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Many thanks for your interesting post on the topic of self-injurious behaviour, in which you succinctly described the two main categories; a suicide attempt, and self-injurious behaviours with no intention of suicide. I appreciated you noting that many adolescents use self-harm as a form of defense mechanism and an emotional coping response (Wheeler, 2020). I also have noted many patients in both psychiatry and in emergency room nursing who have disclosed that sef-harm does reduce their emotional distress, as you also noted. I also explored the topic of cutting, primarily because I do feel like this is an important topic that as Psychiatric Mental Health Nurse Practitioners (PMHNPs) we should be aware of due to its prevalence. Furthermore, it is generally very easy for people to obtain sharp objects and knives (except perhaps in a locked inpatient setting) which likely contributes to its high prevalence. Ryan-Vig et al. (2019) suggest that social media may contribute to adolescents gaining access to ideas, as well as social media often resulting in lower self-estem of young people. Wadman et al. (2018) noted that children in the care system, or looked after children, are more susceptible to psychological damage which can lead to self-destructive behaviours such as self-harm; this is important to note when working in nursing as we may encounter these vulnerable individuals. I was interested to read that already in your clinicals you have seen several adolescents who have a history of cutting. I hope your clinicals are going well. In my job on a FACT team in Florida one of my regular clients (I am an RN case manager) routinely cuts her absomen in criss-cross shapes when she is upset; she has a diagnosis of Borderline Personality Disorder (BPD) which I focused on in my original post. I have noted in my line of work a trend between BPD and superficial self-harm, which is echoed in national statistics (Simone and Hamza, 2020). Thank you for the information on Dialectical Behavioural Therapy (DBT) and medications management with selective serotonin reuptake inhibitors (SSRIs) and mood-stabilisers, which may be effective in reducing the likelihood of self-harming behaviours (Clareus et al., 2021). Good luck on clinicals and I know that your patients will be in great hands.ReferencesClaréus, B., Lundberg, T., & Daukantaité, D. (2021). ‘What I couldn’t do before, I can do now’: Narrations of agentic shifts and psychological growth by young adults reporting discontinuation of self-injury since adolescence. International Journal of Qualitative Studies on Health and Well-Being, 16(1). https://doi.org/10.1080/17482631.2021.1986277Ryan-Vig, S., Gavin, J., & Rodham, K. (2019). The presentation of self-harm recovery: A thematic analysis of YouTube videos. Deviant Behavior, 40 (12), 1596 – 1608. https://doi-org.regiscollege.idm.oclc.org/10.1080/01639625.2019.1599141Simone, A. C., & Hamza, C. A. (2020). Examining the disclosure of nonsuicidal self-injury to informal and formal sources: A review of the literature. Clinical Psychology Review, 82, 101907. https://doi-org.regiscollege.idm.oclc.org/10.1016/j.cpr.2020.101907Wadman, R., Armstrong, M., Clarke, D., Harroe, C., Majumder, P., Sayal, K.,Townsend, E. (2018). Experience of self-harm and its treatment in looked-after young people: An interpretative phenomenological analysis. Archives of Suicide Research, 22 (3), 365 – 379. https://doi-org.regiscollege.idm.oclc.org/10.1080/13811118.2017.1355286
Wheeler, K. (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.).
Springer. ISBN: 978-0826193797
Quite an interesting post this week focused on skin picking disorder. I found it very enlightening as it made me more aware of how self-injury behaviors with specific characteristics are often a disorder of their own. Specifically for skin picking disorder which is also known as excoriation disorder or dermatillomania, it was not until the most recent 5th edition of Diagnostic and Statistical Manual of Mental Disorders that this disorder was made separate from a diagnosis of NSSI or non-suicidal self-injury (Lochner et al., 2017). Defining this disorder separately allowed for skin-picking disorders to be more problem focused (Hooley et al., 2020) which can be helpful when evaluating effective treatments. I felt with the readings I reviewed I got the sense that most treatments for NSSI were similar and independent of the mechanism of self-injury observed, however after reading your post this seems to not truly always be the case and this was helpful for me.
In addition to the differences in how skin-picking disorder diagnostic criteria can vary from NSSI, it was also valuable to learn about how treatment recommendations can be different as well. For NSSI the recommendation or most supported modality is Dialectical Behavioral Therapy (DBT) versus with skin picking disorder being Cognitive Behavioral Therapy (CBT). Looking into this further considering these disorders are types of self-injurious behaviors, it has been shown that these individuals demonstrating dysregulated emotions have benefitted from both CBT and DBT (Chen & Chun, 2019). This is due to both modalities focused on developing emotional awareness and regulation. Where these two therapies vary is that CBT was effective in gaining problem solving skills and DBT helps to develop ways to respond to emotions in the moment and gain better impulse control without the use of maladaptive habits (Chen & Chun, 2019). I also hadn’t noted any discussion about pharmacological agents recommended with NSSI specifically, however it would be dependent on the underlying psychopathology leading an individual to this particular behavior.Thank you for sharing!
Chen, W. L., & Chun, C. C. (2019). Association between emotion dysregulation and distinct groups of non-suicidal self-injury in Taiwanese female adolescents. International journal of environmental research and public health, 16(18), 3361.
Hooley, J. M., Fox, K. R., & Boccagno, C. (2020). Nonsuicidal self-injury: diagnostic challenges and current perspectives. Neuropsychiatric disease and treatment, 16, 101.
Lochner, C., Roos, A., & Stein, D. J. (2017). Excoriation (skin-picking) disorder: a systematic review of treatment options. Neuropsychiatric disease and treatment, 13, 1867.