting but also reinforces the behavior.” 

Beer draws a clear distinction between the thought process of self-injury and that of suicidal students. The intent of self-injury is temporarily escaping psychological distress versus escaping unbearable psychological pain; the affect of self-injuring students is distressed yet hopeful, versus hopeless and helpless; intrapersonally, self-injuring students get a sense of relief and calm, versus frustration, disappointment, and increased distress.

Beer suggests the following ways that schools can improve their response to non-suicidal self-injury among students:

• Faculty and staff should be trained to identify and support students who self-injure, always maintaining confidentiality.
• Take steps to gain students’ and parents’ cooperation, rather than isolating or shaming them; this includes helping parents understand self-injury.
• In appropriate settings, discussing healthy alternatives with students – for example, writing or drawing in a journal; squeezing a stress ball; talking to a trusted adult; doing a physical activity; listening to music; paying attention to breathing; or writing a letter to a person about the problem that has caused the student to be upset.
• Assessments should be conducted only by school staff (or outside clinicians) who have the necessary expertise.
• Specialized instructional support personnel should develop a protocol for helping students who are at risk of self-injury and for notifying their parents.
• If a student has an individual therapist, the therapist should be consulted consistent with confidentiality and parent permission.
• These protocols should be part of the school’s crisis response plan. 

“Helping Students Deal with Self-Injury” by Mary Beer in Principal Leadership, November 2013 (Vol. 14, #3, p. 12-16), www.nassp.org 

From the Marshall Memo #511