Bakgrund: Självskadebeteende är ett omtvistat begrepp som inte är en egen diagnos. De självskadande handlingarna börjar ofta under puberteten och brukar avta i ung vuxenålder. Självskadebeteende är ett uttryck för stort lidande. Det är viktigt att skilja mellan suicidalt beteende och självskadebeteende. Självskadebeteende kan mätas på olika sätt och det saknas i nuläget nationella riktlinjer gällande vård och behandling.  Syfte: Syftet var att undersöka vilken behandling som bör rekommenderas för patienter med självskadebeteende.  Metod: Studien är en systematisk litteraturöversikt med kvantitativ ansats innefattande 14 RCT-studier. Sammanställningen har gjorts enligt de steg som beskrivs av Bettany-Saltikov och McSherry (2016).  Resultat: Resultatet omfattar 14 studier utförda i sju antal länder. Deltagarantal i studierna varierade mellan n=33 till n=832 och utgjordes av både tonåringar och vuxna. Samtliga studier var utförda inom psykiatrisk öppenvård. Olika former av behandlingar undersöktes. Av de 14 inkluderade studierna visade 9 studier att interventionen hade bättre effekt än den som kontrollgruppen gavs, vilket oftast var standardvård. Bäst effekt hade DBT vilket gavs som intervention i tre studier. Slutsats: Denna litteraturöversikts resultat indikerar att DBT är den behandling som ger bäst effekt vid behandling av patienter med SB.  Då populationerna var små och innehållet i behandlingsinterventionerna varierade är det svårt att dra säkra slutsatser. Det behövs fler väldesignade studier som utvärderar behandling för patienter med SB där insatser initieras av sjuksköterskor. Mer forskning behövs kring nya tekniska hjälpmedel som del av behandling vid SB. / Background: Self-Injurious Behaviour (SIB) is a discussed subject and is not classified as a diagnosis. The acts of Self Harm usually start during puberty and clings off in young adulthood. SIB is an expression of great suffering. It is important to differ between suicidal behaviour and SIB. SIB can be measured in various ways. Sweden is currently lacking national guidelines for care and treatment of SIB. Aim: The purpose was to investigate what treatment that should be recommended for patients with SIB Method: The study is a quantitative literature review based on 14 RCT-studies. The joint compilation has been made step by step based on the method described by Bettany-Saltikov och McSherry (2016).  Results: The result includes 14 studies performed in seven countries. The participants varied between n=33 and n=832 and was adolescents and adults. All studies were performed in psychiatric outpatients departments. Of the 14 included studies, 9 showed that the intervention has a better effect than the one given til the control group, often care as normal. Best effect was seen when DBT was given. Conclusion: This literature review indicates that DBT is the treatment that has best effect in SIB. The populations examined were small and the interventions of big variation wherefore it is hard to draw definite conclusion. More well-designed evaluation treatment where care is initiated by nurses are needed. Further research on new technology as a part of treatment in SIB is also required.

[pt] Os fenômenos de autolesão constituem um tema complexo, compreendendo uma enorme variedade de condutas possíveis. De forma geral, trata-se de algum tipo de dano autoinfligido no corpo, com maior ou menor gravide. Essa diversidade de práticas de autoagressão implica a heterogeneidade dos estudos sobre o tema, com diferentes classificações e conceitualizações. Nosso objetivo é analisar a automutilação enquanto cortes superficiais na própria pele e uma decorrente sensação de alívio conferida a um sujeito acometido por uma intensa dor psíquica, sem que haja uma intenção suicida. A presente dissertação pretende promover algumas reflexões acerca das práticas autolesivas enquanto um recurso possível para o indivíduo experimentar vivacidade, isto é, sentir-se vivo diante do excesso de um sofrimento psíquico que não pode ser posto em palavras. Exploraremos, nesse sentido, a importância do registro corporal como fator estruturante do psiquismo, recorrendo a alguns apontamentos sobre a noção de corpo na obra freudiana. Recorreremos também, na teoria de autores pós-freudianos, ao conceito de imagem corporal, que seria parte importante na constituição do Eu, contribuindo para a formação de uma unidade corporal e um sentimento de si. A condição clínica da automutilação parece apontar, no entanto, para um corpo não representado, atravessado pelo excesso pulsional, que prioriza a sensorialidade para se apresentar e se atualizar, em detrimento de uma suposta imagem corporal unificada. Buscaremos, então, na obra de Freud, referências sobre as limitações do campo representacional da linguagem, bem como o papel central que as sensações provenientes do sistema perceptivo podem assumir na constituição psíquica. Traçaremos, por fim, um paralelo entre a vividez sensorial presente no trabalho do sonho e a força sensorial verificada no ato de escarificação, e como ambas podem ser fundamentais na organização psíquica das intensidades experimentadas. / [en] Self-harm phenomena constitute a complex issue, considering a wide range of behaviors that can be related to self-inflicted damage towards one s body, with greater or lesser severity. The diversity of self-aggression practices implies a research heterogeneity on the matter, with different classifications and conceptualizations. Our objective is to analyze self-harm as superficial skin cuts and the ensuing relief sensation experimented by individuals under great psychic pain, without any suicidal intention. This dissertation intends to promote some reflections on self-injurious practices as a possible resource for the individual to experience vivacity, that is, the feeling of being alive while facing the excess of a psychic suffering that cannot be put into words. In this regard, we will explore the importance of the body record as a structuring factor of the psyche, using some notes on the body concept in Freud s work. We will also resort, in the theory of post-Freudian authors, to the concept of body image, which would be an important part in the constitution of the Self, contributing to the formation of a body unity and a feeling of self. The clinical condition of self-mutilation seems to point, however, to an unrepresented body, crossed by instinctual excess, which prioritizes sensoriality to present and update itself, to the detriment of a supposedly unified body image. We will seek, then, in Freud s work, references about the limitations of the language representational field, as well as the central role that sensations from the perceptive system can assume in the psychic constitution. Finally, we will draw a parallel between the sensory vividness present in the dream work and the sensory strength verified in the act of scarification, and how both can be fundamental in the psychic organization of the experimented intensities.

