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Self Harm

 

Article Date: 12 Apr 2011 – 0:00 PDT


A new study published in the current issue of Psychotherapy and Psychosomatics by a group of British investigators outlines the clinical characteristics of self-injury during treatment.

 

Deliberate self-injury (DSI) is significantly associated with personality disorder (PD). However, there are gaps of DSI as an indicator of severity of psychopathology, as moderator of outcome and with regard to its response to different treatment programs and settings. In this study, the investigators compare 2 samples of PD with (n = 59) and without (n = 64) DSI in terms of clinical presentation, response to psychosocial treatment and relative outcome when treated with specialist long-term residential and community-based programs. They test the assumption that DSI is an appropriate indicator for long-term inpatient care by contrasting the outcomes (symptom severity and DSI recidivism) of the 2 DSI sub-groups treated in the 2 different approaches. PD with DSI had greater severity of presentation on a number of variables (early maternal separation, sexual abuse, axis-I comorbidities, suicidality and inpatient episodes) than PD without DSI. With regard to treatment response, the investigators found a significant 3-way interaction between DSI, treatment model and outcome at 24-month follow-up. PD with DSI treated in a community-based program have significantly greater chances of improving on symptom severity and recidivism of self-injurious behaviour compared to PD with DSI treated in a long-term residential program. Although limitations in the study design invite caution in interpreting the results, the poor outcome of the inpatient DSI group suggests that explicit protocols for the management of DSI in inpatient settings may be beneficial and that the clinical indications for long-term inpatient treatment for severe and non-severe PD may require updating.


Sources: Journal of Psychotherapy and Psychosomatics, AlphaGalileo Foundation.

http://www.medicalnewstoday.com/articles/221994.php

NICE Consults On Draft Recommendations For The Longer-Term Management Of Self-Harm


Article Date: 12 Apr 2011 – 2:00 PDT


NICE is currently developing a clinical guideline on the longer-term care of adults, children and young people who self-harm. As part of this process, draft recommendations have been published on the NICE website today (12 April) for public consultation.


This new guideline will follow on from the NICE guideline on the short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care (NICE clinical guideline 16). The new recommendations focus on the longer-term psychological treatment and management of self-harm.


Self-harm commonly involves self-poisoning with medication or self-injury by cutting. People can self-harm for numerous reasons, for example, they may self-harm in order to obtain relief from a particular emotional state or overwhelming situation.


Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE, said: “Self-harm is when someone damages their body on purpose. It is not usually an attempt at committing suicide, but a way of expressing deep emotional feelings, such as low self-esteem. Although the physical effects of self-harm can often be treated easily, the underlying cause of the behaviour needs further attention.


“Our previous guideline on the short-term treatment of self-harm focused on the first 48 hours of an incident. This new guideline aims to help healthcare professionals support people that are known to self-harm in reducing and then stopping the behaviour.”


The draft recommendations are now available for public consultation. Anyone wishing to submit comments should visit our website for more information on the consultation process. Draft recommendations issued for consultation include:


– Working with people who self-harm: Health and social care professionals working with people who self-harm should aim to develop a trusting, supportive and engaging relationship with them and ensure that people are fully involved in decision-making about their treatment and care.


– Risk assessment: When assessing the risks of repetition of self-harm or suicide, identify and agree with the person who self-harms the specific risks for them, taking into account:


– methods and patterns of current and past self-harm


– specific risk factors and protective factors (social, psychological, pharmacological and motivational) that may increase or decrease the risks associated with self-harm


– coping strategies that the person has used to either successfully limit or avert self-harm or to contain the impact of personal, social or other antecedents


– Care plans: Care plans should be multidisciplinary and developed collaboratively with the person who self-harms and their family, carers or significant others. The care plan should identify realistic and optimistic long-term goals, including employment and occupation and identify short-term treatment goals (linked to the long-term goals) and steps to achieve them


– Interventions for self-harm: Consider offering six sessions of a psychological intervention specifically structured for people who self-harm with the aim of reducing self-harm. The intervention may have cognitive-behavioural, psychodynamic or problem-solving elements. Therapists should have significant experience of working with people who self-harm, and be able to work collaboratively with the person to identify the problems causing distress or leading to self-harm.


– Treating associated mental health conditions: Provide psychological, pharmacological and psychosocial interventions for any associated conditions as described in the relevant NICE guidelines, for example, borderline personality disorder (NICE clinical guideline 78), depression (NICE clinical guideline 90),bipolar disorder (NICE clinical guideline 38) etc.


Notes

About the guidance


1. The draft guidance will be available on the NICE website from 12 April, 2011.


2. The focus of this new guidance is the longer-term psychological treatment and management of self-harm, and does not include recommendations for the physical treatment of self-harm.


Source:
NICE

http://www.medicalnewstoday.com/articles/222048.php



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