The notion that acts of deliberate self-harm serve an expressive or communicative function is the central premise upon which many of the main functional models of selfharm are based. However despite the importance of this notion, very little empirical evidence exists to support it. Within this project the notion that acts of DSH serve an expressive or communicative function was explored in detail. Four studies investigating the expressive and communicative qualities of acts of DSH, the content which such behaviours serve to express, and the dynamics by which several different modalities of DSH do this were performed utilising Internet methods of data collection. The use of online methods of data collection findings of this project only apply to the sub-group of individuals who engage in DSH and also participate in online discussion forums. Photographs of words and phrases engraved into the skin along with detailed first person narratives of past episodes of deliberate self-harm were used as data sources in this project. Due to their high frequency of occurrence, acts of skin-cutting, self-burning, self-hitting, and self-poisoning were the main modalities of deliberate self-harm investigated in the four studies. Acts of skin-cutting, self-burning, self-hitting, and self-poisoning were all reported to serve expressive functions which allowed emotions and issues to be released or discharged from the body. Conversely, acts of skin-cutting and self-poisoning were also reportedly used to communicate emotional distress and a need for support from others. The content expressed or communicated by such behaviours, and indeed the dynamics by which they did so depended largely upon the modality by which injuries were inflicted. However in general the content expressed and communicated by the acts of deliberate self-harm reported in this project typically related to the events which preceded such behaviours, how they were interpreted, the types of psychological experiences they represented, and the emotions which they evoked. Such events were overwhelmingly interpersonal in nature, and typically involved the dissolution or disruption of relationships with primary support group members. The dynamics by which acts of deliberate self-harm reportedly served these functions differed widely, however the concept of symbolism was central to all modalities. The data collected within this project relating to the expressive and communicative functions of acts of skin-cutting, self-burning, self-hitting, and selfpoisoning was finally collated with the existing literature on the subject.

