Coping and problem solving of self-mutilators

The perception of pain, discriminative touch and affective touch in patients suffering from Borderline Personality Disorder

Borderline Personality Disorder (BPD) is often characterized by self-injurious behaviors, with one-half to two-third of these patients reporting hypalgesic or analgesic phenomena during self-harming. Research on pain perception in BPD suggested abnormal processing of nociception either within the sensory-discriminative and/or motivational-affective systems of pain. Nevertheless, it is still unclear whether pain insensitivity could be generalized to other somatosensory submodalities. To investigate this question, 30 BPD patients and 30 matched healthy controls were enrolled in the current study and underwent a somatosensory battery composed of well-established psychophysical test assessing all the principal submodalities of somatosensation, namely pain perception (i.e., warm, cold and mechanical), discriminative touch (i.e., tactile acuity and tactile sensitivity) as well as affective touch. Results showed abnormal warm detection threshold, warm pain threshold, mechanical pain perception, and tactile sensitivity in BPD patients, but no differences emerged neither for tactile acuity nor for cold pain thresholds, cold tolerance, or for affective touch perception. Findings point to a deficit in nociception, as well as in tactile sensitivity in BPD individuals, and were discussed in relation to BPD clinical features including self-injurious behaviors.

The mediating role of coping strategy in the association between family functioning and nonsuicidal self-injury among Taiwanese adolescents

OBJECTIVE

Nock's (2009) integrated theoretical model suggests that both intrapersonal and interpersonal factors contribute to the development of nonsuicidal self-injury (NSSI). Based on this model, the present study examined the roles of family functioning and coping strategy in predicting NSSI, as well as the mediating effect of coping strategy in the relationship between family functioning and NSSI. Gender differences on the associations of these variables were also examined.

METHOD

A sample of 1,989 secondary school students (52.0% females) in Taiwan was assessed by self-report measures of perceived family functioning, coping strategy, and NSSI.

RESULTS

Results showed that both family functioning and avoidance/emotion-focused coping strategy predicted NSSI. Additionally, the association between family functioning and NSSI was mediated by avoidance/emotion-focused coping strategy. Gender differences were not found on the associations among these study variables.

CONCLUSIONS

These data provided evidences that the Nock's (2009) integrated theoretical model may help to explain how coping strategy mediates the effect of family functioning on NSSI. The implications of the findings for future research and intervention were discussed.

How people who self-harm negotiate the inpatient environment: the mental healthcare workers perspective

WHAT IS KNOWN ABOUT THE SUBJECT?: Self-harm plays a function, commonly in the form of distress management. There has been little focussed exploration of how individuals who use self-harm to manage distress cope when prevented from self-harm in an inpatient environment and how staff respond to this issue.

WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE

This paper uses the experiences of mental health staff to add to the existing knowledge that self-harm has a functional role and supports the notion that interventions for self-harm should focus on the origins of distress. It describes the potential consequences that focussing on prevention of self-harm as opposed to actually managing distress may have on service-users, how staff attempt to manage these consequences and factors that may impact on staff interventions to prevent further distress/harm. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The findings suggest that mental healthcare staff should aim to understand the function of self-harm, use this understanding to develop an individualized care plan with the aim of managing distress and identify barriers to the effectiveness of the interventions so they can be worked around.

ABSTRACT

Introduction Literature describes self-harm as functional and meaningful. This creates difficulties for service-users detained in an inpatient environment where self-harm is prevented. Aim Mental healthcare staff were interviewed to build on existing evidence of issues with the prevention approach and explore, from a staff perspective, how self-harm prevention impacts on service-users, how they manage distress and how this impacts on staff and their approach to care. Methods Qualitative methods were used to allow unexpected themes to arise. Ten semi-structured interviews were carried out with mental healthcare staff and thematically analysed. Findings and discussion The findings provide new evidence on the benefits and limitations of the inpatient environment for individuals who self-harm. Findings indicate that being unable to self-harm can lead to a continuation of distress and subsequent potentially harmful attempts to manage distress. Staff described experiencing a struggle for control in preventing self-harm, leading to increasingly harmful methods of self-harm. Alternatively some staff were able to support service-users with distress management. We discuss factors influencing which of these 'paths' service-users followed. Implications Considerations for care planning including understanding self-harm, using individualized care planning and attending to barriers are outlined with the ultimate aim of reducing distress and the impact of prevention of self-harm.

