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Description
A view of self-injurious behavior (SIB) informed by trauma theory and therapeutic community principles provides a framework to guide clinical practice, promote a safe living and learning environment, and inform policy development to support a collaborative university response to SIB. A dual emphasis of concern for the safety of the individual who self-injures and the impact of the behavior on the living and learning environment of others is illustrated in a case example.
Much has been written about the rise of mental health concerns on college campuses (Benton, Robertson, Tseng, Newton, & Benton, 2003; Hoover, 2003; Kitzrow, 2003; Voelker, 2003). Some mental health issues are manifested in a range of self-injurious behaviors (SIBs) that are harmful to the individual student who self-injures as well as to others through disruption to their living and learning environment (Juhnke, 1994). White, Trepal-Wollenzier, and Nolan (2002) proposed a range of interventions to address student SIB: assessment, counseling, prevention, outreach, education, and advocacy. A systemic response that involves collaboration with a variety of campus offices is recommended rather than a sole reliance on college counseling centers for crisis management (Hernandez & Fister, 2001; Pace, Stammler, Yams, & Lee, 1996). Responses to student SIB are often explained using an administrative language and perspective that ensure the development of clear policies, procedures, and guidelines; invite a collaborative effort from participants across university offices; and follow legal and ethical standards concerning confidentiality and legislation with regard to mental health and disabilities (Amada, 1994; Francis, 2003; Pavela, 1985). Although an administrative response that includes the aforementioned components is sound practice, it may leave clinicians wondering if this type of response has a therapeutic impact for the student.
College counselors are in a unique position to advocate for policy, procedures, and clinical practices to address the needs of students who self-injure (White et al., 2002). The International Association of Counseling Services (IACS; 2000) endorsed the counselor's role of working collaboratively with campus officials when managing distressed students. This article proposes a framework that can be used by college counselors to assist in the development and implementation of a campus wide intervention that is congruent with sound clinical and administrative practices. A view of SIB informed by trauma theory espouses clinical treatment and a community response that has a dual focus: the safety of the individual who self-injures and the impact of the behavior on the living and learning environment of others. Therapeutic community principles provide a framework to create and maintain a living and learning environment conducive to the health and healing of students, guide clinical practice, and inform the development of policies and procedures that support a collaborative university response to intervene when students self-injure. A case example illustrates the integration of university policy, a collaborative campus response, and sound clinical practice in an intervention with a student who self-injured. College counselors are encouraged to use a multifaceted approach in their work with students who self-injure.
A View of SIB
SIB is defined as a volitional act to harm oneself without any intent to die (Yaryura-Tobias, Neziroglu, & Kaplan, 1995). Simeon and Favazza (2001) have developed a classification system for organizing and categorizing SIB into four types: stereotypic SIB, major SIB, compulsive SIB, and impulsive SIB. Stereotypic SIB behaviors, such as head banging, self-biting, and hair pulling, are most typically seen in individuals with organic mental disorders. Major SIB includes more potentially life-threatening behaviors, such as castration and limb amputation. Compulsive SIB includes mild to moderate behaviors, such as repetitive hair pulling and skin picking. Behaviors occur automatically without an accompanying conscious urge. Impulsive SIB involves behaviors that are mild to moderate in severity, such as self-burning and cutting. Although it is impossible to make a singular etiological formulation, impulsive SIB is typically established in adolescence and can develop into a chronic behavior in adulthood. It is most often associated with the following Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association [APA], 2000) diagnoses: borderline personality disorder; antisocial, dependent, and histrionic personality disorders; eating disorders; posttraumatic stress disorders; and dissociative disorder. SIBs addressed in this article refer to the impulsive SIB classification. Traditional college students (i.e., students between 18 and 23 years of age) fall in the age range of individuals at highest risk for impulsive SIB (White et al., 2002).
The typical pattern of SIB is as follows: A person experiences a precipitating life event such as rejection, then experiences intolerable feelings, attempts to forestall self-injuring, engages in SIB, and then experiences tension release (Grossman & Siever, 2001). Thus, although destructive, SIB can be seen both as pathological and as a self-help strategy (White Kress, 2003) in that it can be viewed as an adaptive way to achieve psychological homeostasis (Van der Kolk, Perry, & Herman, 1991).
The differentiation between suicidal ideation and behavior and SIB is an important, yet difficult, one, because studies of deliberate self-harm and of... |
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