Aims: The initial aim of this thesis was to understand the relationship between non-psychotropic medication and risk of suicidality. This was achieved by conducting a systematic review, which, among other conclusions, identified the need for improved estimation of risk of suicide and attempted suicide associated with antiepileptic drugs (AEDs). This stimulated this programme of research which sought to estimate the risk of suicide and other causes of unnatural death in people with epilepsy, the role of AEDs in fatal poisonings, the risk of self-harm in people with epilepsy and factors associated with self-harm amongst those people with epilepsy. Methods: Cohorts of individuals with prevalent epilepsy were identified separately in two population-based linked-primary care datasets: the Clinical Practice Research Datalink (CPRD) in England and the Secure Anonymised Information Linkage (SAIL) in Wales. Individuals were matched on age, gender and general practice to up to 20 people without epilepsy. The risks of cause-specific types of unnatural death (e.g. suicide, accident) were estimated using stratified Cox proportional hazards models, adjusted for level of deprivation. From each of the prevalent epilepsy cohorts, individuals with incident epilepsy, no history of self-harm and who were new users of the AEDs; carbamazepine, lamotrigine or valproate, were identified. The risk of first self-harm event associated with each AED compared to valproate was estimated using Inverse Probability of Treatment Weighting propensity score analysis. Estimates from each dataset were combined in a random effects meta-analysis. In the CPRD, the risk of self-harm in the incident epilepsy cohort versus a comparison cohort was estimated using a stratified Cox proportional hazards model. From this cohort, a nested case-control study was constructed. Individuals with a first self-harm event (cases) were matched to up to 20 people with no history of self-harm (controls). Conditional logistic regression was used to estimate the risk of self-harm associated with various factors including history of mental illness diagnoses, referrals and AED utilisation. Results: There were 44,678 and 14,051 people in the prevalent epilepsy cohorts and 891,429 and 279,365 in the comparison cohorts, in the CPRD and the SAIL respectively. Increased risks of suicide (HR 2.15, 95%CI 1.51-3.08) and accidental death (HR 2.97, 95%CI 2.54-3.48) were observed for people with epilepsy versus the comparison cohort, from the deprivation-adjusted meta-analysed estimates. Overall, AEDs were involved in 9.7% (95%CI 3.6%-19.9%) of the 62 poisoning deaths in people with epilepsy. There were 5,107 new users of carbamazepine, lamotrigine or valproate with incident epilepsy in the CPRD and 2,654 in the SAIL. No increased risk of self-harm was evident for carbamazepine (HR 1.53, 95%CI 0.89-2.64) or lamotrigine (HR 1.35, 95%CI 0.79-2.29), compared to valproate, from the meta-analysed estimates. In the CPRD, there were 11,690 individuals with incident epilepsy and 215,569 in the comparison cohort. The deprivation-adjusted hazard ratios for first self-harm event were 5.31 (95%CI 4.08-6.89) in the year following diagnosis and 3.31 (95%CI 2.85-3.84) in subsequent years. The nested-case control study derived from this incident epilepsy cohort included 273 cases of first self-harm and 3,790 controls. An increased risk of self-harm was associated with history of a mental illness diagnosis (OR 4.08, 95% CI 3.06-5.42) or referral to specialist psychiatric services (OR 3.41, 95% CI 2.63-4.43), compared to none; or being prescribed no AEDs (OR 1.47, 95% CI 1.01-2.12) or two AEDs (OR 1.84, 95% CI 1.33-2.55) in the 90 days prior to index date, compared to a single AED. Augmentation of AED treatment carried an elevated risk (OR 2.12, 95% CI 1.38-3.26) whereas there was no evidence to indicate that switching from one AED to another altered risk (OR 0.69, 95% CI 0.21-2.23). Conclusions: Compared to those without the condition, people with epilepsy are at an elevated risk of unnatural death, including suicide and accidental death, and nonfatal self-harm. The risk of self-harm is particularly elevated in the year following diagnosis of epilepsy but persists beyond this. Factors associated with increased risk of self-harm within the epilepsy population include prior mental illness and referral to psychiatric services. There was no evidence of difference in the risk of self-harm associated with carbamazepine or lamotrigine compared to valproate, but further replication of this result would be beneficial. However, treatment with multiple AEDs and augmentation of AED treatment increase the risk of self-harm within this population. These may be markers of uncontrolled epilepsy.

This study described self-injury within a general adolescent population. This study involved secondary analysis of data gathered using the middle school Youth Risk Behavior Survey (YRBS) from 1,748 sixth- and eighth-grade students in eight middle schools in a large, southeastern county in Florida. A substantial percentage of students surveyed (28.4%) had tried self-injury. The prevalence of having ever tried self-injury did not vary by race or ethnicity, grade, school attended, or age but did differ by gender. When controlling for all other variables in the multivariate model including suicide, having ever tried self-injury was associated with peer self-injury, inhalant use, belief in possibilities, abnormal eating behaviors, and suicide scale scores. Youth who knew a friend who had self-injured, had used inhalants, had higher levels of abnormal eating behaviors, and higher levels of suicidal tendencies were at increased risk for having tried self-injury. Youth who had high belief in their possibilities were at decreased risk for having tried self-injury. During the past month, most youth had never harmed themselves on purpose. Approximately 15% had harmed themselves one time. Smaller proportions of youth had harmed themselves more frequently, including two or three different times (5%), four or five different times (2%), and six or more different times (3%). The frequency of self-injury did not vary by gender, race or ethnicity, grade, or school attended. Almost half of students surveyed (46.8%) knew a friend who had harmed themselves on purpose. Peer self-injury demonstrated multivariate relationships with gender, having ever been cyberbullied, having ever tried self-injury, grade level, and substance use. Being female, having been cyberbullied, having tried self-injury, being in eighth grade, and higher levels of substance use placed youth at increased risk of knowing a peer who had self-injured. Chi-squared Automatic Interaction Detection (CHAID) was used to identify segments of youth at greatest and least risk of self-injury, frequent self-injury, and knowing a friend who had harmed themselves on purpose (i.e., peer self-injury).

