From: PENT Director
Sent: Friday, April 09, 2004
Subject: HELP on self-mutilation, cutters
Hello PENT members at large, PENT Cadre, Leadership Team, SELPA Directors, and other friends of the Positive Environments, Network of Trainers:
Gail Cafferata, PENT Leadership member, and I have had a discussion recently on difficulties when peer groups begin cutting (self-mutilation). Increasingly I seem to be fielding inquiries about this and have discovered some resources you may wish to have at your disposal. Rich Lieberman, LAUSD Suicide Prevention Unit, has recently written a great summary on what we know about this problem. He has graciously agreed to allow us to disseminate this important document throughout PENT. See attached.
In addition, see: http://www.focusas.com/SelfInjury.html
Also, see google searches under self injury+cutting
Rich's article just appeared in the National Association of Secondary School Principals journal and the reference list is from Rich's workshop handouts.
Some hot points in summary follow:
Cutters are mostly girls with onset occurring in late childhood-early adolescence.
Rich has found mental health staff overwhelmed with referrals everywhere he speaks on this issue.
These students generally assess at low risk for suicide, but that does not preclude a suicide interview if you have information to suggest this should be undertaken.
These behaviors appear to be contagious, so it is important to separate out Alpha females who others are copying. See ODD Girls OUT, a new popular press book that describes relational bullying behaviors in girls for information on the group dynamics around this and other troubling behavior.
This is a very complex behavior, not yet well understood. The behavior can be associated with many behavioral functions: getting social status from the peer group, protesting parental behaviors, etc.
In the mental health realm, i.e., out of the behavior analysis realm, there has been discussion about cutting as a method of using pain in a controlled manner as a protest and to gain a physical feeling when one is highly emotionally defended.
Others have reported that these students are episodic, do not report physical pain, they report tension release and gratification and that this is an additional type of impulse disorder.
50-60% of cutters are abused, and 2/3 have had an eating disorder at some time. Screen for these features.
There is no one therapeutic approach...prevention is key. What we do know is that educators must never work with these kids in groups due to contagion. Work individually.
If your area of expertise is NOT mental health, do be sure that when you are working with a cutter (as teacher, administrator, etc.) that you have involved your site based mental health provider (school psychologist, counselor, social worker, etc.) and/or outside service providers for information on a team approach to service (interventions, behavior support) for this complex disorder. Rich's article is an excellent summary.
Rich and I hope that the attached resources will be of help to you.
Diana Browning Wright