L23: Violence Towards Self: NSSI

Question 1

According to Rhode Island study, what are common characteristics predictive of self-cutting?

Answer 1

• Female - Caucasian - History of sexual abuse - Low impulse control

Question 1

Are medications helpful in treating self-harm pts?

Answer 1

• No studies to evaluate - Useful in reducing co-occuring symptoms

Question 2

Most common form of self-harm

Answer 2

• Cutting

Question 3

Key psychological characteristics of those who self-harm. Out of these characteristics, which indicate high risk of self-harm?

Answer 3

• Negative emotionality* - Difficult with experience, awareness and expression of emotions - Self-derogation* - *

Question 4

Key considerations / elements of an intervention approach to pts who self-harm

Answer 4

• Pillars of Trauma informed care: Safety, connection with others and management of emotion - Tasks: reunite body with one’s sense of self, learn bodily self can assert itself safely in the world without fear of reprisal and learn that body can be source of pleasure not only pain - Body is dissociated from pt’s sense of self – help reconnect them with body – help them identify ways their body has helped them stay safe, hold attitude of respect and appreciation for body of pt - Concerned, but non-reactive - Neither reinforcing, nor punitive - Respectful curiosity - Clear communication of a commitment to help pt find alternative ways - Aligning with pts ultimate desire for greater self-control and relief from stress

Question 4

Intervention outline for self-harm

Answer 4

• Build rapport - Evaluate chronicity of behavior and potential dangers: assess for suicide, where cut, function, depth, intensity and frequency - Mutual education (benefits, liabilities, difficulties) - Be clear about intention to help - Explore alternatives to self-harm (emergency kit) - Establish a therapeutic relationship with mental health professional for ongoing care - Schedule periodic check-in appts

Question 6

Common characteristics of those who self-harm

Answer 6

• Previous self-injury - Frequent urges and attempt to resist them - Used multiple methods

Question 7

Root causes of NSSI

Answer 7

• Severe episodes of affect dysregulation - Loss of attachment - Feelings of worthlessness, self-loathing - Distorted self-blame leading to a felt need to punish oneself - Debilitating effects of breaches of trust and protection by those in care-taking role

Question 8

According to those who self-harm, what are the functions for them?

Answer 8

• A way to feel real and alive (blood inside = life, breaks spell of dissociation) - A way to regulate emotions (distraction of pain from unbearable, terrible states of mind, including suicidal ideations) - A way to make real and externally visible what is only felt internally (concretization of trauma – expression of unexpressed emotions) - A means of self-punishment (dislike for self, self-hate and self-directed anger, pts suffering from dissociative identity disorder) - A means of influencing others (rarely method of manipulation, can establish meaningful connections with others – elicit affection, bond with friend who self-injury, get affirmation)

Question 9

What are ways self-harm helps the pt?

Answer 9

• Regulation of emotional distress - Regulation of interpersonal relationships

Question 11

Common types of self-harm

Answer 11

• Cutting - Burning - Hitting/banging - Puncturing skin with needles - Biting

Question 12

What are ways self-harm hurts the pt?

Answer 12

• Escalates into dangerous forms (ie. suicide) - Becomes habit forming - Source of shame and humiliation - Invites intervention by others

Question 13

With cutting, what areas of body are of greatest concern?

Answer 13

• Face, neck, eyes, breasts, genitals