No description available.

Bakgrund: Självskadebeteende är ett vanligt tillstånd som förekommer på grund av psykisk ohälsa. Psykisk ohälsa kan av vården och samhället upplevas svårt att hantera vilket medför ett sämre bemötande gentemot patienten. Därför är det viktigt att sjuksköterskor har kunskap och förståelse om psykisk ohälsa för att kunna förbättra patientens mående och minimera risken för försämring. Syfte: Sjuksköterskors erfarenheter av att vårda patienter med självskadebeteende. Metod: Allmän litteraturöversikt baserad på sex kvalitativa artiklar samt fyra kvantitativa artiklar. Resultat: Resultatet består av åtta teman: sjuksköterskors attityder, en stigmatiserad kultur, utmaningar i vården, personalbrist och hög arbetsbelastning, prevention av självskada, överväldigande känslor, personcentrerad omvårdnad och sjuksköterskans förhållningssätt. Resultatet visar att negativa attityder hos sjuksköterskor ger en försämrad påverkan på patientens vård. Konklusion: Vikten av att implementera kunskap om självskadebeteende och psykisk ohälsa kan förändra attityderna hos sjuksköterskorna. Med ökad kunskap om självskadebeteende och psykisk ohälsa ökar förståelsen för patienten. Detta i sin tur leder till bättre vård för patienten och till en bättre arbetsrelaterad hälsa för sjuksköterska / Background: Self-destructive behavior is a common condition which occurs due to mental illness. Mental illness can be perceived as difficult by society and in care to manage which leads to poorer treatment towards the patient. It is therefore important that nurses have knowledge and understanding about mental illness to be able to improve the patient’s well-being and minimize the risk of deterioration. Aim: Nurses’ experiences of caring for patients with self-injurious behavior. Method: General literature review based on six qualitative articles and four quantitative articles. Findings: The result consists of eight themes; nurses’ attitudes, a stigmatized culture, challenges in healthcare, staff shortage and high workload, prevention of self-harm, overwhelming emotions, good care, and seeing the patient as a whole person. The result shows that negative attitudes among nurses have a worsening effect on the patient’s care. Conclusion: The importance of implementing knowledge about self-destructive behavior and mental illness can change the attitudes among the nurses. With increased knowledge about self-destructive behavior and mental illness increases understanding of the patient. This in turn leads to better care for the patient and to a better work-related health for the nurse.