The purpose of this study is to describe how, and if, discourses about self-harm in young people has been changed from the late 90-s until today. We chose to do this by studying films where the content of self-harm is a big factor. The study is built on a narrative research, we did however analyze it as a discourse method. The issues we have concentrated on are: Is there a significant quality that describes an individual who cut themselves? How can this phenomenon be seen from a gender point of view? Is there a specific group of people who is labeled as a person who cut themselves from the public? The result from this study show us that self-injury, from symptoms of a (bad) mental state, is a strong discourse where the views from the society lets it become more acceptable. However, there are other reasons for self-harm that is developed by the social difficulties, which is illustrated in these films. Norms and beliefs around what is male or female have not been changed from the beginning of the time period we have studied until today. Self-mutilation is still seen as a typical female thing – a woman problem. The persons who are pointed out as cutting themselves are typical white, young, dramatic girls. These girls also exhibit depth - and shame for the problem and its environment.

The question of the human biological body and technology has been of major concern within posthumanist theories emphasising the co-constituting relationship between materiality and social discourse for the productions of subjectivity. Online space cannot be thought of as liberating the mind from the materiality of the body, but instead seen as effected by the body and affecting the body in return. The philosophy of Gilles Deleuze and Félix Guattari has been used to argue that the body is implicated in online practices for the productions of subjectivity within posthumanist discourses. In this theoretical master thesis, the aim is to investigate the productions and transformations of the subjectivity of self harm between the biological body of the subject and practices of written text in an online message board forum for self harm support. Methodologically, a functional hermeneutics is constructed from Deleuze and Guattari’s concept of the assemblage in order to engage empirical material generated from observations of the message board. The empirical material is interwoven with a theoretical exposition of Deleuze’s philosophy. By the concepts of force and affect, it is concluded that texts on the forum are constituted as bodies. However, the practices leading up to such constitution of bodies would not be considered corporeal. This is further theorised in the concept of the assemblage with particular emphasis on a proposed distinction in Deleuze’s philosophy between bodies and language. These bodies of texts function to create new forms of expressions and enunciations on the forum, and may theoretically be said to transform the biological body of the subject. The concept of expression functions to form the ethical backdrop to transformations of the body in the online space of enunciation. By the relations between bodies in the assemblage of self harm support, expression envelops these bodies in a supportive world. It is through the relations with other bodies in the assemblage that words form the expressive world that envelops all bodies in that world, thereby transforming them. This is further deepened by considering Deleuze’s ontology of the actual and the virtual, where it is proposed that online space is actual in that enunciations are materialised in bodies of texts which in turn create virtual ideas and new possibilities for expression and enunciation. It is argued both with and against posthumanist readings of Deleuze in regards to information technology that bodies and materiality are constituting factors of subjectivity along with language, insofar as the body is theorised as transformed incorporeally.

Bakgrund: Självskadebeteende är ett samhällsproblem som ökar. Personer med självskadebeteende kan ofta uppleva att de inte bemötts på ett bra sätt av vårdpersonal. Beteendet kan vara svårt att begripa och provocerande för omgivningen. Personer som skadar sig själv gör det i syfte att lindra ångest och smärta. Syfte: Syftet var att belysa sjuksköterskors upplevelser i bemötandet av personer med självskadebeteende. Metod: En allmän litteraturstudie har gjorts. Sökord som tilltalade syftet identifierades. Litteratursökningen genomfördes i olika databaser. Resultat: Resultatet framkom ur vetenskapliga artiklar (n=11) som granskades. Resultatet presenterades i fyra subteman: upplevelser av förståelse i bemötandet, upplevelser av ansvar i bemötandet, upplevelser av rädsla och frustration i bemötandet och upplevelser av kunskapsbrist och stress i bemötandet. Resultatet visar att sjuksköterskor upplever personer med självskadebeteende som en ansträngande patientgrupp. Faktorer som utbildning, tidspress och stöd från medarbetare upplevdes som betydelsefullt i vården med personer som skadar sig själv. Diskussion: Genom utbildning och handledning skulle sjuksköterskor kunna bli mer professionella i bemötandet med personer som skadar sig själv. Slutsats: Sjuksköterskor behöver mer utbildning, handledning och kunskap för att bemöta personer som skadar sig själv på ett professionellt sätt. / Background: Self-injury is a social problem that is increasing. People with self-injury can often feel that they have not been treated in a good way of nursing staff. People who harm themselves do it in order to relieve anxiety and pain. The behavior can be difficult to comprehend and provocative for the environment. Aim: The aim was to illuminate nurses’ experiences in the treatment of people with self-injury. Method: A literature review search has been made. Keywords that appealed to the purpose identified. The literature search was conducted in different databases. Results: The results emerged from scientific articles (n = 11) that were reviewed. The results were presented in four sub themes: experiences of understanding in the treatment, experiences of responsibility in the treatment, experiences of fear and frustration in the treatment and experiences of lack of understanding and stress in the treatment. Factors as education, time pressure and support from colleagues were seen as important in the care of people who self-injure. Discussion: Through training and mentoring nurses would be more professional when dealing with people who hurt themselves. Conclusion: Nurses need more education, mentoring and knowledge to deal with people who hurt themselves in a professional manner.

