Introduktion: Att ungdomar medvetet skadar sig själva är ett vanligt problem. Orsaken till detta beteende är lika varierande som motivet för varför man utför dessa handlingar. En del försöker få ut en inre smärta medan andra avser att ta sitt liv. Att hamna i ett självskadebeteende under ungdomsåren kan ge stora hälsoproblem i det vuxna livet och är också en riskfaktor för efterkommande självmordsförsök. Då detta problem är vanligast förekommande bland ungdomar är det också naturligt att skolan har ett viktigt uppdrag då det gäller det förebyggande arbetet mot självskadebeteende.Syfte: Finna stöd för skolsköterskans preventiva arbete då det gäller ungdomar med självskadebeteende.Metod: Systematisk litteraturstudie. Sökning som utförts i databaserna CINAHL, PubMed och PsykInfo resulterade i 21 artiklar som efter granskning och analys ligger till grund för resultatet.Resultat: Flera olika faktorer sätts i samband med självskadebeteende. Kännedom om dessa faktorer är med hälsoinventering och screening metoder för att identifiera problematiken i preventivt och behandlande syfte. Enskild problematik måste alltid tolkas individuellt för att orsaken skall kunna behandlas, vilket kräver en stor portion kunskap vilja och engagemang. Tyngdpunkten av ansvar i folkhälsoarbetet runt denna problematik vilar på skolan i vilken ungdomarna vistas mestadelen av sin tid. Trots detta rapporterar skolsköterskan fortfarande en avsaknad av såväl verktyg som utbildning för sitt viktiga uppdrag då det gäller ungdomar med självskadebeteende.Konklusion: Det krävs ytterligare forskning för att finna fungerande metoder för skolsköterskans preventiva och behandlande insats då det gäller ungdomar med självskadebeteende. / Introduction: young people who deliberately harm themselves are a common problem. The reason for this behavior is as varied as the motive for why they perform these acts. Some are trying to get rid of an inner pain, while others intend to take their own life. Having a self- injurious behavior during adolescence can cause major health problems in adult life, and it is also a risk factor for subsequent suicide attempts. Since this problem is most prevalent among young people, it is also natural that the school in which they spend most of their time has an important role when it comes to the prevention of self- injurious behaviorAim: Identify the support of school nurse preventive work when it comes to young people with self-harm.Methods: A systematic literature review. Search performed in databases CINAHL, PubMed and PsychInfo resulted in 21 articles for review and analysis underlying the results.Results: Several factors are associated with self-harm. Knowledge of these factors is with health inventory and screening, methods for identifying problems in both prevention and treatment purposes. Individual problems must always be interpreted individually for causes to be processed; this requires a huge amount of knowledge, will and commitment from the school nurse. The emphasis of the responsibilities of public health work around this problem rests on the schools in which young people spend most of their time. Despite this report the school nurse still lacks of both tools and training for their important task when it comes to young people with self- injurious behavior.Conclusion: Further research is necessary to find effective methods for the school nursepreventive and therapeutic intervention in the case of adolescents with self-harm.

In this study the aim is to examine how employees in treatment programmes relate to girls that self-harm. To achieve this four questions were formulated: (1) What experiences does the empolyees have of meeting girls that self-harm? (2) Based on the employees’ experiences, what has been the background to why the girls self-harm? (3) Based on the employees’ experience, what increases or decreases the risk of self-harm? (4) How do the employees’ work with girls that self-harm? The method being used was qualitative interviews with vignettes. The theoretical framework is Becker’s Labeling Theory and Bronfenbrenner’s Ecology of Human Development. The result shows that according to the employees issues in the family is a common factor among girls that self-harm. It also shows that the employees’ opinions on how to work with the girls’ physical wounds are divided. Some think that paying attention to the wounds can increase the risk of self-harm while others think that paying attention to the wounds can be helpful for the girls.