Religious coping among self-harm attempters brought to emergency setting in India

This study attempted to evaluate religious coping and its correlates among patients presenting with self-harm to an emergency setting and compared it with a healthy control group. Religious coping was assessed using brief RCOPE. Beck Hopelessness Scale, Beck Depression Inventory, Barratt Impulsivity Scale, Scale for Suicidal Ideations and Irritability Depression Anxiety scale were used to assess for hopelessness, depression, impulsiveness, suicidal ideations and irritability respectively. The study included 32 subjects with depression and 77 subjects without any psychiatric diagnosis who presented with self-harm and 50 healthy controls. Compared to healthy controls, those with self-harm irrespective of presence or absence of psychiatric diagnosis less often used positive religious coping and more often used negative religious coping. Further, among those without psychiatric diagnosis (with self harm), there was positive correlation of negative religious coping with impulsivity and hopelessness. Among those without psychiatric diagnosis with self-harm, both positive and negative religious coping correlated positively with depressive scores, severity of suicidal ideations, anxiety and irritability, but associations were stronger for negative religious coping than that for positive religious coping. The findings of the present study suggest that those who indulge in self harm have lower use of positive religious coping and higher use of negative religious coping.

Blood on the Walls: Self-mutilation in Prisons

Self-mutilation or self-harm is a recognised problem within custodial environments in the English-speaking world. This article utilises the work of Michel Foucault in relation to disciplinary power to provide a fresh analysis of this problem, locating its emergence within the exercise of this power. It also examines various strategies developed by custodial authorities to manage self-harm, as well as the sociological, psychological and criminological discourses that have emerged around it, in order to explore their role in the production and persistence of this problem.

Prevalence, correlates, and prospective predictors of non-suicidal self-injury among New Zealand adolescents: cross-sectional and longitudinal survey data

Non-suicidal self-injury (NSSI) is common among adolescents and linked to many maladaptive outcomes. This study aimed to assess the prevalence and correlates of NSSI among a community sample of New Zealand adolescents. A self-report questionnaire was administered to adolescents at time 1 (N = 1162, mean age = 16.35), and approximately five months later (time 2, N = 830, mean age = 16.49). Prevalence and bivariate correlations were assessed at both time points, and cross-lag correlations using matched data (N = 495, mean age = 16.23). Lifetime history of NSSI was 48.7 % (females 49.4 %, males 48 %). Consistent with previous international research, NSSI was associated with higher Alexithymia, depression, anxiety, bullying, impulsivity, substance abuse, abuse history and sexuality concerns and lower mindfulness, resilience and self-esteem. Cross-lag correlations suggested NSSI is directly (perhaps causally) related to psychological vulnerability in various domains (e.g., increased depression and lower self-esteem), while bullying may be more distal to NSSI, rather than a proximal predictor.

Child maltreatment and deliberate self-harm: a negative binomial hurdle model for explanatory constructs

Emerging adults demonstrate the highest rates of deliberate self-harm (DSH) and thus represent a population in need of further study. While child maltreatment (CM) history is a risk factor for DSH, the mechanisms behind this relationship are not fully understood. This study tested a model of mechanisms linking CM with DSH (likelihood of engaging in the behavior and frequency among those who self-harm) via negative urgency (tendency to engage in impulsive behaviors under conditions of negative affect), distress tolerance, sense of control, and desire for control in a sample of college students. As hypothesized, CM had a strong positive direct association with both the likelihood and frequency of DSH. CM was positively associated with negative urgency and inversely associated with distress tolerance and sense of control. Negative urgency was positively associated with DSH likelihood and frequency. Distress tolerance was not directly associated with DSH but was indirectly associated with DSH likelihood and frequency via negative urgency. Sense of control was not associated with the likelihood of engaging in DSH; however, among those who endorsed a history of DSH, sense of control was positively associated with DSH frequency. Desire for control was not associated with either CM or DSH.

