A ocorrência do comportamento autolesivo logra índices significativos na população adolescente e pré-adolescente, tornando-se queixa frequentemente observada no contexto escolar e clínico, preocupando a todos os envolvidos. Na atualidade, a Organização Mundial da Saúde (OMS) a categoriza como um problema de saúde pública global, e, portanto, foco de atenção de políticas públicas e sociais prementes dada a gravidade e aumento do risco de tentativa de suicídio no futuro. No Brasil, as pesquisas realizadas ainda são incipientes quando comparadas com a produção internacional, ainda mais no que diz respeito à dinâmica psíquica do jovem que se autolesiona e meios de intervenção. Assim, considerando a perspectiva investigativa atribuída à Psicologia Clínica e a indissociabilidade entre prática e pesquisa, este trabalho buscou contribuir por meio da realização de um estudo de caso único com vistas à análise dos traços de personalidade de uma adolescente, estudante de uma escola pública do Estado de São Paulo, sem diagnóstico psiquiátrico e/ou em atendimento psicológico, além de investigar dados do funcionamento familiar e a relação de tal conduta com a sintomatologia depressiva e ansiosa. Para tanto, o método clínico-qualitativo de cariz psicanalítico foi empregado em consonância com o delineamento de estudo de casos único e o processo Psicodiagnóstico Compreensivo e Interventivo. O Psicodiagnóstico previamente esquematizado contemplou duas etapas: 1) primeira aplicação, que contabilizou sete atendimentos, e, 2) fase de follow-up, com três atendimentos. Em ambas as etapas, abarcou a realização de entrevistas com a responsável, entrevistas com a participante, aplicação do Questionário Desiderativo, Teste de Apercepção Temática Infantil - Figuras Humanas (CATH), Inventário de Depressão Infantil (CDI) e Inventário de Ansiedade de Beck (BAI). Os resultados do caso foram examinados individualmente, em cada etapa, e, posteriormente, em conjunto, com a comparação entre essas duas fases por meio da livre inspeção do material à luz das observações oferecidas pelos instrumentos projetivos e objetivos fundamentados na abordagem psicanalítica psicodinâmica. Assim, com base nos aportes winnicottianos, pode-se observar que, no caso analisado, a conduta autolesiva revelou uma dupla função: impedir o aniquilamento total do Eu, e, concomitantemente, comunicar ao ambiente sobre falhas nos cuidados em fases primitivas, reatualizados na adolescência, na tentativa de resgatar algo ofertado, porém percebido como perdido. Adicionalmente, integrando os achados iniciais com os obtidos na reavaliação de follow-up, a significativa remissão de aspectos dissociados da personalidade da participante e sintomas clínicos após o processo Psicodiagnóstico comporta correlações com o conceito winnicottiano de distúrbio psicossomático, recuperável após a presença de condições ambientais favoráveis, ou ainda com o trânsito da posição kleiniana esquizo-paranóide para a depressiva, denotando a retomada do processo de amadurecimento. Por fim, os dados obtidos permitem sintetizar sobre a importância do ambiente para a restauração do sentimento de confiança e de esperança no caso investigado, corroborando a teoria winnicottiana sobre a subordinação da saúde psíquica ao longo da vida aos cuidados iniciais recebidos / The occurrence of self-injurious behavior achieves significant rates in the adolescent and preadolescent population, becoming a frequent complaint in the school context, causing concern to all involved. Currently, the World Health Organization (WHO) categorizes it as a global public health problem, and therefore, focus attention on pressing public and social policies given the seriousness and increased risk of attempted suicide in the future. In Brazil, the research carried out is still incipient when compared to international production, especially with regard to the psychic dynamics of the self-injuring young person and means of intervention. Thus, considering the research perspective attributed to Clinical Psychology and the indissociability between practice and research, this work sought to contribute through the accomplishment of a single case study with a view to the investigation and analysis of the personality traits of a teenager, student of a school of the State of São Paulo and without psychiatric diagnosis, besides the family functioning and the relation of such conduct with the depressive and anxious symptomatology. The clinical-qualitative psychoanalytic method was used in consonance with the design of a single case study and the Comprehensive and Interventive Psychodiagnostic process. The psychodiagnosis previously planned included two stages: 1) the first application, which counted seven meetings, and 2) the follow-up phase, with three sessions. Interviews with the participant, interviews with the participant, application of the Desiderative Questionnaire, Child Thematic Apperception Test - Human Figures (CAT-H), Infant Depression Inventory (CDI) and Anxiety Inventory of Beck (BAI). The results of the case were examined individually at each stage and then together with the comparison between these two phases through the free inspection of the material in the light of the observations offered by the projective and objective instruments based on the psychoanalytic psychoanalytic approach. Thus, on the basis of Winnicott\'s contributions, it can be observed that, in the case analyzed, self-defeating behavior revealed a double function: to prevent the total annihilation of the ego, and, at the same time, to communicate to the environment about the failures in care, in an attempt to rescue something offered, but perceived as lost. Additionally, integrating the findings with those obtained in the follow-up reassessment, the significant remission of aspects dissociated from the participant\'s personality and clinical symptoms after the Psychodiagnostic process correlates with the winnicottian concept of psychosomatic disorder, recoverable after the presence of favorable environmental conditions , or with the transit from the kleinian position schizopanoid to the depressive, denoting the resumption of the maturation process. Finally, the data obtained allow us to synthesize the importance of the environment for the restoration of the feeling of trust and hope in the case investigated, corroborating the Winnicottian theory about the subordination of the psychic health throughout the life to the initial care received

