Self Mutilation

The individual engages in self-injury expecting to:

-- get relief from a negative emotion -- to deal with a personal issue -- to create a positive feeling

Nursing Diagnosis

Ineffective impulse control Risk for self-mutilation

Functions of NSSI behavior

-- Has no one single cause -- Major purpose of NSSI appears to be affect regulation and management of distressing thoughts -- Data has shown that adolescents with NSSI demonstrated higher levels of physiological arousal during a stressful task compared with adolescents without NSSI -- NSSI may also regulate emotions by increasing the affective experience. --- Teens may experience emotionally feeling "numb" or "empty" and NSSI may help a teenager to gain a sense of control, to feel excitement or to stop dissociative experiences.

Assessment

-- Medical history and physical examination -- Identification of comorbid psychiatric illness -- Assessment of suicide risk -- History of physical and sexual abuse -- Evaluation of risk factors -- Evaluation of family functioning and social supports

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-- The act is not socially acceptable -- The act or its consequence can cause significant distress to the individual's daily life -- The act is not taking place during psychotic episodes, delirium, substance intoxication, or substance withdrawal. It also cannot be explained by another medical condition.

The self-injury is associated with one of the following

-- The individual experienced negative feelings right before committing the act --Right before self-injury, the individual was preoccupied with the planned act -- The individual thinks a lot about self-injury even if the act does not take place

Diagnostic criteria

--Classification of NSSI in the DSM-5 Child and Adolescent Disorders Workgroup --Over the past year, the person has to be at least 5 days engaged in self-injury with the anticipation that injury will result in some bodily harm. No suicidal intent

Adolescents and Self-mutilation

--Self injury, self-harm, nonsuicidal self injury (NSSI) --Deliberate and direct attempts to cause bodily harm does not result in death --90% of people who engage in self harm begin during their TEENS or PRE-ADOLESCENT years --Nearly 50% of those engage in self injury activities have been sexually abused --Most begin around age 14 and carry onto their 20s

Nursing Goals

-Have injuries treated -Refrain from self-injury -Identify triggers to self-mutilation -State appropriate ways to cope with increased psychological and physiological tension - Express feelings - Seek help when having urges to self-mutilate

Nursing Interventions

-Provide medical treatment for injuries - Assess for risk of suicide or other self-damaging behaviors - Assess for signs of psychiatric disorders including depression, anxiety etc. - Monitor the patient's behaviors closely, using engagement and support as elements of safety checks - Establish trust, listen to patient, convey safety and assist in developing positive goals for the future - Assess ability to enter into a no-self harm contract

Treatment

-Psychotherapy is the first line of treatment - Medications needed to treat co-morbid psychiatric issues such as BPD, depression and anxiety - Problems solving therapy - good coping mechanisms - Cognitive behavioral therapy -- Dialectical behavioral therapy (DBT) - Group and residential placement - Family involvement

Functions of nonsuicidal self injury

Affect Regulation -- Anxiety -- Anger -- Frustration -- Depression Change Cognitions -- Distraction from problems -- Stopping suicidal thoughts Self punishment Stop dissociation Interpersonal -- secure care and attention -- fit in with peers

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Behavioral assessment -- Antecedents - situations/stressors leading to self harm -- Behavior characteristics - frequency, intensity, duration of NSSI -- Consequences - emotional relief, care and attention from others

Characteristics of adolescents with NSSI

In the past NSSI was seen as primarily associated with -- Developmental disabilities -- Eating disorders -- Borderline personality disorder (BPD) More recent research -- Depression -- PTSD -- Generalized anxiety -- Conduct disorder and oppositional defiant disorder -- Substance abuse

Functions continued . . .

Interpersonal -- Positive reinforcement in the form of attention -- Avoid difficult situations -- Feeling emotionally disconnected from or invalidated by their parents -- Wanting to "fit in" within a particular peer group

Common methods

Most common : -- Skin cutting (70-90%) -- Head banging or hitting (21-44%) -- Burning (15-35%) Other methods include: pinching, banging or punching walls and other objects to induce pain, breaking bones, ingesting toxi substances, inserting objects into the skin or body openings