Att avsiktligt skära, bränna eller på annat sätt skada sig själv illa är förenat med ett stort lidande och väcker ofta starka reaktioner hos de anhöriga. Problematiken är omfattande och självskadebeteende förefaller vara en stark prediktor för självmordsförsök och fullbordade självmord. Globalt är självmord den näst vanligaste dödsorsaken bland ungdomar. Efterfrågan på effektiva behandlingsmodeller för denna målgrupp är stor. I Sverige, närmare bestämt i Uppsala har behandlingsmodellen IKB – Intensiv Kontextuell Behandling utvecklats för ungdomar med självskadebeteende och/eller suicidala beteenden och deras familjer. Modellen är en integrerad individ- och familjeterapeutisk behandlingsmodell. Föreliggande studie syftade till att undersöka behandlingsmodellen IKB:s effektivitet i förhållande till minskat självskadebeteende hos ungdomarna och minskade nivåer av Expressed emotion hos föräldrarna. Sammanlagt har 34 familjer deltagit i studien och de har samtliga genomgått behandling inom ramen för IKB-modellen. Resultatet visade på en effektivitet i behandlingsmodellen IKB avseende att minska självskadebeteende hos ungdomarna samt att minska nivåerna av Expressed emotion hos föräldrarna. Utfallet av studien diskuteras utifrån tidigare forskning och metodologiska frågor. / To intentionally cut, burn or hurt oneself severely is associated with great suffering and often arouse strong reactions within the family context. The problem is extensive and self-harm appears to be a strong predictor of suicide attempts and completed suicides. Globally, suicide is the second leading cause of death among young people. Effective treatment models for this group is urgent. In Sweden, (Uppsala) the model IKB - Intensive Contextual Treatment was developed for adolescents with self-harm and / or suicidal behavior, and their families in order to provide support. IKB is an integrated individual and family therapeutic model. The aim of the study were to evaluate the effectiveness of IKB in relation to frequency of self-harm and levels of Expressed emotion. A total of 34 families participated in the study and they all received treatment in the context of the IKB-model. The families completed the self-assessment forms for data collection before treatment, after treatment and follow-up. Results showed efficiency to reduce self-harm among adolescents and to decrease levels of Expressed emotion. The outcome of the study are discussed based on previous research and methodological issues. / <p>27</p>

This dissertation has multiple goals. First to analyze self-destructive behavior and its relations to ethics. Secondly to evaluate four different ethical perspectives regarding self-destructiveness from a certain position of human nature. The third goal is to construct a position that deals with self-destructive behavior in a way that is improved and well-managed compared to the four ethical perspectives analyzed earlier. The first goal is met by comparing and evaluating different theories concerning self-destructive behavior and discussing the ethical implications surrounding them. Self-destructive behavior is seen as a way of communicating, which puts a moral pressure on both the self-destructive person and the society around her. The four ethical perspectives represented by Robert Nozick and Thomas Szasz, two neoliberals, James B Nelson, a body theologian inspired by Paul Tillich, Gail Weiss, a body feminist and Mary Timothy Prokes, a catholic body theologian, are hence met by the problem of self-destruct, analyzed and critically evaluated. In the final chapter the author constructs an improved ethical perspective concerned with self-destructiveness, based on altruism, responsibility and broad-mindedness.

Bakgrund: Det framkommer centrala aspekter vid omvårdnaden av patienter som skadar sig själva som i sin tur ställer krav på vårdpersonalens förmåga att förhålla sig till mötet med dessa patienter. Syfte: Syftet med litteraturstudien var att belysa psykiatrisk vårdpersonals upplevelser i mötet med patienter som skadar sig själva. Metod: En systematisk litteraturstudie baserad på Evans analysmetod och resultatet grundar sig på 22 artiklar av kvalitativ ansats. Resultat: Vårdpersonalens möten med patienter som skadar sig själva redovisas sex teman; Att utmanas av negativa känslor, Att stänga av sin empatiska förmåga, Att vara osäker på vad som komma skall, En svår balansgång, Ett gynnsamt möte och Professionell utveckling. Slutsats: Resultatet visade på att vårdpersonal i psykiatrisk vård har att hantera flera negativa känslor i sina möten med patienter som skadar sig själva. Kontinuerlig fortbildning och handledning framstår som nödvändiga förutsättningar för att möjliggöra gynnsamma möten med patientgruppen. / Background: It appears to be central aspects regarding the care of patients who self-harm and these aspects set requirements on psychiatric health care personnel's ability to relate to the meeting with the patients. Aim: To illustrate psychiatric health care personnel's experiences of meeting with patients who self-harm. Method: A systematic literature review based on a method described by Evans with a result based on 22 articles of qualitative design. Result: To meet patients who self-harm can be seen out of the six themes described in the result of the present study; To be challenged by negative emotions, To disconnect from your empathic ability, To be unsure of what´s to come, A difficult balancing act, A favorably meeting and Professional development. Conclusion: The result of the present study shows that the negative emotions were prominent. Continuous further training and tutorial appears necessary conditions to enable favorable meetings with the patient group.