The purpose of the present study was to increase our understanding of the relations among embarrassment, Theory of Mind (ToM), and emotion dysregulation in adolescents with Asperger's Syndrome and High Functioning Autism (AS/HFA), topics that have not previously been the foci of research in this population. The research sample consisted of 42 participants, split equally between adolescents with AS/HFA and typically developing (TD) adolescents. Participants with AS/HFA were matched with TD participants for chronological age and gender. Parents of all participants, typically mothers, were also required to complete measures. Participants were presented with vignettes of embarrassing or anger inducing scenarios, following which they were asked to provide ratings indicating the degree to which they would be embarrassed or angry in the protagonists' positions. Next they were asked to justify those ratings. Results indicated that the AS/HFA group experienced greater difficulty than the TD group with measures requiring ToM abilities. This was particularly true of embarrassment/social faux pas situations. In contrast, both groups performed similarly on measures involving anger-inducing situations that require less ToM. The significant difficulty of the AS/HFA group in understanding ToM in embarrassment measures was corroborated by their poor performance on an independent ToM measure. In addition to having significant difficulty in understanding embarrassment, the AS/HFA group was significantly less able than the TD group to recount personally embarrassing experiences. Regarding emotion regulation, participants with AS/HFA were significantly less able than their TD peers to regulate their emotions through reappraisal. Similarly, parents of the AS/HFA participants reported a significantly higher level of emotion dysregulation in their children than did the parents of the TD participants. Further, participants with AS/HFA had a significantly higher utilization frequency of negative strategies than their TD peers when embarrassed, which aligned with parent report. Negative strategies included internal, verbal, and physical self-injurious behaviors, as well as destructive interpersonal behaviors, e.g., falsely accusing, yelling at, or hitting others. These findings emphasize the critical and potentially harmful impact of embarrassing experiences in the daily lives of adolescents with AS/HFA.

Hälso- och sjukvårdspersonalens bemötande och attityd avspeglas i mötet med patienter med självskadebeteende och är avgörande för utfallet av behandlingen. Den allmänna litteraturöversikten belyser patienters upplevelse av vårdpersonals bemötande inom hälso- och sjukvård. Sökningarna utfördes i tre databaser Cinahl, PubMed och PsycINFO, vilket resulterade i tio kvalitativa vetenskapliga artiklar som granskades, analyserades och bearbetades med utgångspunkt från studiens syfte. I resultatet framkom tre kategorier, bli sedd, vårdmiljöns betydelse och vårdkontaktens betydelse, som visade att positiva uppfattningar av vården var känslan av att bli tagen på allvar, främjandet av integritet samt när vårdpersonal lyssnade. När patienter kände sig dömda på förhand samt upplevde bristande intresse från vårdpersonal, vilket ledde till ytterligare skuld och skam innebar negativa uppfattningar. Tidigare negativa erfarenheter under vårdkontakten ledde till att patienter undviker att söka hjälp. Litteraturöversikten visar på att det krävs mer forskning ur ett patientperspektiv för att utveckla ett bättre evidensbaserat arbetssätt för vårdpersonal som idag möter och behandlar patienter med självskadebeteende. / The health professionals’ attitude reflects in the meeting with patients with self-injury disorder and is crucial for the patients’ treatment. Therefore, it is important to highlight the patients’ experience of the meeting, which is the purpose of this literature study. The study is a systematic literature study with searches performed in three databases, Cinahl, PubMed and PsycINFO. The results were ten qualitative original articles, which have been reviewed, analysed and summed up. In the result three categories emerged: to be seen, environment and care contact, which showed that positive perceptions about health care was the feeling of being taken seriously, the promotion of integrity and that the health care professionals listened. Negative results that emerged was when patients felt pre-judged and also when they felt that the caregivers didn’t really care, which led to further guilt and shame. Previous negative experiences lead to patients feeling reluctant of seeking help. The literature overview shows that more research from a patient's perspective is needed to reach an evidence based and improved way of care giving for health professionals that meet and treat patients with self-injury behaviour.

