Nonsuicidal Self-Harm and Anorexia For Teens and Young Adults With Erica Johns

In this episode, we talk to Licensed Professional Counselor Erica Johns as she explains:

• What nonsuicidal self-harm and Anorexia are
• Signs to look for
• What to do about it. 

Visit SandstoneCare.com or call (888) 850-1890 for teen and young adult support. 

Learn more about self-harm
Learn more about eating disorders

Erica Johns serves as the Clinical Program Director for the Reston location of Sandstone Care. Erica holds a Bachelor’s Degree in Psychology and Criminal Justice along with a Master’s Degree in Mental Health Counseling. Erica is a Licensed Professional Counselor in Virginia. Erica has several years of clinical experience, including individual, family, and group therapy. Erica has worked in both Residential and Intensive Outpatient settings and holds experience in outpatient settings. Erica is trained in Trauma Focused Cognitive Behavioral Therapy, Family Based Therapy and has extensive experience with both DBT and CBT.

Transcript

Immanuel Jones: 0:05

Talking about anorexia and self harm are normally two topics that don't come up in everyday conversation, especially at the same time. But here in this episode, Dad's what Erica John's, a licensed professional counselor, and clinical program director at sandstone care will be discussing. She'll be talking about what anorexia is, how it's treatable. It even about non suicidal self harm and ways to recover from it. My name is Emmanuel, and this is the real common treatable podcast, where we talk about overcoming mental health, addiction, and substance use challenges in simple everyday language. Every single individual faces their own unique set of challenges. When we go through a situation that is uncomfortable, stressful, or painful, our body and mind try to find a way to cope. The thing is though, in some cases, the way we choose to cope may actually be unhealthy or even harmful to our body. The good news, again is that Erica is here to help us better understand and navigate why some teens and young adults would choose not to eat or inflict self harm. But before diving in deep First, let's listen to where and why she has a passion for studying and helping individuals struggling with self harm and anorexia.

Erica Johns: 1:33

So I didn't discover both topics as loves and passions at the same time. So when I was in grad school, I got educated on non suicidal self injurious behavior. And really the idea that people can engage in things like cutting, which is very popular without the intent of wanting to kill themselves. And it's really a passion for mine, because media and social media and movies and things like that really portray it as a, if you cut, therefore, you want to die. And that's nine times out of 10, not what it is, or they portray it as it's just a cry for attention, which is also not what most individuals who engage in non suicidal self injurious behavior, yes, they're crying out for help. But it's not based in just needing attention. It's they're hurting inside, they have emotions that they can't regulate, and they don't know how to regulate them. Specifically, with teens, they're experiencing some very adult emotions and thoughts that they have no idea how to wrap their heads around. And this is a great way of releasing that emotion and temporarily filling that void that they have. It's not dealing with the emotion, but at least this the emotions and the thoughts temporarily go away. My love for anorexia came when I got formally trained in how to treat anorexia and adolescents and teens. And again, the misconception that comes with it as well, that they just have negative self image, and they don't love the way that they look. And that they're really trying to improve their self concept of themselves. It's something bigger than just self like how they look and self image, it's really negatively impacting people and that they don't, they're not chasing, looking skinny or looking prettier. They want to be healthy and they want to eat, but this thing is taken over their thoughts. And it's telling them really harsh mean lies about themselves that if they do eat that pizza, that they're going to look a certain way. And this voice can be really loud and really mean. So really just bringing to both topics, some just education about it, and that it's not the normal go to stigma that people have associated with each both diagnosis.

Immanuel Jones: 3:34

We can see why Erica is passionate about the subject. So let's start to dive a little deeper into the topic of self harm. What exactly are triggers or some feelings that cause someone to want to inflict self harm?

Erica Johns: 3:49

It could be anything. So non suicidal self injurious behavior, as baseline is a maladaptive coping skill. It's just a really bad coping skill that we use. So you're right. Most people think, Oh, you're cutting, you must be sad. But it doesn't always have to be that it can be anxiety, it can be stress, pressure from family, school, friends, things along those lines, it could be having an emotion that you just simply don't know how to regulate and don't know how to understand. Like I said, a lot of adolescents, they experienced adult emotions and adult feelings, but in an adolescent body. So imagine trying to understand a really complex emotion as a 16 year old, you don't even know where to start to verbalize that to somebody what you're feeling. So how are you supposed to ask for help if I can't even possibly explain to you what I'm feeling on the inside. So a good way to handle that is sometimes hurting my own self or engaging in self pain or self infliction, also comes in social media, too. People do it in social media, you have friends who do it, they say it helps, so maybe I should try it and see if that helps. Again, at its baseline, it's a really maladaptive coping skill. And so what they're trying to do is regulate an emotion or a feeling or a thought they've tried it, it works. So therefore, they keep reusing. CNET because it does what it's intended to do.

Immanuel Jones: 5:06

maladaptive behavior. Now personally, I've never heard about this type of behavior before this interview. If this is your first time hearing about this term airco describes what it means here.