Bakgrund: Fenomenet självskadebeteende har blivit allt vanligare i vårt samhälle och väcker många reaktioner hos omgivningen. Sjuksköterskor möter patienter som skadar sig själva i flera olika miljöer. Det har dock visat sig att sjuksköterskor själva utrycker bristfällig kunskap då de upplever det svårt att bemöta patienter med självskadebeteende.Syfte: Syftet med litteraturstudien var att belysa faktorer som påverkar sjuksköterskors attityder till patienter med självskadebeteende, samt dess konsekvenser för omvårdnaden.Metod: En allmän litteraturstudie, där empiriska artiklar publicerade i vetenskapliga tidskrifter har analyserats. Fynd från artiklarna som svarade på syftet har identifierats och fyra kategorier skapades.Resultat: Resultatet presenteras utifrån fyra kategorier vilka är: Sjuksköterskors känslor och tankar, Sjuksköterskors erfarenhet och genus, Sjuksköterskors arbetsmiljö och Sjuksköterskors behov av utbildning. Detta är faktorer till sjuksköterskors attityder och påverkar den omvårdnad som patienterna får.Diskussion: Genom att påverka bakomliggande faktorer till sjuksköterskors attityder skulle de kunna förändras i en positiv riktning. Då fenomenet självskadebeteende blivit allt vanligare i vårt samhälle krävs också vidare forskning och utveckling inom området. / Background: The phenomenon of self-injury has become increasingly common in our society and has prompted many reactions in the surroundings. Nurses encounter patients who injure themselves in a variety of environments. However, it has been shown that nurses express themselves inadequate knowledge since they find it difficult to respond to patients with self-injury.Aim: The aim of this study was to illuminate factors influencing nurses' attitudes to patients with self-injury, and its implications for nursing care.Method: A literature review, in which empirical studies published in scientific papers have been analyzed. Findings from the articles that responded to the aim has been identified and four categories were created.Results: The results are presented in four categories which are:Nurses' feelings and thoughts, Nurses' experience and gender, Nurses´ work and Nurses´ Training needs. These are the underlying factors of nurses’ attitudes which affect the care that patients receive.Discussion: By affecting the underlying factors for nurses' attitudes, they could change in a positive direction. Since the phenomenon of self-injury has become increasingly common in our society also requires further research and development in the area.

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.

Bakgrund: Att vårda patienter med självskadebeteende är en utmaning fِör sjukvårdspersonalen. Ur patienternas perspektiv i samband med vårdandet inom hälso och sjukvården den framkom att patienterna upplevde lidande. Samtidigt presenterades i tidigare forskning bland annat hur vårdpersonalen gjorde sitt bästa fِör att hjälpa patienterna ur sina lidanden. Syfte: Syftet med denna studie var att beskriva hur patienter med självskada upplever vårdande inom hälso och sjukvården. Metod: En kvalitativ innehållsanalys enligt Evans metod användes av tolv artiklar som låg till grund för denna studie. Resultat: Resultatet av analysen bekräftade problematiken bakom vårdandet fِör patienter med sjävskadebeteende. Sjukvårdspersonalen föِrsِkte hela tiden hjälpa patienter ur sina lidande men det tolkades som negativa upplevelser av patienterna. Negativa attityder, osedda behov och brist på bekräftelse låg till grund fِör deras vårdlidande. Den självskadande patienten hade ett stort behov av att tas påallvar och att bli bekräftad. Slutsats: Med bakgrund och analysresultat som underlag kom det fram att kommunikationen och en ِöppen dialog mellan vårdare och patienten var ett viktigt verktyg fِör att kunna hjälpa den självskadande patienten ur sitt lidande. / Background: Caring for patients with self-injury is a challenge for health professionals. From a patient perspective in the context of caring in health care showed that patients experie need suffering in the context of caring. While presented in the previous research has included the nursing staff did their best to help patients out of their sufferings. Purpose: The purpose of this study was to describe how patients with self -injury experience caring in health care. Method: A qualitative content analysis according to Evans method used by the twelve articles which formed the basis for this study. Results: The results of the analysis confirmed the problem behind caring for patients with self injury. The medical staff tried to continually help patients from their suffering, butit was interpreted as negative experiences of patients. Negative attitudes, unseen needs and lack of confirmation on the basis of their health suffers. The self-harming patient had a strong need to be taken seriously and to be confirmed. Conclusion: The background and analysis results as a basis, it emerged that the communication and open dialogue between the caregiver and the patient was an important tool to help the selfharmingpatient from his suffering.

<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>

Research in the area of self-injurious behaviors and the family context is still emerging. The majority of research available is quantitative in nature. The limited qualitative research available in this area has been conducted outside of the United States. A collective case study was conducted with four parents with an adolescent that had been admitted to an inpatient psychiatric residential facility with a presenting problem of self-injurious behavior. The purpose of this study was to gain an in-depth, qualitative understanding of the parent perspective and comprehension of adolescent self-injurious behavior including the parents' ideas on how the parent-child relationship or other family relationships may have influenced the self-injury. With-in case and cross-case analyses were utilized from the collected data including field notes, interview scripts, member checking sessions, and medical record reviews. Themes identified using an inductive content analysis were discussed based on each primary interview question. Clinical implications included the importance of providing parental education, encouraging parent participation in therapy, treating self-injurious behavior from a trauma-informed perspective, and others were considered. Limitations of the present study, directions for the use of the present research, as well as implications for future research were reported.

