Bakgrund: Självskadebeteende är en avsiktlig handling av vävnadsskada genom att rispa, skära eller bränna huden utan avsikt till suicid. I Sverige under 2016 vårdades cirka 6900 personer på sjukhus till följd av avsiktlig destruktiv handling, varav 62 % var kvinnor. Resultat: Kvinnor med självskadebeteende hade ofta växt upp i en otrygg miljö, varit med om trauma eller saknat vuxenstöd. Självskada hade varit ett sätt för att lindra emotionellt lidande och för att kunna fortsätta att leva. Effekten av självskada avtog och blev som ett beroende innan det eskalerade. Känslor av skam, skuld och ensamhet var vanliga. Stigmatisering hindrade hjälpsökande. Bristande bemötande och vård upplevdes. Främjade för tillfrisknad var att behandla bakomliggande orsak till beteendet, finna alternativa åtgärder till att hantera det emotionella och ha ett holistiskt synsätt. Slutsatser: Självskadebeteende har för kvinnor inneburit ett oavbrutet lidande, psykiskt och fysiskt. För sjuksköterskan och övrig vårdpersonal är det viktigt att ha kunskap om orsaker till att kvinnor inte söker hjälp för sitt självskadebeteende för att kunna nå och hjälpa dem. I föreliggande studie framkom att hinder för att söka hjälp hade varit vårdens bristande bemötande och okunskap om självskadebeteendet. Sjuksköterskan behöver ökade kunskaper om självskadebeteendet, sträva efter ett empatiskt bemötande och utföra god holistisk omvårdnad.

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Self-injurious behavior (SIB) is one of the most dangerous behavioral responses among individuals with autism spectrum disorder (ASD), often leading to injury and hospitalization. There is an ongoing need to measure the triggers of SIB to inform management and prevention. These triggers are determined traditionally through clinical observations of the child with SIB, often involving a functional assessment (FA), which is methodologically documenting responses to stimuli (e.g., environmental or social) and recording episodes of SIB. While FA has been a "gold standard" for many years, it is costly, tedious, and often artificial (e.g., in controlled environments). If performed in a naturalistic environment, such as the school or home, caregivers are responsible for tracking behaviors. FA in naturalistic environments relies on caregiver and patient compliance, such as responding to prompts or recalling past events. Recent technological developments paired with classification methods may help decrease the required tracking efforts and support management plans. However, the needs of caregivers and individuals with ASD and SIB should be considered before integrating technology into daily routines, particularly to encourage technology acceptance and adoption. To address this, the perspectives of SIB management and technology were first collected to support future technology design considerations (Chapter 2). Accelerometers were then selected as a specific technology, based on caregiver preferences and reported preferences of individuals with ASD, and were used to collect movement data for classification (Chapter 3). Machine learning algorithms with featureless data were explored, resulting in individual-level models that demonstrated high accuracy (up to 99%) in detecting and classifying SIB. Group-level classifiers could provide more generalizable models for efficient SIB monitoring, though the highly variable nature of both ASD and SIB can preclude accurate detection. A multi-level regression model (MLR) was implemented to consider such individual variability (Chapter 4). Both linear and nonlinear measures of motor variability were assessed as potential predictors in the model. Diverse classification methods were used (as in Chapter 3), and MLR outperformed other group level classifiers (accuracy ~75%). Findings from this research provide groundwork for a future smart SIB monitoring system. There are clear implications for such monitoring methods in prevention and treatment, though additional research is required to expand the developed models. Such models can contribute to the goal of alerting caregivers and children before SIB occurs, and teaching children to perform another behavior when alerted. / Doctor of Philosophy / Autism spectrum disorder (ASD) is a prevalent developmental disorder that adversely affects communication, social skills, and behavioral responses. Roughly half of individuals diagnosed with ASD show self-injurious behavior (SIB), including self-hitting or head banging), which can lead to injury and hospitalization. Clinicians or trained caregivers traditionally observe and record events before/after SIB to determine possible causes (“triggers”) of this behavior. Clinicians can then develop management plans to redirect, replace, or extinguish SIB at the first sign of a known trigger. Tracking SIB in this way, though, requires substantial experience, time, and effort from caregivers. Observations may suffer from subjectivity and inconsistency if tracked across caregivers, or may not generalize to different contexts if SIB is only tracked in the home or school. Recent technological innovations, though, could objectively and continuously monitor SIB to address the described limitations of traditional tracking methods. Yet, “smart” SIB tracking will not be adopted into management plans unless first accepted by potential users. Before a monitoring system is developed, caregiver needs related to SIB, management, and technology should be evaluated. Thus, as an initial step towards developing an accepted SIB monitoring system, caregiver perspectives of SIB management and technology were collected here to support future technology design considerations (Chapter 2). Sensors capable of collecting the acceleration of movement (accelerometers) were then selected as a specific technology, based on the reported preferences of caregivers and individuals with ASD, and were used to capture SIB movements from individuals with ASD (Chapter 3). These movements were automatically classified as “SIB” or “non-SIB” events using machine learning algorithms. When separately applying these methods to each individual, up to 99% accuracy in detecting and classifying SIB was achieved. Classifiers that predict SIB for diverse individuals could provide more generalizable and efficient methods for SIB monitoring. ASD and SIB presentations, however, range across individuals, which impose challenges for SIB detection. A multi-level regression model (MLR) was implemented to consider individual differences, such as those that may occur from diagnosis or behavior (Chapter 4). Model inputs included measures capturing changes of movement over time, and these were found to enhance SIB identification. Diverse classification models were also developed (as in Chapter 3), though MLR outperformed these (yielding accuracy of ~75%). Findings from this research provide groundwork for a smart SIB monitoring system. There are clear implications for monitoring methods in prevention, though additional research is required to expand the developed models. Such models can contribute to the goal of alerting caregivers and children before SIB occurs, and teaching children to perform another behavior when alerted.