Erica Johns: 5:20

Like really bad coping skills. So when we get stressed, angry, mad, sad, anxious, whatever it may be, we all use cooking skills, things that make us feel better. Most people will read, take a walk, spend time with family, friends, maybe watch a movie or a TV show, do things that intentionally bring them joy, or less than their emotion. Those are good coping skills, you're not hurting yourself, you're not hurting anybody else. maladaptive or bad coping skills are when you're hurting yourself, you're hurting other people cutting, I'm hurting myself, utilizing drugs, I'm hurting myself,

Immanuel Jones: 5:54

even though we might now have a better understanding of what self harm is, please know that there are still some misconceptions parents have when it comes to understanding why their child would even choose to flick self harm. Here hear, Erica shares one of her experiences, working with the parent that voice one of the many misconceptions she faces when working with families.

Erica Johns: 6:23

So I had a client bless her heart who was 13 years old. She was engaging in self harm and cutting on her ankles. And mom discovered it as they were just out one day, it kind of saw what was on her legs, did some research and realize that she was intentionally cutting herself. And I remember mom telling me during the intake, I don't understand, I tell her all the time, she's so beautiful and how loved she is. She has such a great supportive family, she's got all these friends, like, just don't get why she would do something like this. And so I had to tell Mom, this has nothing to do with you or your family or your friends, like people could have it all and still be struggling. And so just because it looks like from the outside that she has it all or you think she has it all? Does it mean she feels the same way emotionally. And so it was a great example of like having to set the record straight that like happy people don't always look so happy. And it's really easy to put a facade on and there may be other things that are going on and even happy people can still struggle with things and still engage in self harm. And again, not necessarily want to die because then that was mom's neck, oh my god, do I need to lock her up and keep her safe? And it was no she's not she doesn't want to die. She's just hurting. And this is how she knows how to fix the pain and make the pain go away.

Immanuel Jones: 7:45

One last misconception about self harm is that if someone is inflicting self harm, that must mean they want to end their life. As Erica points out here, that is not always true.

Erica Johns: 7:56

So non suicidal self harm is self harm that does not have the intent of ending one's life typically, in what happens is people like will engage in self harm in terms of means like cutting, and most people assume that person is suicidal and wants to die and wants to in their life. Not always the case, there is such thing as engaging in behavior, that is harming yourself and the intent is to not end your life or to commit suicide.

Immanuel Jones: 8:23

Before talking about anorexia next. Here's a quick suggestion for a starting point, when it comes to beginning the recovery process from so far. So

Erica Johns: 8:32

at its baseline is trying to find what need is that fulfilling for that client? So what is it fulfill for you when you engage in self harm? Does it make your anxiety go down from a 10? To a five? Does it make your stress go from a 10? To find what need does that feel for you. And once you can identify what that need is, then you guys can start working on educating better ways to fulfill that need. And sometimes that comes with certain thoughts to that I have certain thoughts, these thoughts tell me I need to do these things. Well, let's challenge those thoughts. I am constantly preaching to people. Feelings are not facts. Just because we have a feeling about something doesn't mean it's a fact about a situation. So we sometimes need to challenge the facts. Like I may feel that because I got B on that paper that I'm worthless, and I'm never going to go anywhere in life or whatever the scenario may be. That's not true. Just because I get a B in on an assignment doesn't mean I'm going to fail the class. It means that maybe next time I need to study a little bit harder, maybe I should estimate a proofread that paper for me. But it doesn't equal that I'm a failure. So I'm constantly preaching that to people when we have feelings, soft facts about a situation. So once you're able to identify the need that it fills, then you can work on some of the thoughts that are surrounding by it, but then also filling in with more of those better, like adaptive coping skills that we talked about.

Immanuel Jones: 9:48

I want to pause for a quick second and take a moment to talk to the person that could currently be struggling with any of the topics we've discussed so far in this episode. Please know that there are tangible and real solutions out there that will help you better healthily get through your situation. For example, treatment centers. One of the best, if not the best treatment centers I know of it says don't care if you haven't heard of them before. Sandstone care helps teens, young adults, and their families overcome challenges with substance use, addiction and mental health conditions. They offer a wide range of age specific treatment options that can help you or your child. If you're interested in learning more about their mental health, and substance abuse treatment centers, you can actually live chat them at sandstone care.com, or call the number in the description box. You'll talk to a real person who gets to know you and your situation. And they'll even connect you with the support that you need, even if it's not with them. So definitely check them out. So diving back into it, we've talked about self harm, some of its misconceptions, and even about some of its triggers. Now, let's talk about anorexia. What is anorexia? Does it also have any misconceptions? How does it affect someone's self esteem? Erica helps us get a better understanding by first breaking down how to easier define anorexia.