Currently, most adolescent self injurious behavior research is focused on adolescent White females, indicating that self-injury may be more prevalent among females and those of Caucasian decent (Whitlock, 2010). This session will present data from a current study indicating that perhaps males and other ethnic groups are also engaging in this destructive coping mechanism, perhaps in differing ways (self hitting and/or physically aggressive behaviors resulting in injury) than are being focused on by current conceptual and empirical works.

Research has focused on adolescent white females indicating self-injury may be more prevalent among female Caucasian individuals. This presentation will present data from a current study that indicates males and other ethnic groups are engaged in self-injury, in differing ways than are being studied. Future research, clinical practice, and supervision needs to understand the importance of a broader holistic approach to conceptualize and treat self-injury.

University of Macau / Faculty of Social Sciences and Humanities / Department of Psychology

Students of a south central university provide data for this study investigating knowledge of self-injury (SI), experiences with those who self-injure, and perceptions of SI. This study proposes that college peers of those who self-injure have higher levels of SI knowledge than professionals who work with individuals who self-injure. In addition, the study proposes that individuals who have experience with others who self-injure have higher levels of SI knowledge than individuals who do not have experience with others who self-injure. An additional purpose of this study is to explore information regarding experiences people have with others who self-injure and their perceptions of self-injurious behavior. A convenience sample of 495 members solicited from psychology courses at a south central university completed the survey, which consisted of four sections including the following: demographics, knowledge of SI, experiences with SI, and perceptions of SI. The knowledge section of the survey contains a 20-item measure previously used by Jeffrey and Warm (2002). A knowledge score was created based on participants responses to these 20 items. This score was used in the analysis of both hypotheses one and two. Results indicate that participants have a poor understanding of SI, based on their mean knowledge score. In addition, results reveal that the current sample’s mean SI knowledge level is lower than seven of the seven groups' mean knowledge scores. Mean knowledge scores are significantly greater for individuals indicating experience with others who self-injure than individuals reporting no experience with others who self-injure as assessed through independent t tests. Descriptive information indicates that participants do not reject those who self-injure, but rather are supportive in peer relationships with others that engage in the behavior. However, participants indicate considerable confusion surrounding the behavior and are generally not accepting of the behavior, choosing to encourage cessation of the behavior. Limitations discussed include sample demographics, possibility for misinterpretation of survey items, and potential social desirability bias.

SAMMANFATTNING Vårdpersonal möter patienter med självskadebeteende på olika avdelningar inom sjukvården. Vårdpersonalen har ofta svårt att bemöta denne patientgrupp eftersom de trots allt vårdar patienterna efter bästa förmåga ändå skadar sig igen. Detta väcker frustration och negativa känslor som vrede och mindre sympati för dessa patienter. Oftast är det unga kvinnor som lindrar sin ångest med att skada sig själva medan unga män oftare väljer att vara våldsamma eller aggressiva. Syftet med studien var att belysa vårdpersonalens uppfattning och bemötande av patienter med självskadebeteende. Metoden är en artikelgranskning. Resultatet visade att det är viktigt att vårdpersonal ser, förstår och bemöter patienterna med respekt för att de skall få ett bättre självförtroende. Varje person är unik och en egen individ. Det är därför viktigt att se bakom självskadande för att se till varje persons behov och förstå att det oftast är andra problem som ligger bakom självskadandet. Vårdpersonal med utbildning till att vårda patienter med självskadebeteende är bättre på att ta hand om dessa patienter än personal utan utbildning. Mera kunskap och utbildning om självskadandet skulle hjälpa personal till att upptäcka problemet tidigare. Vården skulle då bli bättre och kanske kortare för patienter med självskadebeteende.

