Self mutilation

Self mutilation

1. Self Mutilation By Burhan Hadi Alsultany

2. Definition and Description Self mutilation is defined as intentional, non-lethal, repetitive self bodily harm or disfigurement that is considered socially unacceptable such as cutting, carving, burning, scalding, punching oneself, and breaking bones. Self mutilation is a symptom of mental disorders such as: borderline personality, bipolar, major depression, anxiety, schizophrenia, and PTSD and it is not a mental disorder of it’s own. Self mutilation acts are not to cause death; it usually begins in late childhood or early adolescence and may continue for 10-15 years after acts.

3. Classification in North American Nursing Diagnosis (NANDA) SELF MUTILATION SELF MUTILATION RELATED TO borderline personality disorder major depression Eating disorder (anorexia nervosa) Anxiety disorder, schizophrenia Post Trauma Stress Disorder

4. Etiology of Self-Mutilation Social and Behavioral Considerations 2004 Study by Nock and Prinstein (89 adolescent inpatients surveyed) To stop bad feelings (immediate relief) To feel something, even if it was pain To punish yourself To relieve feeling numb or empty To feel relaxed Way of coping with intense internal emotions, or even preventing suicide . Social modeling – 82% of responders say at least one friend self-injured in the last 12 months

5. Risk Factors of Self-Mutilation History of physical or sexual abuse Family neglect Comorbid conditions such as depression, eating disorders, personality disorders (BPD, antisocial, histrionic), PTSD, and anxiety disorders Alcoholism and illicit drug use Female sex

6. Prevalence Is on the rise with young adolescents in middle school. It is expected that 8 million Americans will have one episode of self-mutilation. Most common in have history childhood sexual abuse Prevalence rates in urban and suburban Skin cutting is the most common form of self-mutilation More common in females than males More common in singles than married Prevalent in all races and economic groups Often associated with eating disorders(anorexia nervosa)and BPD and prison Found in homes in which communication is indirect and at times violent . Found with a family history of mood disorders and other forms of addiction

7. Categories of Self-Mutilation There are three types of self-mutilation behavior: Major self- mutilation : extreme acts usually associated with a psychotic state or acute intoxication that cause considerable damage. Stereotypic self-mutilation : repetitive, rhythmic self-injurious behavior (such as head banging) carried out by individuals who are autistic, mentally retarted , and those with Tourette’s syndrome which has a strong biological component. Moderate or superficial self-mutilation : more common form of self-mutilation which includes hair pulling, skin scratching, picking, cutting, burning, and carving.

8. (Moderate or superficial ) Self-Mutilation Moderate or superficial self-mutilation is then further divided into three groups: Compulsive self-mutilation : repetitive, ritualistic, behavior that occurs several times a day such as hair pulling and cut to the skin. Episodic self-mutilation : periodical behavior that does not preoccupation the individual. Is seen in clients who have depression, anxiety, personality disorders, and most commonly in borderline personality disorder. Repetitive self-mutilation : a major preoccupation and consider it an addiction they can’t stop. Most common in females and appears in late childhood or early adolescence and continues for many years.

9. Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA: Pearson Custom Publishing.

10. Theoretical Views Biological Theories : explain that there are low levels of serotonin in the brains of self-mutilators. Psychodynamic Theories : explain that real or anticipated loss is a significant antecedent to self-mutilation . Cognitive Behavioral Theory : explains that self-mutilation is strengthened through positive and negative reinforcements in the individuals life . Narrative Theory : explains that individuals who self-mutilate are seeking a way to re-enact the childhood trauma they once experienced to prove that they are incapable of self-protection because they were not protected as children

11. Most common methods to self mutilation Cutting: Scratches with sharp objects Branding: Burning self with a hot object or friction burn=rubbing a pencil or eraser on skin Picking at skin or re-opening wounds Hair pulling Hitting

12. There are various treatment options for individuals who self-mutilate, however, not one single one is more effective than another. Such option are: Medication Dialectical Behavior Therapy Manual Assisted Cognitive-Behavior Therapy Cognitive Analytic Therapy Narrative Therapy Group Therapy Impatient Treatment Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA: Pearson Custom Publishing.

13. Treatment Manual Assisted Cognitive-Behavior Therapy : This therapy is normally given in no more than six sessions. Can be very practical because it can be given to patients via bibliotherapy. Cognitive Analytic Therapy : used with repeat self-mutilators and can be done in one session. It’s focus is on helping the client understand self-mutilation behavior, teaching problem-solving focus, help the client find alternatives to dealing with stress, and analysis of reciprocal role relationships.

14. Treatment Medication : SSRIs such as Prozac, Paxil, and Luvox are used to reduce self-mutilation in individuals and is most successful in conjunction with other forms of treatment. Dialectical Behavioral Therapy : An outpatient program that includes weekly individual and group therapy for the duration of a year that includes instruction in mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance.

15. Treatment Options Narrative Therapy : sees symptoms of self mutilation as “stories”, in which the problem is located outside the individual. Three stages: Outer: The counselor inquires about the context of the client’s life with no focus on the self-mutilation. Middle: The counselor inquires about the client’s trauma and symptoms and encourages client to build a support system. Inner: The counselor focuses on identifying the aspects of the client that were internalized as a way to cope with the trauma or abuse. Group Therapy : used simultaneously with individual therapy. It allows the client to feel that they are not alone in this problem. Inpatient Treatment : usually for those who are not benefiting from outpatient therapy.

16. Assessment Self- report are more common Assessment to child past life . Assessment to any psychiatric disorder Assessment to psychiatric family history. Observation and direct questioning are the best ways to assess an individuals level of self-mutilation behavior When self-mutilation behavior is acknowledged, then it is important for the counselor to follow up with more in depth questioning Counselors should refer patients to a physician to treat any possible infections to sight

17. Nursing intervention Monitor the patient behavior for anxiety status . Determine emotional and situational triggers. Help client recognize and understand the function and origin of the behavior Provide support for the recognition of feelings ,reality testing impulse control. Use therapeutic holding some might need special restraints (helmets , mittens , special padding ) Use play and art therapy (swinging , drawing , singing).

18. References Bauman, S. Self-mutilation. In N. Danner (Ed .), Pearson custom education (pp. 33-58). Boston, MA : Pearson Custom Publishing. (2008 ). Varcarolis ,E, ,manual psychiatric nursing care planning,4 th ed ,saunder , USA 2011