Risk-related and protective correlates of nonsuicidal self-injury and co-occurring suicide attempts among incarcerated women

Individual and environmental correlates of nonsuicidal self-injury (NSSI) and co-occurring suicide attempts (SA) among incarcerated women (N = 104) were examined. Participants completed measures of putative risk and protective factors, including coping styles, childhood maltreatment, and hopelessness. Results indicated that active coping was uniquely, negatively associated with the presence and frequency of NSSI, whereas avoidant coping and childhood physical/emotional abuse were positively associated with NSSI frequency. Conversely, among women with a history of NSSI, hopelessness was uniquely, positively associated with the presence and frequency of SA. Further, childhood sexual abuse was associated with the presence of SA, while physical/emotional abuse was associated with SA frequency. Hopelessness was more strongly related to SA frequency than NSSI frequency. These findings help disentangle the unique risk and protective factors for NSSI and co-occurring SA in incarcerated samples.

Emotion: The Self-regulatory Sense

While emotion is a central component of human health and well-being, traditional approaches to understanding its biological function have been wanting. A dynamic systems model, however, broadly redefines and recasts emotion as a primary sensory system-perhaps the first sensory system to have emerged, serving the ancient autopoietic function of "self-regulation." Drawing upon molecular biology and revelations from the field of epigenetics, the model suggests that human emotional perceptions provide an ongoing stream of "self-relevant" sensory information concerning optimally adaptive states between the organism and its immediate environment, along with coupled behavioral corrections that honor a universal self-regulatory logic, one still encoded within cellular signaling and immune functions. Exemplified by the fundamental molecular circuitry of sensorimotor control in the E coli bacterium, the model suggests that the hedonic (affective) categories emerge directly from positive and negative feedback processes, their good/bad binary appraisals relating to dual self-regulatory behavioral regimes-evolutionary purposes, through which organisms actively participate in natural selection, and through which humans can interpret optimal or deficit states of balanced being and becoming. The self-regulatory sensory paradigm transcends anthropomorphism, unites divergent theoretical perspectives and isolated bodies of literature, while challenging time-honored assumptions. While suppressive regulatory strategies abound, it suggests that emotions are better understood as regulating us, providing a service crucial to all semantic language, learning systems, evaluative decision-making, and fundamental to optimal physical, mental, and social health.

A Cognitive-Behavioral Approach to Case Formulations for Nonsuicidal Self-Injury

Nonsuicidal self-injury (NSSI) is a highly prevalent behavior among clinical and nonclinical samples. Despite the prevalence, maladaptive, and potentially dangerous nature of the behavior, no empirically supported interventions have been identified specifically for NSSI, and clinicians report a lack of knowledge regarding the treatment of NSSI. This article discusses the application of a common component of therapy, the case formulation, to conceptualizing and treating NSSI. This strategy for case formulation incorporates cognitive-behavioral and functional analytic approaches while focusing on factors pertinent to the development, maintenance, and treatment of NSSI. A case example is presented.

Changes in ecological momentary assessment reported affect associated with episodes of nonsuicidal self-injury

Although emotion regulation deficits have been frequently implicated in the incidence of nonsuicidal self-injurious behavior (NSSI), no research to date has examined in vivo change of affect associated with real-world NSSI behavior. The present study employed Ecological Momentary Assessment (EMA) to assess change in affect associated with episodes of experienced NSSI in a sample of 36 college students with a self-reported history of NSSI. Results indicated that individuals who reported NSSI behavior over the course of the study experienced increases in negative affect prior to an episode of NSSI that peaked during the episode and faded gradually in the hours following the episode, with affect change roughly approximating a quadratic curve. These changes in affect were detected only at times in which individuals engaged in NSSI and were absent for individuals who did not report NSSI over the course of the study. Moreover, changes in negative affect associated with NSSI were, on average, detectable hours prior to the NSSI event. These findings suggest that episodes of NSSI may be predicted through a careful examination of affect change long before actual NSSI behavior occurs.

A systematic literature review: self-mutilation among adolescents as a phenomenon and help for it-what kind of knowledge is lacking?

The aim of this review article is to present current knowledge of self-mutilation among adolescents as a phenomenon and to define what kind of knowledge is lacking based on existing literature. The literature searches were executed in the CINAHL and Medline databases in 2010. The analysed data consisted of 126 articles and inductive content analysis was carried out. Existing knowledge of self-mutilation was categorized into the following two classes: (1) self-mutilation as a phenomenon and (2) caring for persons who self-mutilate or self-harm.