Bakgrund: Självskadebeteende är ett allvarligt problem som förekommer idag. Under senare år har vårdgivare inom hälso- och sjukvården uppmärksammat en ökning av detta problem som leder till fysiska och psykiska hälsobesvär. Dessa hälsobesvär kan förekomma i form av exempelvis depression, fysiska skador och kan i värsta fall leda till självmord. En form av terapi som visat sig ge goda resultat för att komma till rätta med detta beteende är DBT, dialektisk beteendeterapi. Syfte: Att undersöka om DBT- terapeuters beskrivning av sitt arbete med dialektisk beteendeterapi stämmer överens med litteraturens beskrivning av behandlingen, och därmed uppnå en fördjupning i dialektisk beteendeterapi och självskadebeteende. Metod: En kvalitativ studie med sex stycken semistrukturerade intervjuer med DBT- terapeuter har genomförts. Analysen har utförts med hjälp av kvalitativ innehållsanalys. Resultat: Resultatet har delats upp i två huvudkategorier: arbetsmetod samt terapeuter och andra vårdgivares bemötande av patienter. I resultatet framkommer det hur en DBT- behandling stegvis ser ut samt vikten av ett gott bemötande av patienter. Ett gott bemötande omfattar bland annat ett respektfullt och icke- dömande förhållningssätt. Konklusion: Resultaten i studien bekräftar resultaten från den tidigare forskningen. Dock krävs det mer forskning om DBT som behandlingsmetod för att kunna dra tillförlitligare och säkrare slutsatser. Genom att arbeta med behandling av självskadebeteende kan individers hälsa förbättras, vilket i sin tur även kan leda till minskning av antalet självmord och psykisk ohälsa. / Background: Self- harm behavior is a serious problem that occurs today. In recent years care providers in the health-care have noticed an increase of this problem that leads to physical and mental health- problems. These health- problems can occur, for example, in the form of depression, physical harms and can lead to suicide in worst case. A form of therapy that has been shown to give good results to manage this behavior is DBT, dialectical behavior therapy. Aim: To investigate whether DBT- therapist’s description of their work with dialectical behavior therapy is consistent with the literature’s description of the treatment, and thereby achieve a deepening in dialectical behavior therapy and self- harm behavior. Method: A qualitative research with six semi-structured interviews with DBT- therapists have been implemented. The analysis has been done using a qualitative content analysis. Results: The result has been divided into two main categories: working- method and therapist’s and other care provider’s treatment of patients. It appears in the result how a DBT- treatment looks like, step- by step, and the importance of a good treatment of patients. A good treatment includes a respectful and non- judgemental attitude. Conclusion: The results in the study confirms the results from the recent research. However, more research on DBT as a treatment is necessary, in order to make stronger and more reliable conclusions. People’s health can be improved by working with treatment of self- harm behavior, which also can lead to a reduction in the number of suicide and mental illness.