Erica Johns: 11:28

Anorexia is restricting of food intake obviously, it results in decrease of weight, but it's been at a body weight that is unhealthy for your age, height, gender developmental like state that you're at body type in general, and based off your family history. And it's been at a low BMI for your demographic and your age. And restricting a food trying to hit a weight that you seem is ideal, which is not in your healthy BMI category. Most people's thoughts, we say anorexia, and I've had many clients and parents tell me same thing. I don't get it. I tell her because again, we see a lot more females a but regardless, I tell them all the time how beautiful they are, how loved they are, they seem so popular, they have so many friends at school, they have such a great family support. They dress like well all the time. I don't get it, why they're intentionally starving themselves. And again, it is not always fueled by low self esteem. What it is, is this, again, it's separating it from the client. It says boys are this entity that is telling them if you eat that food or eat this meal, you are going to feel a certain way. And it's a really strong really mean voice. And when you're so young, it's really hard to like combat that sometimes and say, No, that's not right, you're wrong. Like I do need to eat because I do need to feel my like feel my body and feel my growth, when you have this really strong outside voice influencing the way you're thinking and your feeling.

Immanuel Jones: 12:58

So a question that came to my mind after hearing this was his self esteem, isn't it? What causes someone to get anorexia? Why would someone choose not to eat.

Erica Johns: 13:10

Just because you have high self esteem doesn't mean you're never going to get anorexia. It doesn't work that way. Explain to clients parents all the time, nobody asks for it. It's not a if you have these six factors, you're definitely going to get interacts yet it just sometimes develops, there's no rhyme or reason to it. But what we can do is treat it and try to get your child back in a healthier mindset.

Immanuel Jones: 13:32

Recovering from anorexia is challenging. And family based therapy, which has three phases is an absolutely great way to nourish a child who needs treatment for anorexia. So what

Erica Johns: 13:47

I'm trained in, and what I practice is family based therapy. And so it's a family based therapy. In terms of treating anorexia, it's really empowering the parents and their support system to help nourish their child back to wellness. So the concept of it is there's three phases and the first phase, the child themselves cannot make decisions in terms of their eating and activity level. Because the eating disorder is doing all the thinking for them, the eating disorder is telling them no, you do not need to eat that piece of fruit because of XYZ. So parents really need to step in, and they need to take over what their child's eating, how much their child is eating, like exercise regulation, because again, the eating disorders gonna say you need to run three miles to burn off that apple which is not healthy. So the first phase is really focused on weight gain, gaining back weight and getting to a healthy BMI and a healthy stable medical level. The second phase is at that point where we start to see a little bit so we talked about that eating disorder being like attached to the client. So as we start to feel the client, the eating disorder slowly loses grip because you're no longer feeding into it anymore. So as it slowly loses grip and the client and the eating disorder are able to see separate from each other, the client is now able to make decisions for themselves. So in phase two, we slowly transition control over what they eat, how much they eat when they eat back to the client, so they can start making some of those decisions for themselves. And then by phase three, we've got complete separation, the clients making all decisions about food when how much and then we're able to actually tackle normal adolescent problems, school stress, friend stress, peer pressure, things along those lines. So I have clients who have come in really underweight and really malnourished, and will tell me they know they need to eat but won't eat anything, and unfortunately had to result in being hospitalized to at least just get the medically stable enough to be an outpatient therapy, and then was supportive parents and even siblings to were able to get healthy again and separate from their eating disorder, I would never recommend any client, whether it be self interest behavior, or non suicidal self injury behavior, or an eating disorder, simple things depression, anxiety, school stress, family stress, peer stress, I would never recommend that anybody tackle that alone, like, we all have support systems, and we should utilize this support system, parents, friends, guardians, family members, and even can be professionals like we should utilize a support system to help us with things and also normalize that it's okay to struggle with certain things in life like it can be hard from time to time, and we need support sometimes to help us along that journey.

Immanuel Jones: 16:25

I hope this podcast episode helped you better understand what self harm and anorexia is, and about treatment and recovery options that are available for you. Before we go, Erica does have one last message she wants to share with a parent or a loved one. When it comes to a teen or young adult struggling with self harm, or anorexia.

Erica Johns: 16:45

It's not about you, it's real easy as a parent to stop and go, What did I do wrong? What did we do that led to this? Or what did we not do that led to this and it's not about you and really know that there is help out there. And again, there's no shame in going and asking for professional help. But my biggest thing to parents is just reassuring them that it's nothing that you did or did not do. And unfortunately, sometimes these things just come, we can work through it. But as long as you are willing to support and to work through it with your child, we can overcome that. But that's my biggest like, thing to parents is like, it's not about you. It's not a reflection on you. It's not a reflection on your parents scene. It's unfortunately you didn't ask for it either. Just as much as your child didn't ask for it to come into their lives. Nobody has asked for it to leave. We're going to tell it to leave, but it's not about you.

Immanuel Jones: 17:41

If you want to continue the conversation, join us in a real calm and treatable Facebook group. It's a safe place where you can connect with other people trying to overcome mental health, addiction and substance abuse challenges. Listen, this self harm thing, it's real, but it's also more common than you think. But most importantly, it is treatable. We'll see you in the next episode.