Suicidality and non-suicidal self-injury are highly prevalent on college campuses and death by suicide is the number two cause of death for that age demographic. Even with such a deadly public health concern, little is known about how self-harm behavior can be prevented or effectively treated. Research has suggested that differences in affect regulation may differentiate those who engage in self-harm from those who do not, but many of these studies have examined disparate pieces of affect regulation without addressing the overlap and interaction of regulatory behaviors. The field must discover what specific aspects of affect regulation go awry, if self-harmers demonstrate a different pattern of affect regulatory strategies, and if subtypes of persons who engage in self-harm have different patterns of affect regulation that will need to be addressed differently in treatment and prevention efforts. The purpose of this study is to explore these associations between affect regulation, specifically emotion regulation and coping, and self-harm behaviors. Two-hundred and fifty undergraduates completed surveys on emotion regulation, coping strategies, and health-risk behavior. An extremely high prevalence of self-harm and risky behavior was discovered (nearly 47% endorsing self-harm and 86% endorsing risky behavior). Results from three different measures of emotion regulation and coping strategies were factor analyzed to produce three factors, corresponding to maladaptive, active adaptive, and passive adaptive (distress tolerance) affect regulation strategies. Persons with and without a history of self-harm behavior endorsed similar levels of adaptive affect regulation strategy utilization, but those with a history of self-harm behavior had much higher utilization of maladaptive affect regulation strategies. Similar patterns of affect regulation strategy utilization were found for persons engaging in risky behavior (sexual, alcohol, illicit substances, disordered eating, safety, and smoking) and all subtypes of persons engaging in self-harm (i.e., non-suicidal self-injury, suicide attempts, or both). Those who had engaged in self-harm could be differentiated from participants with no history of self-harm behavior or ideation on the basis of their utilization of maladaptive affect regulation strategies. Implications for prevention and intervention are discussed.

Nonsuicidal self-injury (NSSI) is a behavior recently added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a condition for further study. In this dissertation, I present findings from three studies that inform the clinical description of NSSI as well as some of the cognitive and emotional aspects of NSSI. In Study 1, I examined data from a community sample of adult women who met proposed DSM-5 criteria for NSSI or subthreshold NSSI. The findings show that any experience with NSSI is associated with significant impairment. Further, they suggest that greater self-criticism may be a key variable capable of distinguishing between people who engage in more versus less frequent NSSI. In Study 2, I examined the extent to which cognitive deficits in inhibiting emotional information may characterize people who engage in NSSI. Although NSSI participants endorsed greater difficulty with negative thoughts relative to controls, the groups demonstrated no differences on a directed forgetting task. These findings are consistent with previous research on emotional reactivity and impulsivity in NSSI that shows a similar dissociation between self-report and behavioral-based results. In Study 3, I examined how people process NSSI images. Results suggest that people who engage in NSSI view NSSI stimuli as relatively non-aversive. This is in sharp contrast to healthy controls, who consider NSSI images as highly aversive. These finding are consistent with models of NSSI that regard self-injury as providing reinforcement (positive and negative). Overall, the findings from these studies add to the clinical description of NSSI and support its diagnostic validity. Our examination of the clinical characteristics of the NSSI as described in DSM-5 highlights the importance of assessing the presence of any NSSI behavior as well as highly self-critical thoughts. Importantly, we found no evidence of memory deficits in NSSI. Of great clinical concern, however, is the extent to which engaging in NSSI appears to erode the aversive nature of NSSI stimuli. Taken together, our findings support a model in which self-criticism may reduce the initial barriers to engaging in NSSI, with the mood benefits associated with NSSI subsequently serving to maintain it. / Psychology

Abstract   Author: Robert Andersson &amp; Oskar Karlsjö Title:“My first thought is a girl that cuts herself” – A qualitative study about professionals in human service organizations description of self-injurious behavior. Supervisor: Ann Ottengrim Assessor: Rickard Ulmestig   The purpose of this study has been to understand how professionals in human service organizations (HSO) describe self-injuries behaviour, how they describe the individuals that self-harm and if the professionals describe any possible differences in how men and women self-harm as well as how professional’s knowledge concerning self-injurious behaviour is contructed. The study answers three questions; - What kind of actions do professionals in HSO describe as being self-injurious behaviour? - How is knowledge constructed by professionals in HSO concerning self-injurious behaviour? - How are people who engage in self-injurious behaviour being described? - How do professionals in human service organizations describe potential differences between men and women´s self-injurious behaviour?   Qualitative interviews have been chosen as the method in this study to gather empirical data and the social constructionism theory has been implemented to analyse the empirical data. The result of this study shows that self-injurious behaviour is a complex and at the same time a dynamic phenomenon. There are a lot of different actions that are being describes as being self-injurious behaviour. An individual that cuts its own body tissue or an individual that often gets involved in psychical fights are examples of acts that are being described as having a self-injurious behaviour. The informants also described that their knowledge and what they define as self-injurious behaviour has changed over time in the field which indicates that self-injurious behaviour is a dynamic category. According to our results it doesn’t seem to exist a stereotype of whom and why someone engages in self-harm. But men tend to self-harm in a more severe way than women.