Background People with psychiatric problems, despite efforts in recent decades still experience vulnerability. Patients with borderline personality disorder (BPD), where self-harm is common, often live in difficult and complex social relationships because of their illness. Additional knowledge and studies about mental illness, self-harm, dialectical behaviour therapy (DBT) and the therapeutic alliance are needed. Purpose and Method This study aims to examine how staff perceive and describe: DBT as a treatment method; the therapeutic alliance and the importance it has for treatment. The study utilises a qualitative approach with a qualitative content analysis method and presents earlier research on DBT and the therapeutic alliance. The empirical material consists of focus group interviews comprising three DBT - teams. The theoretical framework is based on attachment theory which addresses the dynamics of close relationships and how we act in them. Results Results show that DBT - teams describe patients with self-harm as vulnerable. Here, self-harm represents a way to reduce aggression and make life bearable. DBT is produced as a collaboration between therapist and patient, giving patients the opportunity for a new secure attachment to achieve self-respect and a meaningful life. The teams assess DBT as successful and effective. The therapeutic alliance is seen as an emotional and social interaction and is considered the most important tool in the treatment. Conclusions Patients who self-harm and have emotional difficulties may indicate insecure and lack of attachments. Through DBT, trust and confidence are trained and developed to enhance attachment patterns and move the process forward. New aspects emerge such as the significant role of relatives and the team and the importance of feeling hope in both the patient and the therapist. Furthermore, the health professional’s knowledge of the BPD diagnosis affects the care and the treatment of the patients and thus the patients’ possibility to live better lives. In a broader discussion of health determinants, health care, early intervention, cooperation and long-term measures are assessed to be important factors for promoting health and good living conditions for the patients.

The aim of this study is to shed light on the phenomenon of destructive sexual behavior among youth from the perspective of professionals working at nonprofit organizations. To examine this, we used a qualitative method; we interviewed professionals working at nonprofit organizations. To analyze our results we used gender theory and empowerment theory. Our main results are that the professionals view this behavior as deliberate self-harm, such as cutting, as they do it to achieve relief from anxiety. Also, the professionals think that gender norms affect young people with destructive sexual behavior in that it imposes guilt and shame, which inflicts their already low self-esteem and makes them feel inferior. The profes- sionals view this as the common denominator for this group of young people. Therefore it is very important for professionals to help these young people build self-esteem by using empowerment. Hopefully, this study can provide additional knowledge to the field of social work, due to the focus on a relatively new perspective on the phenomenon of deliberate self-harm. It is therefore important for agents in social work to have knowledge and comprehension about how to approach the phenomena and how to view and work with this group of young people.

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Lietuvoje yra nedaug mokslinių tyrimų apie įkalintų asmenų tyčinį savęs žalojimą, susijusį su savižudybės rizika. Užsienio šalių moksliniais tyrimais nustatomos įkalintų asmenų tyčinio savęs žalojimo sąsajos su negatyviomis situacijomis ir depresiškumu yra nevienareikšmės. Įkalintų asmenų tyčinio savęs žalojimo atsiradimui gali būti svarbūs stabilesni asmenybiniai veiksniai, kaip kertiniai įsitikinimai. Tyrimo tikslas. Nustatyti patirtų negatyvių situacijų, depresiškumo ir kertinių įsitikinimų (pagal kognityvinę - elgesio teoriją) sąsajas su nuteistų vyrų tyčiniu savęs žalojimu. Tiriamieji. Tyrime savanoriškai dalyvavo 168 nuteisti vyrai, kalintys Pravieniškių pataisos namuose – atvirojoje kolonijoje. Tiriamųjų amžiaus vidurkis – 29,39 metai. Tyrimo metodai. Duomenys buvo renkami, naudojant: Tyčinio savęs žalojimo skalė – sutrumpinta versija (DSHI-s), Kongityvinės triados skalė (CTI), Depresiškumo skalė (CES-D), Negatyvių situacijų įkalinimo įstaigoje skalė. Taip pat tiriamiesiems buvo pateikiami klausimai apie jų sociodemografinius, kriminogeninius rodiklius bei save žalojantį elgesį praeityje. Tyrimo išvados. Tyčia save žalojusių nuteistų vyrų kertiniai įsitikinimai apie save, pasaulį ir ateitį yra negatyvesni nei savęs nežalojusių nuteistų vyrų. Nuteistų vyrų negatyvesni kertiniai įsitikinimai apie ateitį yra susiję su didesne tyčinio savęs žalojimo tikimybe, atsižvelgus į tyčiniam savęs žalojimui reikšmingus šalutinius veiksnius: tyčinį savęs žalojimą... [toliau žr. visą tekstą] / The number of scientific researches about deliberate self-harm that are associated with the risk of suicide among incarcerated persons is not plentiful. The results of scientific researches in foreign countries about the associations of deliberate self-harm with negative situations and depressiveness among incarcerated persons are not unambiguous. Therefore it might be important more stable personality factors such as core beliefs for the deliberate self- harm of incarcerated persons. Research aim. The aim of the study was to identify the links of experienced negative situations, depressiveness and core beliefs (according to cognitive-behaviour theory) with convicted men’s deliberated self-harm. Research participants. The research included 168 convicted men in Pravieniskes Correction House-Open Prison Colony. The average age of research participants is 29,39. Research methodology. The data was gathered using psychological assessment methods: Deliberate Self-Harm Inventory-short version (DSHI-s), Cognitive Triad Inventory (CTI), The Center for Epidemiologic Studies Depression Scale (CES-D), Negative Situations in Prison Scale. Also was asked about sociodemographic, criminogenic factors and self - harm behaviour in the past. Research conclusions. The convicted men who deliberately self-harmed have more negative core beliefs about themselves, the world and the future than convicted men who do not deliberately self-harmed. The more negative core beliefs about the... [to full text]

