Self-injurious Behaviors and Self-Harm are terms used to describe behavior that results in a person causing physical harm to themselves.

Self-harm is often described as one of the most devastating behaviors exhibited by people with developmental disabilities. Common types of this behavior include: eye poking, self-biting, head banging and skin picking. Some of the causes for the self-harm can be arousal, pain, sensory, anxiety and frustration.

Self-harm has become more frequent over time as the structured schedule of activities and social interactions diminished after Jess graduated from high school. Her form of self-harm is skin picking.

Problems

1. She is one of those mosquito attracting people.
2. Post-bite scratching results in bleeding.
3. Bleeding leads to scab to pick off.
4. Which leads to another scab to pick off.
5. You get the idea.
6. Problem # 55 is that sometimes bandaids pull off her skin, thus leaving another scab to pick.

Our Self-Harm Interventions

Our interventions have and do include, anti-itch cream, otc antibiotic ointment, lots and lots and lots of bandaids, wraps, long pants, and long sleeves. The newest interventions, thigh-high socks and a consequence/reward system, have been the most helpful so far. But even then, she’s having some failures.

Failures

Jess was acting somewhat secretive at bedtime one night recently. Since she had climbed under the covers with her skort on, I suggested she change into pj’s. But NO! She was fine, she said. The thing she didn’t understand was the obvious visibility of the blood on her quilt. Sister Hannah volunteered to handle the situation, so I left it to her. After I left the room, Jess admitted to Hannah that she did not want me to see what was under the bandaid on her leg.

The next morning, Jess admitted to me that she had ‘forgotten’ and picked her leg. Much to my disappointment, we soon experienced another failure. Finally, she made it through the goal of 5 days of no picking. Or so I thought. As the days went on, she kept wanting to wear the thigh-high socks. I thought it was preventative.

One morning, we were changing into clean socks before she left the house. About 15 minutes later, she was asking me where were the clean socks. I answered and the silence was too obvious. I knew she had already picked in the short time frame since taking the others off when she answered “yes” to the question, “do you need them on right now?”  Sure enough, there was a fresh bandaid on her leg, and also freshly smeared blood around it.

sigh…

Causes

This situation with self-harm is discouraging. It makes me sad for her that she can’t control this behavior. Today, I saw her own sadness about it. Our system to manage the self-harm behavior had been working well. What caused the break down?

It seems to be related to anxiety. Each time there is a falter in the management system, I can put my finger on some source of anxiety. Much of the time, the anxiety is related to a change in her schedule. This week her schedule has changed from usual. Sometimes she manages change okay, but sometimes not. This week, she is exhibiting insecurity about her everyday schedule and is needing a lot of reassurances.

Remedy

There isn’t necessarily a remedy. There are methods of behavior modification that can help. Each person who experiences self-harm behaviors is unique. Therefore, each intervention should be customized for each individual.

In Jessica’s case, reward has always worked better for behavior modification than consequence. We will try to turn things back around in a positive way. Our current consequence/reward system will be tweaked a little. It is and always will be a trial and error method of management.

This last time, part of my attempt at a remedy included an explanation to Jess about the importance of asking for help. I modeled her calling me, sister, or anyone for help immediately when she feels the urge to pick something. Then, I modeled me calling Hannah to take a bag of chips away from me because I can’t stop eating them. She saw the humor and smiled.