This study sought to assess the effects of pairing a neutral stimulus with a reprimand contingent on occurrences of two topographies of problem behavior. Using a multiple baseline withdrawal with a nested multi-element design, contingencies were first applied to eye poking and, subsequently, to a second behavior, skin picking. In each case, the participant wore wristbands (a previously neutral stimulus) during treatment sessions. Results indicated that the reprimands were effective in decreasing both behaviors. In addition, when skin picking resulted in reprimands, eye poking also decreased. However, when reprimands were contingent on eye-poking, the effects did not appear to generalize to skin-picking. Some possible accounts for this asymmetrical pattern of generalization are discussed.

Bakgrund: Självskadebeteende har funnits i decennier med många olika termer och definitioner. Självdestruktiva känslor kan grundas av olika övergrepp och kränkningar. Självskadebeteendet kan användas för att återfå kontroll samt som självbestraffning. I dagens samhälle finns större fokus på fenomenet än tidigare och ny forskning leder till nya insikter. Syfte: Syftet med litteraturstudien var att belysa sjuksköterskors attityder och faktorer som har betydelse i mötet med patienter som lider av självskadebeteende samt beskriva urvalsmetod i artiklarna. Metod: Detta är en deskriptiv litteraturstudie med artiklar från 2005-2015 i PubMed och PsycINFO. Resultatet baseras på 14 vetenskapliga artiklar med kvalitativ och/eller kvantitativ ansats. Resultat: Sjuksköterskors attityder är övervägande positiva till patienter med självskadebeteende. Trots detta uttrycker de även negativa attityder som antipati, frustration, maktlöshet och oro i mötet med självskadande patienter. Sjuksköterskorna upplever att de saknar kunskaper och resurser till att ge en god omvårdnad. Slutsats: För att sjuksköterskor ska känna sig självsäkra i sitt arbete och ge patienter med självskadebeteende en god omvårdnad så behöver de utbildning om självskador samt mer tid och stöd av ledning och kollegor. Klinisk betydelse: Förhoppningen är att denna studie ska ge insikt och förståelse för självskadebeteende hos vårdgivare och vårdchefer. / Background: People who self-harm is nothing new, this behavior has a lot of different terms and definitions. Self-destructive feelings can be rooted in assaults and violations. A self-harming behavior is sometimes used to regain control or to be used as self-punishment. Today there is a greater attention towards research in the subject of self-harm which brings new knowledge. Aim: The aim is to illuminate nurses’ attitudes an factors that is important in the encounter of patients who suffers from self-injurious behavior and to exanimate the samples selection in the articles of this study. Method: A descriptive literature study was conducted and fifteen articles from PsycINFO and PubMed between years 2005-2015. The chosen articles have qualitative and/or quantitative approach. Results: Nurses attitudes towards people who self-harm are predominantly positive. Negative attitudes are also presented in the encounter in form of antipathy, frustration, powerlessness and anxiety. Nurses are experiencing a lack of knowledge and resources. Conclusion: For nurses to feel confident in their work and give the best possible care to people who self-harm there is a need of education and organizational improvements such as more time and support from colleagues. Clinical significance: Our expectation with this study is to bring attention and understanding in the subject of self-harm.