This study intends to illuminate women’s experiences of their own self-harm. Self-harm is mostly associated with women and research shows that women mostly are over-represented. This study describes women’s experiences about their self-harm but also how they perceive the elements around them during their illness. There is a focus on women’s abilities to manage emotions and how they are expressed. There is also a focus on how women perceive the support from important people in their individual social network. This study is completed by a qualitative approach based on six autobiographies there young women tells about their self-harm and mental health. The study has a hermeneutic approach which enables interpretation of our collected material. The result is presented based on two themes that focus on the women’s emotional management and their support from their social network. The empirical material is analyzed on the basis of theoretical concepts of systems theory and network theory but also Antonovsky’s (1987) theory; KASAM. The result of this study resulted that the women’s social network have significance for them during the time with self-harm whether their social network are functional or not. The study has also found that the women’s emotional management are affected by meaningsfullness, manageability and comprehensibility.

Syftet med denna studie var att öka kunskapen om hur professionella inom socialtjänsten bemöter och arbetar med unga vilka har sex som självskadebeteende. Behovet av studien baserades på att unga med sex som självskada har ökat och att socialtjänsten är en central aktör för att uppmärksamma denna målgrupp. Socialtjänsten ska verka för att unga växer upp under trygga förhållanden och särskilt uppmärksamma utvecklingen hos unga som visar tecken på ogynnsam utveckling. Uppsatsens ansats var kvalitativ där semistrukturerad intervjumetod tillämpats, vilket innebar möjligheten för intervjupersonerna att bidra till en nyanserad bild av studiens syfte. Resultatet tolkades tematiskt och analyserades sedan med hjälp av en teoretisk referensram för att bättre kunna förstå hur professionella inom socialtjänsten bemöter och arbetar med unga vilka har sex som självskadebeteende. Den teoretiska referensramen bestod av två teoretiska begrepp och ramverk: sex som social konstruktionoch relationens betydelse i professionellt arbete med människor. Uppsatsens resultat visar att de professionella inom socialtjänsten inte aktivt arbetar med unga som har sex som självskada, enbart vid fåtal tillfällen när problematiken är uttalat i ett ärende. Resultatet visar även att problematiken ännu inte har uppmärksammats inom socialtjänsten och att de professionella sällan eller aldrig för samtal kring det, varken inom verksamheten eller med de unga. Resultatet visar vidare att relationen är en förutsättning för att de unga ska berätta om denna typ av problematik och att de professionella behöver mer kunskap. / The aim of this study was to raise awareness of how professionals in social services treat and work with adolescents who have sex as self-injury behavior. The need for this study was based on the increased numbers of the adolescents who have sex as self-injury and also that social service is a key actor to notice these adolescents. Swedish social service should work for adolescents to grow up under safe conditions and pay special attention to adolescents who show signs of contrary development. In order to answer to the aim of this study the approach was qualitative in which semi structured interviewing was used. By using semi structured interviewing, the interviewees were given the opportunity to contribute to a nuanced aspect of the problem. The result was interpreted thematically and then analysed using a theoretical framework in order to better understand how professionals in social services treat and work with adolescents who have sex as self-injury behavior. The theoretical framework consisted of two theoretical concepts and frameworks: sex as a social construction and the significance of the relationship in professional work with people. The result of this essay show that professionals within social service do not actively work with adolescents with sex as self-injury, only when the problem is explicit in a specific case. The result also shows that the problem has not been addressed in social services and that the professionals rarely or never talk about it, either within the organization or with the adolescents. Besides that, the result also shows that the professionals need more knowledge about the problem and that the relationship is a prerequisite for the adolescents to tell professionals about this type of problems.

