Thesis on "Self-Harm Treatment"

Thesis 4 pages (1467 words) Sources: 4 Style: APA

[EXCERPT] . . . .

Self-Harm Treatment

Self-harm: Classification and treatment issues in adolescents

Despite the frequent reportage on adolescent self-harm in the popular media, achieving a consensus on how to treat this difficult problem continues to vex the psychiatric community. One of the first problems is how to define deliberative self-harm (DSH). Some therapists contend that DSH is best classified as an anxiety disorder, and self-harm is a way for the adolescent to self-medicate feelings of panic and a sense of a lack of control about the future. The adolescent retaliates against the world by inflicting harm upon the self rather than dealing with unpleasant thoughts. Others view it as a subset of obsessive-compulsive disorder (OCD), given the repetitive and compulsive nature of the acts. A contrary view of the behavior is that it is less as a condition in and of itself and more of a symptom of a more severe and pervasive condition known as borderline personality disorder (BPD). "Borderline personality disorder (BPD) is a psychiatric disorder with a pervasive pattern of instability in four areas: affect regulation, impulse control, self-image, and interpersonal relationships" (Bland et al. 2007, p.1). These characteristics are often especially manifest and acute in adolescents, especially since even normal adolescents may manifest these symptoms, albeit to a far lesser and self-destructive degree.

The overall self-harm personality profile in both adults and adolescents is characterized by the intense emotions and a heightened sensitivity to rejection characteristic of BPD patients. BPD patients, like self-harm patients are often notoriously difficult to treat, and may be 'passed on' from therapist to therapist after unsuccessful treatments. Personality disorders in adolescents are notoriously unresponsive to conventional talk therapies. It should also be noted as well the dissociative state that self-harmers describe entering into during the 'cutting' and mutilating acts has caused still other therapists to view DSH as symptoms of dissociative personality disorder, a less commonly diagnosed personality disorder than BPD, and one with features not particular to adolescent development. Finally, the addictive quality of DSH is viewed by many therapists to have an addictive quality. They point to its frequent coexistence of other addictions seen in these individuals, such fixations upon alcohol and drug abuse (Mangnall & Yurkovich 2008, p.2). Adolescents may also be especially vulnerable to addictive, thrill-seeking behaviors and a more likely to spiral into the addictive 'high' caused by self-mutilation. However, the use of twelve-step programs for DHS for adolescents, has not been subject to research studies and is not accepted as customary course of treatment at present.

One of the greatest difficulties of treatment shared by BPD and self-harmer is treatment resistance. BPD patients often demand therapists that are emotionally supportive and provide them with understanding and affection, but may not be willing to do the critical, self-searching work demanded of conventional psychotherapy. "In the absence of caring listeners, it may be that self-harmers feel the need to turn to a more dramatic communication method," and therapists may find themselves accused of being unable to give enough 'support' to the patient, because the therapist does not validate all of the patient's impulses (Mangnall & Yurkovich 2008, p.5). The extent to the patient makes such accusations will affect the view of the therapist as to whether DSH is anxiety-related, a compulsive, a personality disorder, or a mixed phenomenon. This is one reason why the classification of the disorder is so contentious, given that subjective therapeutic experiences over time may affect its conceptualization as well as the view of an individual patient.

One therapeutic dynamic amongst self-harmers that has met with some success, as well as with OCD and anxiety conditions is cognitive behavioral therapy. OCD and anxiety disorders often arise, according to CBT therapists, "from inaccurate beliefs about stimuli" such as emotional pressures and developmental issues (Sullivan 2006, p.1). The cognitive therapeutic process is behavior-based. Rather than identify past traumas, the patient focuses on the here and now, identifying and correcting the specific thoughts that produce the anxiety and compulsive behaviors. To identify cognitive errors patients keep a thought record. The document consists of recording the action, the thought that came with it, the accompanying anxiety or fear level, and the resulting ritual and then "writing logical thoughts that could counteract the illogical assumptions" about the self and the need to repeat the behavior (Sullivan 2006, pp.1-2).

For example take the thought: 'I did poorly on a test, so I deserve to be… READ MORE

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