Despite a well-documented gender pattern of adolescent mental health, public health research investigating possible influencing factors from a gender-theoretical approach is scarce. This study aimed to explore what factors and circumstances are related to adolescent mental health and to apply a gender analysis to the findings in order to improve the understanding of the relationships between life circumstances and the gendered patterning of mental health among young people.   The study population was 16-19-year-old Swedish students and data was collected by means of focus groups (N=29) and self-administered questionnaires (N=1,663, 78.3% response rate) in school settings. Mental health problems were defined in a broad sense including the adolescents’ own understandings, perceived stress, psychological distress and deliberate self-harm.   The mental health problems of perceived stress, psychological distress and deliberate self-harm were twice as common among girls as boys. The findings suggest that adolescent mental health is associated with the life circumstances of social relationships, demands and responsibility taking and experiences of violence and harassment.  Supportive relationships with friends, family and teachers were found to be of importance to positive mental health, whereas poor social relationships, loneliness and lack of influence were associated with mental health problems.  Perceived demands and responsibility taking regarding school work, relationships, future plans, appearance and financial issues were strongly related to mental health problems, particularly among girls regardless of social class. The results indicate that physical violence, sexual assault, bullying and sexual harassment are severe risk factors for mental health problems in young people. Boys and girls experienced different types of violence, and the victim-perpetrator relationships of physical violence differed. These diverging experiences appeared to influence the associations with mental health problems in boys and girls.   A gender analysis provides the tools to gain knowledge about the ways that boys’ and girls’ lives are shaped by gender relations and constructions at different levels in society and how these life circumstances represent risk- or protective factors for mental health. For example, unequal power structures and the ways girls are expected to ‘do’ femininity likely influence their life circumstances in ways that place them at greater risk of mental health problems. Hegemonic constructions of masculinity and advantaged positions likely contribute to life circumstances that are positive for mental health but are also implying risk factors for poor mental health among boys, e.g., violence. It is also important to recognise how the intertwined cultural and structural aspects of gender and social class influence the lives and mental health of boys and girls. In conclusion, gendered and class-related mechanisms at the different levels in society influence the distribution of risk factors unevenly among boys and girls, which could be a possible explanation for the gender differences in reports of perceived stress, psychological distress and deliberate self-harm.   The likelihood of gender and socioeconomic differences in mental health problems should be taken into account in prevention and health promotion strategies at all levels in society. A greater awareness about gender relations and the gendered social circumstances under which young people live is required. The school environment is an important arena with respect to prevention and health promotion. There is also a need for a joint action against violence and harassment at all levels in society. Implications do not only concern young people; social policy and legislation should focus on reducing gender and class inequalities in general. / Sammanfattning Svensk titel: Livsvillkor och ungdomars psykiska hälsa: uppfattningar, associationer och en genusanalys.   Trots ett väldokumenterat genusmönster i ungdomars psykiska hälsa finns det en kunskapslucka i den folkhälsovetenskapliga forskningen avseende genusteoretiska analyser av sambanden mellan ungas livsvillkor och psykisk hälsa. Föreliggande studie syftade till att undersöka vilka faktorer och omständigheter som är relaterade till psykiska problem, samt att analysera fynden ur ett genusperspektiv för att fördjupa förståelsen av relationerna mellan ungas livsvillkor och genusmönster i psykiska hälsa.   Studiepopulationen var gymnasielever i åldern 16-19 år. Studien genomfördes i skolmiljö och data insamlades genom fokusgrupper (N=29) och en enkätstudie (N=1,663, 78.3% svarsfrekvens). En bred definition av psykisk ohälsa tillämpades vilken representerades av ungdomarnas egen förståelse, samt de psykiska problemen upplevd stress, psykiska besvär samt självskadebeteende.   Resultaten visade att stress, psykiska besvär och självskadebeteende var dubbelt så vanligt bland flickor som bland pojkar. Psykiska problem var relaterade till livsvillkoren sociala relationer, krav och ansvarstagande samt utsatthet för våld och trakasserier. Stödjande relationer med vänner, familj och lärare var av stor betydelse för psykisk hälsa medan dåliga relationer, ensamhet och brist på inflytande var relaterat till psykiska problem. Psykiska problem var starkt kopplade till erfarenheter av höga krav och ansvarstagande avseende skolarbete, relationer, framtidsplaner, utseende och ekonomi, i synnerhet bland flickor oavsett socioekonomisk bakgrund. Resultaten indikerar att olika former av våld och trakasserier är allvarliga riskfaktorer för psykiska problem och att flickors och pojkars skiljda erfarenheter av olika former av våld samt relationen till förövaren, kan vara relaterade till skillnader i psykiska problem.   Genusanalysen av resultaten föreslår att flickors livsvillkor påverkas av ojämlika maktstrukturer och konstruktioner av femininitet och att dessa livsvillkor bidrar till en ökad risk för psykisk ohälsa bland flickor. Livsvillkor kopplade till manlig överordning och hegemoniska konstruktioner av maskulinitet influerar sannolikt pojkars psykiska hälsa positivt. Dessa villkor kan dock också innebära risk faktorer för psykiska problem, t.ex. i fråga om våld. Studien uppmärksammar även hur kulturella och strukturella aspekter av både genus och social klass kan påverka livsvillkor och psykisk hälsa för pojkar och flickor. Studiens slutsats är att genusifierade och klassrelaterade mekanismer på olika nivåer i samhället bidrar till en skev fördelning av riskfaktorer för psykiska problem vilket kan vara en möjlig förklaring till skillnaderna mellan pojkar och flickor i fråga om upplevd stress, psykiska besvär och självskadebeteende.   Genus- och socioekonomiska skillnader i psykiska problem bör tas i beaktande i preventivt och hälsofrämjande arbete på alla nivåer i samhället. Detsamma gäller för en ökad medvetenhet om hur ungas livsvillkor är relaterade till psykisk hälsa och hur dessa villkor är genus- och klassrelaterade. Studien uppmärksammar skolan som en viktig arena för preventivt och hälsofrämjande arbete samt att gemensamma insatser krävs på olika arenor för att motverka våld och trakasserier. Implikationer av studien omfattar även generella samhällspolitiska insatser för minskad ojämlikhet. Nyckelord: Stress; psykiska besvär; självskadebeteende; gymnasieelever; maskulinitet; femininitet; sociala determinanter; sociala relationer; krav; ansvarstagande; våld och trakasserier; skola. / Forskarutbildningsämne: Hälsovetenskap.

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.