Bakgrund: De senaste åren har flera studier gjorts på den stora mängd självskaderelaterat material som finns på internet i form av bloggar, videos, foton och chatforum. Dessa studier har i huvudsak fokuserat på materialet i sig och funktionen det fyller för de som kommunicerar sitt självskadande på internet. Således finns kunskap om företeelsen i sig men ingen eller ytterst lite kunskap om vårdpersonalens erfarenheter och föreställningar kring självskadekommunikation. Syfte: Att belysa vårdpersonals erfarenheter och föreställningar kring patienters självskadekommunikation på internet. Metod: En kvalitativ metod användes. Data samlades in genom nio halvstrukturerade intervjuer med vårdpersonal inom psykiatrisk verksamhet. Dessa analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Studiens resultat redovisas i de fyra kategorierna; Ovanlig företeelse, som visade att personalen generellt hade lite erfarenhet av patienter som självskadekommunicerar. Internet finns på gott och ont,visade att vårdpersonalen kunde upplevde starka negativa känslor i mötet med dessa patienter samt belyste vårdpersonalens dubbla förhållande till internet. Att försöka förstå, visade att vårdpersonalen hade många föreställningar kring vilka funktioner självskadekommunikationen kunde ha för patienterna. Att ta ansvar,visade att personalen kände ett ansvar för att uppmärksamma patienter som självskadekommunicerar på både ett personligt och organisatoriskt plan. Slutsats: Det visade sig att vårdpersonalen hade begränsad erfarenhet av att möta patienter som kommunicerar sitt självskadebeteende på internet. Vidare tyder resultatet på att vårdpersonalen upplever osäkerhet i mötet med patienter som självskadekommunicerar på internet vilket i sin tur leder till att det sällan ställs frågor kring självskadekommunikation. / Background: Several studies have mapped self-injury related material online, consisting of blogs, videos, photos and chatcommunities. These studies have mainly focused on the material itself as well as the function it has for those who communicate self-injury online. Thus knowledge of the phenomenon itself exists but little or no studies have been made attempting to study the experiences and conceptions of health professionals relating to this phenomenon. Aim: To illuminate health professionals experiences and conceptions of patients self-harm communication on the internet Method: A qualitative approach was applied. Data was collected through nine semistructured interviews with health professionals working in psychiatric care. The data were analysed with qualitative content analysis. Result: The results are presented in the following categories; Unusual phenomenon, wich showed that the staff generally had litlle experience of patients who communicated self-harm online. Internet exists for good and bad, showed that the health professionals could experience strong negative emotions when meeting patients who communicated self-harm online and illuminated the double relationship health professionals described having to the internet. Trying to understand, showed that the health professionals had many conceptions about wich functions the self-harm communication might have for the patients. To take responsibility, showed that the staff experienced a sense of wanting to take responsibility for  these patients.  Conclusion: The study showed that health professionals had limited experience with patients who communicated self-harm online and indicated that the health professionals experienced uncertainty when meeting these patients.

This thesis comprises a rigorous and coherent body of work related to the use of the HCR-20 and the START to inform risk assessment and management of secure mental health inpatients. The thesis contributes significant theoretical and applied knowledge by: 1) investigating the extent to which these tools can be generalised beyond restricted validation samples to the full range of individuals in contact with secure services, 2) determining whether they can aid assessment and management of adverse outcomes beyond aggression, and 3) offering practical, empirically-derived advice for clinicians regarding management strategies that may reduce the occurrence of adverse events. This collection of papers has used considerably novel methods, such as rocreg analysis in risk assessment of behavioural outcomes, and high quality, routinely collected data to gain a more realistic representation of what occurs in clinical practice. Further, the papers draw on larger sample sizes than have previously been reported in this area, allowing for more complex statistical analysis. This thesis has helped clarify the contexts in which these instruments perform effectively and therefore has important implications for clinical risk assessment in inpatient settings. Specifically, there is evidence that the HCR-20 and the START may aid assessment and management of aggression for the majority of groups examined, and that both tools have some efficacy for predicting self-harm among female populations. However, the HCR-20 should not be used to inform prediction and management of aggression and self-harm for individuals with developmental and organic disorders and is unlikely to be beneficial at informing risk management strategies targeting self-harm among males; the START should not be used to inform prediction and management of substance abuse, victimisation, or unauthorised leave. Finally, this thesis highlights a number of directions for future research to continue advancement in this area.

Current research on factors predicting self-harm focus on disparate factors and may not be able to comprehensively explain the mechanisms causing self-harm. The aim of the current study was to examine factors that may be related yet independently predict self-harm. Factors discussed include rumination, self-criticism, and working memory. A binary logistic regression found that the only factor that predicted the presence of self-harming behavior was a high level of self-criticism. Further, a Classification and Regression Tree found that the single strongest predictor of self-harming behavior was a belief that love needs to be continually earned from others. Our findings have implications for improving the efficacy of interventions aimed at preventing self-harm, which traditionally have been ineffective. Treatments incorporating ways to reduce self-criticism, such as a focus on improving self-compassion with Compassionate Mind Training, may address underlying mechanisms that can trigger self-harm behavior.

