Self Harm Flashcards
What is NSSI?
Non suicidal injury disorder
What is the epidemiology of self harm?
- 7% 16-24 year old women reported having self harmed at some point in their life.
- 7% of 16-24 year old men.
For every suicide, there are many people that are in hospital for self harm and many that have self harmed in the community.
What are predictors of NSSI?
Feelings of hopelessness, anxiety, younger age and female gender.
Previous self harm.
Disadvantaged socioeconomic background, social isolation, negative life events including childhood emotional, physical or sexual abuse
What are some personality traits that underpin self harm?
Sense of entrapment Lack of belonging Black and white thinking patterns Low self esteem Impulsivity Hopelessness Difficulties in problem solving Lack of emotion regulation skills.
What are the reasons people self harm?
Getting relief form terrible state of mind Wanting to die Wanting to punish oneself Wanting to feel something Wanting to get back in control.
Describe the card sorting task.
There are often distal factors that people say have a role in making them SH.
There are also cognitions they feel beforehand.
There was a difference between the motives of the first time they self harmed vs the last time. It used to make them feel better but not anymore.
What are the main underpinnings in the cause of self harm?
Emotional dysregulation.
Increased self reported impulsivity.
Emotional cascade- continued rumination occurs, leading to negative emotion. The only way they break this cycle is by self harming. (social negativity aswell)
Reward processing abnormalities (3) :
- Those who were currently self harming vs those who harmed a month ago showed an inability to learn a low risk strategy (card profit task)
- There is reduced reward anticipation. (Monetary incentive delay task).
- Greater reward processing activity when looking at self harming images.
How is mental imagery involved?
People have picture in mind before self harming. How you experience the image might make a difference.
The more distressing they found the image distressing, the less likely they are to act.
Vividly imaging the reward can strengthen the motivation to engage in an action.
What is the proposed biology of self harm behaviour?
Dysfunction in pain perception.
- Increased tolerance, higher pain threshold.
- Opioid dysfunction theory: Increased baseline endorphins in acute SH, causing pain relief?
Neurofunctional abnormalities:
Aberrant amygdala activity & connectivity
Dysfunctional activity during emotional regulation.
Physical pain task:
In SH, self administered pain stimuli = activity in areas involved in reward/addiction.
Current treatment?
No pharmacological therapy.
Targeted psychological intervention: Reduces repetition. Not everybody responds.
Adaptations to CBT
(emotion regulation techniques)
DBT: Dialectic behavioural therapy.
Interpersonal therapy, social support.
What are some digital interventions?
Imaginator: Imagery based training emotion regulation, motivation and planning.
My self-help tool: Online tool based on decision aids principles.
Blueice: CBT and DBT principles and strategies. Mood monitoring diary and menu of mood lifting activities.
