1st Edition

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

By Bo Møhl Copyright 2020
    234 Pages
    by Routledge

    234 Pages
    by Routledge

    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.

    Chapter 1. What is self-injury?

    Direct self-injury

    Indirect self-injury

    Self-injury by proxy

    Digital self-harm

    Terminology

    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

    Skin

    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

    Attachment

    Internal working models

    The Strange situation and patterns of attachment

    Mind-in-mind and affect regulation

    Congruent and marked mirroring

    The alien self

    Mentalizing

    Mentalizing, mindfulness and validation

    Developing a mentalizing capacity

    Good mentalizing

    Failure of mentalizing deficit and NSSI

    Dissociation

    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

    Serotonin

    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

    Validation

    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

    Sedatives

    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

    Scars

    Biography

    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.