Selbstvergiftung in der Akutmedizin – 2005–2012 Zusammenfassung Ziel. Beschreibung des Trends der akuten Selbstvergiftung in der Notfall- und Intensivmedizin. Methode. Elektronische Akten erwachsener Patienten, die zwischen 2005 und 2012 wegen einer akuten Selbstvergiftung infolge eines Selbstmordversuches (Selbstmordgruppe), einer Berauschung (Intoxikationsgruppe) oder Medikamentenüberdosierung zwecks Schmerzlinderung (Überdosierungsgruppe) in der Notaufnahme des Universitätsklinikums Leipzig eingewiesen worden waren, wurden ausgewertet. Ergebnisse. 3533 Patienten (62,6 % männlich) wurden identifiziert, mit einem Anstieg von 305 Fällen im Jahre 2005 auf 624 in 2012. Die Aufnahmerate bezogen auf die Gesamtaufnahmen stieg von 1,2 % im Jahre 2005 auf 1,9 % im Jahre 2012 an. 31,7 % der Patienten waren < 25 Jahre alt. Die Ursachen der Selbstvergiftung waren Suizidversuch (18,1 %), Intoxikation (76,8 %) und Medikamentenüberdosierung (2,9 %). Bei 80 Fällen war eine genaue Gruppenzuordnung nicht möglich. Während psychotrope Medikamente bei 71,6 % der Suizidversuche angewandt wurden, war Alkoholintoxikation die Ursache bei 80,1 % der Fälle in der Intoxikationsgruppe. Selbstvergiftung mit mindestens zwei Substanzen lag bei 52,0 % der Suizidversuche, 10,3 % der Intoxikationsgruppe und 29,7 % der Gruppe mit Medikamentenüberdosierung vor. Während die Alkoholintoxikation nach wie vor am häufigsten vorkam, gab es eine drastische Zunahme der Intoxikationen mit Cannabinoiden, Crystal Meth und Gamma- Hydroxybuttersäure in den Jahren 2011 und 2012. Eine Aufnahme auf die Intensivstation war bei 16,6 % der Fälle erforderlich. Es gab 22 Todesfälle (0,6 % der gesamten Studienpopulation), von denen 15 aus der Suizidgruppe (2,3 %), vier aus der Intoxikationsgruppe (0,15 %), und drei aus der nicht eindeutig zugeordneten Gruppe (3.8 %) waren. Zusammenfassung. Akute Selbstvergiftung ist ein zunehmendes medizinisches Problem. Psychotrope Medikamente stellen nach wie vor die häufigsten Suizidversuchsmittel dar. Obwohl die Alkoholintoxikation weiterhin am häufigsten vorkommt, nehmen illegale Drogen als notfallmedizinischer Einweisungsgrund zu. / Self-poisoning in the acute care medicine 2005–2012 Abstract Objective. To describe the trend of acute self-poisoning in the emergency and intensive care. Methods. Electronic charts of adults who presented to the emergency department of the University Hospital Leipzig with selfpoisoning following a suicide attempt (suicide group), intoxication (intoxication group), drug overdose for relief of pain or discomfort (drug overdose group) between 2005 and 2012 were analyzed. Results. 3533 adults (62.6 % males) were identified, with the yearly admissions increasing from 305 in 2005 to 624 in 2012. The admission rate in relation to the total emergency department admissions also increased, from 1.2 % in 2005 to 1.9 % in 2012. 31.7 % of the patients were younger than 25 years. The reasons for self-poisoning were suicide attempt (18.1 %), intoxication (76.8 %) and drug overdose (2.9 %). The reason could not be clearly classified in 80 patients. Psychotropic drugs were used in 71.6 % of suicide attempts, while alcohol was the sole cause of intoxication in 80.1 % of cases in the intoxication group. Self-poisoning using at least two substances was observed in 52.0 % of the suicide attempts, 10.3 % of those with intoxication and 29.7 % of those with drug overdose. While alcohol remains the most common cause of intoxication, there was a drastic increase in the consumption of cannabinoids, Crystal Meth and gamma-hydroxybutyrate in the years 2011 and 2012. ICU admission was necessary in 16.6 % of the cases. There were 22 deaths (0.6 % of the study population), of whom 15 were in the suicide group (2.3 %), four (0.15 %) in the intoxication group, and three in the not clearly classified group (3.8 %). Conclusion. Acute self-poisoning is an increasing medical issue. Psychotropic drugs remain the most common means of suicide attempt. Although alcohol intoxication is very frequent, intake of illicit drugs as the cause of emergency admission is increasing.