The Relationship Between Emotion Dysregulation and Deliberate Self-Harm Among Inpatients with Substance Use Disorders

Despite the emphasis on the role of emotion dysregulation in deliberate self-harm (DSH), no studies have examined this association among patients with substance use disorders (SUD). This study examined if emotion dysregulation is heightened among SUD inpatients with (vs. without) DSH, and if the association between DSH and emotion dysregulation remains significant when controlling for their shared association with risk factors for both, including borderline personality disorder (BPD), posttraumatic stress disorder (PTSD), childhood abuse, and substance use severity. Findings indicate heightened emotion dysregulation among SUD patients with (vs. without) DSH, and provide evidence of a unique association between emotion dysregulation and DSH when controlling for BPD, PTSD, childhood abuse, and substance use severity. Findings also highlight the particular relevance of three dimensions of emotion dysregulation to DSH among SUD patients: limited access to effective emotion regulation strategies, difficulties engaging in goal-directed behaviors when distressed, and emotional nonacceptance.

Risk factors and correlates of deliberate self-harm behavior: a systematic review

OBJECTIVE

Deliberate self-harm behavior--without suicidal intent--is a serious health problem and may be studied as a clinical phenomenon in its own right. Empirical studies of sociodemographic and psychological correlates and risk factors are systematically reviewed.

METHODS

We searched Medline, PsycINFO, PSYNDEX (German psychological literature), and reference lists. We targeted self-induced bodily harm without conscious suicidal intent. Studies on suicidal behavior or self-poisoning were only included if they also assessed nonsuicidal self-harm.

RESULTS

Fifty-nine original studies met the criteria. Deliberate self-harm may occur at all ages, yet adolescents and young adults are at a higher risk. Evidence on gender is complex. Only 5 studies realize a prospective design (6 months to 10 years) and test predictors. The majority use cross-sectional and retrospective methods. No longitudinal study (separately) examines new incidence. Evidence of correlates encompasses distal/proximal, person/environment, and state/trait factors. Many studies report associations between current self-harm behavior and a history of childhood sexual abuse. Adolescent and adult self-harmers experience more frequent and more negative emotions, such as anxiety, depression, and aggressiveness, than persons who do not self-harm. Two studies yield specific interactions between childhood trauma and current traits and states such as low emotional expressivity, low self-esteem, and dissociation with respect to a vulnerability to self-harm.

CONCLUSION

Evidence of distal, biographical stressors is fairly strong. Proximal stressors have rarely been investigated; protective factors, hardly at all. Despite many findings of correlates, the data do not yet justify terming them risk factors. Longitudinal studies are needed.

The nature and extent of non-suicidal self-injury in a non-clinical sample of young adults

This study aimed to examine the nature, extent and correlates of non-suicidal self injury (NSSI) in a non-clinical sample of young adults. Two hundred and eleven participants (18-30 years) completed self-report questionnaires assessing history of NSSI, emotional regulation, coping strategies, symptoms of psychopathology, and alcohol use. Of the sample, 43.6% reported engaging in NSSI; approximately 10% engaged in moderate/severe NSSI. Those that reported NSSI reported greater psychopathology, avoidant coping and alcohol use than those who did not self-injure. The extent of these differences was magnified as the severity of NSSI increased. These findings highlight the need to consider any form of NSSI, no matter how mild, as an indication of distress and ineffective coping.

Self-mutilation and coping strategies in a college sample

The goal of this study was to examine the use of specific coping strategies among self-mutilating college students. The self-mutilating group (n = 44) reported utilizing avoidance strategies more often than did a control group (n = 44) matched for general psychological distress but with no history of self-mutilation. In addition, female, but not male, self-mutilators endorsed using problem-solving and social support seeking strategies less often than nonmutilators. These findings suggest that coping strategies in general and avoidance-based strategies in particular may be important targets for the treatment of self-mutilative behaviors.

[Stress, coping, and craniomandibular disorders]

BACKGROUND

Stress is an etiologic factor of pain-relevant craniomandibular disorders (CMD). Interindividual differences in coping with stress and their relation to CMD have rarely been examined.