published_or_final_version / abstract / Social Work and Social Administration / Doctoral / Doctor of Philosophy

This study examined the effects of response restriction (blocking and protective equipment) on subsequent durations of self-injury with two female participants with developmental disabilities. First, a functional analysis was conducted with each participant to identify potential maintaining variables of the self-injury. Second, access to the response was systematically restricted in a multiple schedule restriction paradigm. A baseline extended alone was conducted without the restriction component in place as a control condition. For one participant the results suggested that response restriction may have increased subsequent durations of responding once the restriction element was removed. For a second participant responding did not appear to be affected by the restriction component.

Results of a functional analysis indicated that the self-injurious behavior (SIB) of an adult female with profound mental retardation occurred primarily in the alone and demand conditions. Graphs of the separate topographies (head slaps and head bangs) showed that head banging occurred in the alone condition and that both head banging and head slapping occurred in the demand condition. A data analysis procedure to identify within-session trends across sessions and fluctuations in rates of SIB by topography revealed that most of the demands escaped were escaped by head slaps and that over 80% of all head slaps were associated with escape, compared to less than 1%of all head bangs, indicating that head banging and head slapping were members of separate functional response classes. Treatment consisted of noncontingent availability of preferred leisure materials, and produced substantial decreases of both head banging and head slapping. Interpretation of the results are discussed, as well as some implications and limitations of the study.

Self-injury behavior is identified as the non-suicidal, deliberate infliction of a wound to oneself in an attempt to seek expression. Self-injury is becoming more prevalent in the adolescent population; however, many nursing professionals are unaware of this phenomenon and the implications it holds for nursing. Approximately 12 to 17 percent of adolescents deliberately injure themselves although accurate statistics are difficult to obtain due to the secret and private nature of the behavior. Nurses, especially those who care for adolescents, could benefit from an understanding of the implications of self-injury, the characteristics of adolescents who self-injure, the expressivity of the behavior, and the repetitive patterns of the emotions experienced by adolescents who self-injure. Six adolescent females were interviewed for this study. Their stories were shared in rich, descriptive narratives. Common themes emerged from the words of the participants and these themes described the essence of self-injury by cutting for adolescent females. The themes which emerged were living with childhood trauma, feeling abandoned, being an outsider, loathing self, silently screaming, releasing the pressure, feeling alive, being ashamed, and being hopeful for self and others. The general structure that emerged from a synthesis of the themes was that the experience of self-injury by cutting for adolescent females is one where they are struggling for well-being and hoping for more being by using their skin as a canvas upon which internal pain is expressed as tangible and real. / by Rhonda Goodman Lesniak. / Thesis (Ph.D.)--Florida Atlantic University, 2008. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2008. Mode of access: World Wide Web.