Att skapa en god vårdrelation mellan sjuksköterska och patient är en förutsättning för att patienten ska kunna delta och vara motiverad till att förbättra sin psykiska hälsa. Patienter med borderline personlighetsstörning (BPD) och självskadebeteende är patientgrupper som omnämns med en negativ attityd inom psykiatrisk omvårdnad. Vårt syfte med studien är sjuksköterskors beskrivning av faktorer som kan påverka vårdrelationen med patienter med BPD och självskadebeteende. Metoden är systematik litteraturstudie där sökning av vetenskapliga studier har gjort i databaserna OneSearch beta, Medline , Cinahl och PSYC-info. Studierna granskades utifrån modifierade kvalitetbedömningsprotokoll. Data analyserades, granskades och bygger på ramen för innehållsanalys. Resultatet visade att patienter med BPD och patienter med självskadebeteende skapade känslor av bl.a. frustration och hopplöshet hos sjuksköterskor. Känslorna skapades av att inte kunna ge adekvat vård pga. resursbrist, kompetensbrist och brist på tillit från patienterna. Att inte vara överens i arbetsgruppen skapade känslor som påverkade patienternas vård negativt. Vår förhoppning är att fler studier kan göras, och resultaten tydliggöras för att få ökad kvalité på arbetet inom psykiatrisk omvårdnad för främst dessa patientgrupper.

No description available.