PATIENTS AND METHODS

A total of 72 volunteers (20 men, 52 women) were examined according to the Research Diagnostic Criteria for Temporomandibular Disorders. Stress parameters and coping skills were assessed by questionnaires.

RESULTS

Stress and one coping factor are correlated with CMD indices. Linear regression analysis found the Life Event Score and cognitive coping by changing appraisals to significantly predict CMD.

CONCLUSION

Stress and coping skills are independent predictors of CMD.

Three assessment tools for deliberate self-harm and suicide behavior: evaluation and psychopathological correlates

OBJECTIVE

The aims of this study are to adapt two validated self-report questionnaires of deliberate self-harm and suicidal behavior to German, to investigate their psychometric properties and agreement with clinician-administered ratings, and to examine their psychopathological correlates.

METHODS

The Deliberate Self-Harm Inventory [Gratz KL. Measurement of deliberate self-harm: preliminary data on the deliberate self-harm inventory. J Psychopathol Behav 2001;23:253-263] and the Self-Harm Behavior Questionnaire [Guttierez PM, Osman A, Barrios FX, Kopper BA. Development and initial validation of the self-harm behavior questionnaire. J Pers Assess 2001;77:475-490] were completed by 361 patients hospitalized for depressive, anxiety, adjustment, somatoform, and/or eating disorders. A clinician-administered rating scale of self-destructive behavior was included. Psychopathological variables were assessed by standardized questionnaires.

RESULTS

The self-report questionnaires demonstrated good reliability (alpha=.81-.96, split-half r=.78-.98, test-retest r=.65-.91). Reliability of the clinician-administered ratings was acceptable (interrater kappa=.46-.77, test-retest kappa=.35-.48). Intraclass correlations (ICC=.68) for all three instruments were satisfactory. Rates of self-harm and associations between self-harm and suicidal behaviors are reported. The findings support the hypotheses of a higher degree of psychiatric symptomatology in patients with self-harm behavior compared to those without.

CONCLUSION

The two questionnaire adaptations are reliable and valid self-report scales for the assessment of self-harm and past suicidal behavior.

Self-mutilation and symptoms of depression, anxiety, and borderline personality disorder

The goal of this study was to examine the relationship between self-mutilation and symptoms of depression and anxiety in a nonclinical population. Self-mutilators reported significantly more symptoms of depression and anxiety than did the control group. When the group of self-mutilators was divided into individuals who cut themselves and individuals who harm themselves in other ways, we found that the between-group differences were primarily due to individuals with a history of cutting. Yet when symptoms of borderline personality disorder (BPD) were statistically controlled, all significant between-group differences in depressive and anxious symptoms were reduced to nonsignificant. These findings highlight the importance of assessing symptoms of BPD in self-mutilators, regardless of diagnosis.

A Multi-Dimensional Perspective of Adolescents' Self-Cutting

Adolescent self-cutting behaviours has a long been a problem in modern society. In this paper, the writer tries review six perspectives in interpreting adolescent self-cutting behaviours. Based on these six perspectives, the writer tries to re-conceptualise a multidimensional model on adolescent self-cutting behaviours. This model tries to include the family system, peer system and socio-cultural context in perceiving the antecedents, process and aftermath in adolescents' self cutting behaviours. The implications of this perspective to intervention with adolescents are also discussed.

Dispositional and contextual perspectives on coping: toward an integrative framework

The clinical disciplines have witnessed a rapidly growing literature on the conceptualization and measurement of coping and on the role of coping in confronting stressful life circumstances and maintaining adaptive functioning. This literature has spawned a diversity of concepts and contrasting perspectives on the determinants and effects of coping. To address this complexity, we comment on dispositional and contextual perspectives on the coping process, describe the domains of coping styles and coping skills, and review some measures of these constructs. Next, we present a conceptual framework that integrates key aspects of these constructs and use the framework to guide a selective review of the linkages between personal and social resources, coping skills, and adaptive functioning. We then consider applications of the framework to clinical practice.

