Self Harming

Self-harm is the non-fatal intentional acts of self-poising or self-injury irrespectively of the extent of suicidal intent. Self-harming has been a growing problem, it is estimated that there are more than 200000 persons presenting with self-harming in general hospitals over the UK at the moment. Self-harming is most common in younger people aged between 15 to 35 years old and moreover, it appears to be more frequent in women than men and also decreases over lifespan.

A history of self-harming is the strongest risk factor for suicide across a range of psychiatric disorders.

Furthermore, the repetition of the self-harming behaviour further increases the risk of suicide. Given the size of the problem of self-harming and the frequency with which is repeated, it is important that effective treatment interventions are developed for this patient group.

There is not much good evidence yet of which therapies work well for people who have harmed themselves. However, what evidence there is, suggests that problem-solving therapy and cognitive-behavioural therapy are useful. Although there is a growing evidence for the effectiveness of long-term psychological therapies to reduce the risk of self-harm, few interventions have been developed specifically for acute settings. Most research has been conducted in emergency departments concerning direct care and support of the self-harming individual.

When it comes to Cognitive Behavioural Therapy studies reported that evidence seems to be sufficient to conclude that CBT is effective in adult patients following self-harm; CBT was associated with significant improvements in scores for both depression and hopelessness as well as suicidal ideation in the post assessments of their study.

Cognitive Behavioural Psychotherapy (CBT; comprising of cognitive-behavioural and problem-solving therapy) is associated with fewer patients repeating self-harm in 6 months. Furthermore, this therapy is associated with improvements in depression, hopelessness, suicidal ideation and problem solving.

Another therapeutic intervention becoming very popular in supporting deliberate self-harmers is the Dialectical Behavioural Therapy. Despite a range of psychosocial, educational and pharmacological interventions, dialectical behavioural therapy has also been shown to reduce repeat episodes of self-harming. Dialectical Behavioural Therapy can also reduce the frequency of self-harming in patients with borderline personality disorder who engage in more than one self-harming acts.

DBT has already demonstrated considerable success in dealing with both non suicidal self-harm, suicidal behaviours and violence.

On the other hand studies have also shown that there are four features of Cognitive Analytic Therapy, which are effective in the treatment of deliberate self-harmers. These are flexibility, type of focus, rapid engagement and the use of problem-solving techniques. However, it is noted that the time limited aspect of CAT may be a limitation with this patient group, due to their increased sensitivity to the experience of separation and loss.

In a further article we will continue discussing possible interventions for deliberate self-harming as well as propose the option that according to research works better with this particular client group.

 

 

References

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Betz, M. E., Wintersteen, M., Bourdreaux, E. D., et al. (2016). Reducing suicide risk: opportunities in the emergency department. Ann Emerg Med, 68: 785-65.

Chapman, A., Gratz, K. and Broan, M. (2006) Solving the puzzle of deliberate self-harm: the experiential avoidance model. Behavior Research and Therapy. 44(3): 371–394.

Cowmeadow, P. (1994). Deliberate self-harm and cognitive analytic therapy. International Journal of Short-Term Psychotherapy, 9(2-3), 135-150.

Fruzzetti, A. and Levensky, E. (2000) Dialectical behaviour therapy for domestic violence: rationale and procedures. Cognitive and Behaviour Practise. 7(4): 435–447.

Fleischmann, A., Bertolote, J., de Leo, D., et al. (2005). Characteristics of attempted suicides seen in emergency-care settings of general hospitals in eight low- and middle-income countries. Psychol Med, 35: 1467–74.

Hawton, K., Harriss, L., Hall, S., Simkin, S., Bale, E. (2003). Deliberate self-harm in Oxford, 1990  2000: a time of change in patient characteristics. Psychol Med, 33: 987–96.

Hawton, K., Bergen, H., Casey, D., et al. (2007). Self-harm in England: a tale of three cities. Multicentre study of self-harm. Soc Psychiatry Psychiatr Epidemiol, 42: 513–21.

Hawton, K., Harriss, L., (2008). The changing gender ratio in occurrence of deliberate self-harm across the life-cycle. Crisis, 29: 4–10.

Hawton, K., Witt, K. G., Taylor-Salisbury, T, L., Arensman, E., Gunnell, D., Hazel, P., Townsend, E., & van Heeringen, K. (2016). Psychosocial Intervention Following self-harm in adults: a systematic review and meta-analysis. Published Online July 12, 2016;

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Leitner, M., Barr, W., & Hobby, L. (2008). Effectiveness of interventions to prevent suicide and suicidal behaviour: a systematic review. Health and Community Care Research Unit, Liverpool University and Scottish Government Social Research.

Linehan, M., Comtois, K.A., Murray, A.M., Brown, M.Z., Gallop, R.J., Heard, H.L., Korslund, K.E., Tutek, D.A., Reynolds, S.K. and Lindenboim, N. (2006) Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry. 63(7): 757–766.

Milner, A. J., Carter, G., Pirkis, J., Robinson, J., & Spittal, M. J. (2015). Letter, green cards, telephone calls and postcards: systematic and meta-analytic review of brief contact interventions for reducing self-harm, suicide attempts and suicide. The British Journal of Psychiatry, 206: 184-190.

NICE Guidelines (2011). Self-harm: Longer-term management: NICE guideline DRAFT: 21-24.

Muehlenkamp, J. (2006) Empirically supported treatments and general therapy guidelines for non-suicidal self-injury. Journal of Mental Health Counseling. 28(2): 166–185.

Razzaque, R. (2012). An acceptance and commitment based protocol for the management of acute self-harm and violence in severe mental illness. Journal of Psychiatric Intensive Care, 00: 1-5.

Zahl, D., & Hawton, K. (2004) Repetition of deliberate self-harm and subsequent suicide risk: long-term follow-up study in 11 583 patients. Br J Psychiatry, 185: 70–75.

Witt, K. (2017). The use of emergency department-based psychological interventions to reduce repetition of self-harm behaviour. Retrieved: www.thelancet.com/psychiatry Date: November 2017.

 

Read also the 2nd part of the article: Deliberate Self Harming & Possible Interventions 

Συγγραφή Άρθρου

Λυδία Μυλωνάκη

lydia mylonakiΨυχολόγος - MSc Forensic Mental Health.
Απόφοιτος του Τμήματος Ψυχολογίας του Αριστοτέλειου Πανεπιστημίου Θεσσαλονίκης.
Επιστημονική Συνεργάτιδα του E-Psychology

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