i Understanding Self- Injury ii iii Understanding Self- Injury A Person- Centered Approach STEPHEN P. LEWIS AND PENELOPE A. HASKING iv Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and certain other countries. Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America. © Oxford University Press 2023 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. You must not circulate this work in any other form and you must impose this same condition on any acquirer. Library of Congress Cataloging- in- Publication Data Names: Lewis, Stephen P., author. | Hasking, Penelope A., author. Title: Understanding self- injury : a person- centered approach / Stephen P. Lewis, Penelope A. Hasking. Description: New York, NY : Oxford University Press, [2023] | Includes bibliographical references and index. Identifiers: LCCN 2022044716 (print) | LCCN 2022044717 (ebook) | ISBN 9780197545065 (paperback) | ISBN 9780197545089 (epub) | ISBN 9780197545096 (ebook) Subjects: LCSH: Self- mutilation. | Self- mutilation— Treatment. | Parasuicide. | Parasuicide— Psychological aspects. Classification: LCC RC 552 . S4 L49 2023 (print) | LCC RC 552 . S4 (ebook) | DDC 616.85/8 2— dc23/e ng/ 20221021 LC record available at https:// lccn.loc.gov/ 2022 044 716 LC ebook record available at https:// lccn.loc.gov/ 202 2044 717 DOI: 10.1093/m ed- psych/9 780197545065.001.0001 9 8 7 6 5 4 3 2 1 Printed by Marquis, Canada v We dedicate this book to the countless people with lived experience whose resilience and generosity in sharing their stories has allowed us to write this book. Their silent strength is a constant reminder of the need to advocate for a person- centered approach in all aspects of research, clinical practice, and outreach. vi vii CONTENTS List of Illustrations ix Preface xi 1. Self- Injury: An Overview 1 2. Self- Injury and Suicidal Thoughts and Behaviors 13 3. A Person- Centered, Strengths- Based Framing of Self-I njury 22 4. Self- Injury and Stigma 28 5. Use of Appropriate Language to Discuss Self- Injury 39 6. Rethinking and Addressing Contagion 45 7. Self- Injury, the Internet, and Social Media 55 8. Addressing Self- Injury in Schools: A Student-C entered, Strengths-B ased Approach 67 9. Families and Self- Injury 75 10. Clinical Approaches for Self-I njury: Assessment and Intervention 85 11. Self- Injury Recovery: A Person- Centered Framework 96 12. Building Resilience Through Recovery 109 13. Supporting People With Lived Experience 124 14. Advocating for a Person-C entered, Strengths-B ased Approach 135 Postface 151 References 153 Index 193 viii ix LIST OF ILLUSTRATIONS FIGURES 2.1. Conceptualization of self-h arm. 14 2.2. Joiner’s interpersonal model of suicide. 16 4.1. Self-i njury stigma framework. 31 11.1. Person- centered recovery model. 101 13.1. Components of a person-c entered approach when talking about self- injury. 125 BOXES 1.1. Proposed diagnostic criteria for nonsuicidal self-i njury disorder. 7 1.2. Summary of key considerations regarding reasons for self- injury. 10 10.1. Overview of psychological approaches. 90 13.1. Example questions for a person-c entered approach when talking about self- injury. 128 13.2. Reputable online resources for people with lived experience of self- injury. 131 TABLES 1.1. Common intrapersonal and social reasons for self- injury. 9 2.1. Practical tips regarding language and asking about suicidal thoughts and behaviors. 19 2.2. Sample safety plan to be individually tailored. 20 4.1. Forms and examples of self-i njury stigma. 29 4.2. Overview and application of the self-sinjury stigma framework to different forms of stigma. 35 5.1. Appropriate language to use when talking about self-i njury. 44 6.1. Practical tips for minimizing socialization effects. 53 7.1. Recommended resources for people with lived experience of self- injury. 65 8.1. Key elements of a school policy. 71 9.1. What young people think caregivers can do to support individuals who self- injure. 80