<p>SAMMANFATTNING</p><p>Vårdpersonal möter patienter med självskadebeteende på olika avdelningar inom sjukvården. Vårdpersonalen har ofta svårt att bemöta denne patientgrupp eftersom de trots allt vårdar patienterna efter bästa förmåga ändå skadar sig igen. Detta väcker frustration och negativa känslor som vrede och mindre sympati för dessa patienter. Oftast är det unga kvinnor som lindrar sin ångest med att skada sig själva medan unga män oftare väljer att vara våldsamma eller aggressiva. Syftet med studien var att belysa vårdpersonalens uppfattning och bemötande av patienter med självskadebeteende. Metoden är en artikelgranskning. Resultatet visade att det är viktigt att vårdpersonal ser, förstår och bemöter patienterna med respekt för att de skall få ett bättre självförtroende. Varje person är unik och en egen individ. Det är därför viktigt att se bakom självskadande för att se till varje persons behov och förstå att det oftast är andra problem som ligger bakom självskadandet. Vårdpersonal med utbildning till att vårda patienter med självskadebeteende är bättre på att ta hand om dessa patienter än personal utan utbildning.</p><p>Mera kunskap och utbildning om självskadandet skulle hjälpa personal till att upptäcka problemet tidigare. Vården skulle då bli bättre och kanske kortare för patienter med självskadebeteende.</p>

Bakgrund: Självskadebeteende är fortfarande tabubelagt och förknippat med skam, trots att det är mer uppmärksammat nu än innan. Litteraturen beskriver att dessa patienter ofta bemöts med avsky och okunskap då hälso- och sjukvårdspersonal upplever det problematiskt att förhålla sig till dem. För att öka förståelsen för dessa patienter kommer denna litteraturöversikt att fokusera på patienternas egna erfarenheter av hälso- och sjukvården. Syftet: Syftet var att beskriva erfarenheter av hälso- och sjukvården hos patienter med ett självskadebeteende. Metod: Litteraturöversikt med kvalitativ innehållsanalys av 12 artiklar genomfördes. Resultatet: Fem kategorier skapades: Att finnas men inte synas- erfarenheter av den sviktande organisationen, En miljö som hämmar eller främjar- erfarenheter av den fysiska miljöns påverkan, Att hjälpa eller stjälpa- erfarenheter av personalens attityder, Mellan hopp och förtvivlan- erfarenheter av patientens egna känslor i mötet och Jag är unik men ni väljer att inte se- erfarenheter kring patientens önskemål om en individanpassad vård. Diskussion: Fynden diskuteras utifrån negativa och positiva aspekter samt diskuteras patienternas behov. Utifrån den etiska värdegrunden diskuteras hur vi kan förbättra patienternas erfarenheter av hälso- och sjukvården. Författarna diskuterar även fördelarna med individanpassad vård. / Background: Self- injurious behaviour is still taboo and associated with shame, even though it is more talked about now than before. The literature describe that these patients are still met with disgust and ignorance because the care-staff finds it problematic to relate to them. To increase understanding of this patient group, this literature review focuses on describing patient’s experiences of health-care. Aim: The aim was to describe experiences of health-care among patients with self-injurious behaviour. Method: A literature review with qualitative content analysis, based on 12 articles. Results: Five categories were created: To be but not be seen- experiences of the failing organisation; An environment that inhibits or promotes- experiences of the physical environment; To help or hinder- experiences of the staff´s attitudes; Between hope and despair- experiences of the patients own feelings in the encounter; I am unique but you choose not to see- experiences around the patient’s wishes for an individual- centered care. Discussion: The findings are discussed from a negative and positive view-point; also the patient’s individual needs are discussed. With a basis in ethical values, a discussion around how to better the experiences of health-care is held. The authors also discuss advantages of patient- centered care.