Coping and coping styles in personality and treatment planning: introduction to the special series

Coping is a complex process. It is variously described as a situational and as a trait-like response, as a response to stress and as a disposition to respond to change. In this article, we review the current research on coping within the context of considering the contributions of the articles presented in this series. We present two broad views of coping, the more general one under the title of "coping response" defines coping as containing emotional, behavioral, and cognitive qualitites. It is generally considered to be a stress-specific pattern by which an individual's perceptions, emotions, and behaviors prepare for adapting and changing. The more narrow view of coping is described here as "coping style" and represents a more observable but general style of interacting. In this usage, coping is a trait-like variable that is activated when an environment changes in some way. It resembles other personality qualities and describes dispositions to respond in certain ways. In this article, we consider the implications and extant knowledge about coping within these two definitions, with special consideration to the prediction of treatment processes and outcomes. The articles in this series are discussed both in terms of extant research on these two views of coping and in terms of their contributions to the available literature on coping and coping responses.

Coping, treatment planning, and treatment outcome: discussion

The articles presented in this issue are discussed within the context of the general literature on coping and coping style. The focus of this special issue was to determine if these articles are both consistent with extant research and advance the field. We identify at least two general definitions of coping, as used in these articles. We refer to one definition as reflecting one's "coping style." This is largely a descriptive concept and closely related to one's enduring behavioral traits. It is closely related to other personality characteristics such as introversion-extroversion, stability, etc. The other definition of "coping" in the literature is much more specific to stressful environments and to the changes noted in one's behavior and cognitions during times of stress, than the first definition. We refer to this broad stress response as one's "coping response." Coping response, unlike coping style, includes both a cognitive and an affective component. We conclude that it may be advantageous to differentiate between these two broad definitions in future research. We also conclude that the articles in this issue provide information that advances the field's understanding of coping styles and coping responses.

Adolescent perceptions of relevant social problems

PROBLEM

Social problems can be a significant stressor for adolescents. Disturbed youth often experience negative outcomes to social problems, solve problems poorly, and display distortions in reasoning about social problems.

METHODS

A series of focus groups was conducted with adolescents (N = 36), and the data was analyzed inductively. Activities to increase the rigor of the study data (establishing credibility, trustworthiness, and transparency) were incorporated into the phenomenological research design.

FINDINGS

Five social problem themes with critical attributes were perceived to be relevant to teenagers in today's society.

CONCLUSIONS

Adolescents' social problems shift in response to a changing society. Findings from this study can be used to help target assessments and treatment plans when working with disturbed youth.

Stress coping strategy in Japanese patients with eating disorders: relationship with bulimic and impulsive behaviors

Although maladaptive coping strategies in eating disorder patients have been reported, the relationship between impulsivity and coping strategy has not previously been studied. Subjects consisted of 43 patients with anorexia nervosa restricting type (AN-R), 42 patients with anorexia nervosa binge eating/purging type (AN-BP), 71 patients with bulimia nervosa purging type (BN), and 97 controls. The Coping Inventory for Stressful Situations was used to evaluate coping strategies. Only AN-BP patients had a significantly lower task oriented-coping score than controls, and AN-R and BN patient groups used significantly less social diversion-avoidance coping strategies than controls. Emotion-oriented coping scores of AN-BP and BN patients were significantly higher than those of controls. In addition, impulsive BN patients had significantly higher emotional coping scores than less impulsive BN patients. These results suggest that maladaptive coping strategies may be a perpetuating factor even for impulsive patients and emphasizing a change in maladaptive coping strategies may be a useful treatment strategy even for highly impulsive patients.

Body piercing medical concerns with cutting-edge fashion

OBJECTIVE

To review the current information on medical complications, psychological implications, and legislative issues related to body piercing, a largely unregulated industry in the United States.

METHODS

We conducted a MEDLINE search of English language articles from 1966 until May 1998 using the search terms "body piercing" and "ear piercing." Bibliographies of these references were reviewed for additional citations. We also conducted an Internet search for "body piercing" on the World Wide Web.

MAIN RESULTS

In this manuscript, we review the available body piercing literature. We conclude that body piercing is an increasingly common practice in the United States, that this practice carries substantial risk of morbidity, and that most body piercing in the United States is being performed by unlicensed, unregulated individuals. Primary care physicians are seeing growing numbers of patients with body pierces. Practitioners must be able to recognize, treat, and counsel patients on body piercing complications and be alert to associated psychological conditions in patients who undergo body piercing.