Assessment and Treatment of Non-Suicidal Self-Injury : A Clinical Perspective book cover
1st Edition

Assessment and Treatment of Non-Suicidal Self-Injury
A Clinical Perspective

ISBN 9781138349803
Published June 24, 2019 by Routledge
234 Pages

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Book Description

Assessment and Treatment of Non-Suicidal Self-Injury: A Clinical Perspective is the ideal primer for anyone who works with people who self-injure. Profiling who is affected as well as what their behaviour includes, the book explores the range of factors behind why people self-injure, from the influence of social media to the need for self-regulation, and offers recommendations for both assessment and outpatient treatment.

Throughout, the book is permeated by profound respect for those who use self-injury in an attempt to live a good life, while conveying a deep understanding of the challenges that self-injury presents for family members and treatment professionals. It recognizes that the behaviour can spread in hospital wards or other institutional setting, introducing the concept of self-injury by proxy, and assesses the range of therapies available, including CBT, MBT, ERGT and family therapy. Each chapter is complemented by clinical vignettes.

In an era when a great number of professionals will come into contact with someone who self-injures – including teachers, social workers and nurses as well as therapists – The Assessment and Treatment of Non-Suicidal Self-Injury is an invaluable resource that examines both the causes and the treatments available.

Table of Contents

Chapter 1. What is self-injury?

Direct self-injury

Indirect self-injury

Self-injury by proxy

Digital self-harm


Typologies of self-injury

Chapter 2. Non-suicidal self-injury – an independent diagnosis?

Categorizing self-injurers in non-clinical populations

Autonomous diagnosis in DSM-5

Differential diagnoses

Chapter 3. Epidemiology and gender differences

Prevalence in different age groups

Onset, course and prognosis

Gender differences

Women cut, men hit themselves

A literary example of a man who self-injures

Chapter 4. Self-injury as a sign of the times

Historical descriptions of self-injury


Late modern society

When perfect becomes the new normal

Self-injury as social pathology

Demedicalizing and normalizing self-injury

Social media

Chapter 5. Historical theories and new models for understanding non-suicidal self-injury

Historical theories

Emotion dysregulation and three theoretical models

The benefits and barriers model

Vulnerability and resilience factors for the development of self-injurious behaviour

Risk factors

Resilience factors

Diversity in the presentation of self-injury

Chapter 6. Attachment, affect regulation and growing up in an invalidating environment


Internal working models

The Strange situation and patterns of attachment

Mind-in-mind and affect regulation

Congruent and marked mirroring

The alien self


Mentalizing, mindfulness and validation

Developing a mentalizing capacity

Good mentalizing

Failure of mentalizing deficit and NSSI


Dissociation and self-injury

The biosocial theory and the impact of an invalidating childhood environment

Chapter 7. From meaning to function

A functional model of NSSI

Model for perpetuation self-injuring behaviour

Functions of NSSI

Chapter 8. Pathophysiology and neurobiological perspectives on self-injury

The role of neurotransmitters in NSSI

Adrenalin, noradrenalin and cortisol

The low road and the high road

Endogenous opioids


Other neurotransmitters

Chapter 9. Assessment of patients with non-suicidal self-injury

Therapeutic contact with the self-injuring patient

Assessing patients with self-injury

Assessment instruments

Motivation for treatment

Levels of treatment

Prioritizing treatment focus

Chapter 10. Treatment of non-suicidal self-injury – an overview

Problem-Solving Therapy (PST)

Manual-Assisted Cognitive Therapy (MACT)

Emotion Regulation Group Therapy (ERGT)

Mobile apps

Family therapy

Physical exercise

Medical treatment

Core elements in the psychotherapeutic treatment of NSSI

Chapter 11. Dialectical Behaviour Therapy

Dialectical dilemmas

Treatment structure

The five stages of DBT


Change strategies

Crisis card

Contact between patient and therapist

Effect of DBT on NSSI

Chapter 12. Mentalization-based therapy – keeping mind in mind

Treatment structure

Case formulation

Treatment principles

General intervention

Intervention hierarchy

Elements of MBT

Impact of MBT on NSSI

Chapter 13. Treating self-injury during hospitalization

Emotional dysregulation during hospitalization


Self-injury by proxy – mechanical restraints

The spiral of self-injury – the ‘tacit dialogue’

Reactions that may exacerbate self-injuring behaviour

NSSI and peer influence

Principles of a non-confrontational culture

The practical organization of the treatment

Chapter 14. When a loved one self-injures

Walking on eggshells

Accepting the difficult situation

Survivor’s guilt

Neutral topics

Talk about it

Educate yourself online and via the literature

Parental burnout

Parental relations – GIVE


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Bo Møhl is Professor of Clinical Psychology at Aalborg University in Denmark. He holds an MA in Literature and Education and an MSc in Psychology. He has published several articles and books about general psychiatry, psychotherapy, sexology and self-injury. He is trained in Group Analysis, MBT and DBT and has been treating self-injuring patients for more than 20 years. He is a member of the International Society for the Study of Self-Injury.