SAMMANFATTNING BAKGRUND: Suicidalt beteende och självskadebeteende kan förekomma hos personer med emotionell instabil personlighetsstörning (EIPS). Det kan finnas en negativ attityd till patienter med EIPS och liknande ohälsa hos personal som vårdar denna patientgrupp. Tidigare studier beskrev att sjuksköterskor upplevde att de hade för lite kunskap och utbildning i hur självskadebeteende ska bemötas i vården. SYFTE: Syftet med litteraturstudien var att analysera och sammanställa relevant vetenskaplig litteratur som utifrån vårdpersonalens och patientens perspektiv belyser bemötande och vård av patienter med emotionell instabil personlighetsstörning och liknande ohälsa. METOD: Systematisk litteraturstudie. Litteratursökningarna utfördes i databaserna, CHINAL, PubMed och SCOPUS. RESULTAT: Resultatet består av 21 inkluderade studier. Data genererade fyra teman vilka var vårdpersonalens attityder, vårdrelationens betydelse, behov av kunskap i vårdandet och vårdlidande. Personer med EIPS och liknande ohälsa kunde uppleva att de fick ett icke respektfullt bemötande och en negativ attityd från personalen. Vad som även kunde påverka vårdandet var ifall vårdpersonalen hade bristande kunskap, förståelse och verktyg för att behandla och vårda denna patientgrupp. Personer med EIPS och liknande ohälsa ansåg att viktiga aspekter för att lindra lidande kunde vara respekt, stöd, tillit, förståelse och omsorg. Att känna sig hörd av vårdpersonalen och delaktig i såväl sin behandling som beslutsfattande kring medicinering ansågs vara av stor betydelse. SLUTSATS: Negativa attityder och bristande kunskap hos vårdpersonal bekräftades av både vårdpersonal och patienter. Dessa aspekter kunde leda till stort vårdlidande hos patienten. Att minska lidandet hos patienten kunde göras genom att få patienten att känna sig delaktig i sin vård, känna sig hörd samt att ha ett respektfullt sätt gentemot patienten. Nyckelord: Emotionell instabil personlighetsstörning, självskadebeteende, vård / BACKGROUND: Suicidal and self-harming behaviour can present itself in people with borderline personality disorder. There can be a negative attitude towards patients with borderline and similar disorders among staff caring for these patients. Previous studies highlights that nurses feel they have too little knowledge and training in how to adress self-harming behaviour. AIM: The aim with this literature review was to analyse and compile relevant literature highlighting treatment and care of patients with borderline personality disorder and other similar disorders from the viewpoint of healthcare professionals and the patient’s perspective. METHOD: Systematic literature review. Literature search was made in the databases CHINAL, PubMed and SCOPUS. RESULTS: The result consists of 21 included studies. Data generated four themes which were attitudes of health care professionals, the importance of the nursing relationship, the need for knowledge for caring and care suffering. Patients with borderline and other similar disorders may experience that they are treated with non-respectful behaviour and a negative attitude. Another aspect that may influence the care is whether or not the nursing staff had the adequate knowledge, understanding and tools to care for these patients. Patients with borderline and other similar disorders considered respect, support, trust, understanding and care important aspects of alleviating suffering. To feel heard and to feel involved in their treatment as well as decisions regarding medication was considered of great importance. CONCLUSION: Negative attitudes and lack of adequate knowledge among health care professionals could be confirmed from both the health care professionals themselves and the patients. These aspects can result in suffering for the patient. This suffering can be alleviated by getting the patient to feel involved in their care, to feel heard as well as approaching the patient with a respectful manner.

Bakgrund: I takt med att psykisk ohälsa ökar, ökar även antal personer med självskadebeteende. Självskadebeteendet ses som ett negativt fenomen i samhället och därför upplever personer med självskadebeteende att de blir illa behandlade inom vården. Sjukvården upplever patienter med självskadebeteende som den besvärligaste patientgruppen. Sjuksköterskor önskar att föräldrar är delaktiga i barnets vård. Det kan bli en tvist när barnet själv inte vill att föräldrarna är delaktiga, vilket sjuksköterskorna upplever som svårt. Syfte: Syftet var att belysa föräldrars upplevelse att leva med ett barn med självskadandebeteende. Metod: Uppsatsen är en litteraturöversikt som involverar tio vetenskapliga artiklar. Nio kvalitativa och en av kvantitativ studie. Artiklarna är inhämtade från databaserna CINAHL, SOCINDEX och PsycInfo Resultat: Analysen av artiklarna skapade fyra huvudteman och fem underteman; Familjesituation innefattar underrubrikerna En utmaning för familjen, Känslan av utanförskap samt Föräldraskap. Delaktighet innefattar Att bli förd bakom ljuset och Att bli tagen på allvar. Behov av stöd och sedan Kunskap. Föräldrarna upplevde känslor av hjälplöshet, maktlöshet, sorg och frustration över att inte få vara delaktig samt att inte få information för att kunna hantera den svåra situationen. Föräldrarna kände att de inte fick tillräckligt med stöd från vården. Diskussion: Begriplighet innefattar brist på information. Vården måste bli bättre på att ge relevant information till föräldrar som har ett barn med självskadebeteende. Vårdpersonalen har verktyg som kan hjälpa föräldrarna att handskas med situationen. De bör bjuda in föräldrarna och samarbeta för att uppnå välbefinnande hos föräldrarna. Med hjälp av begriplighet och hanterbarhet kan föräldrarna finna hopp i den svåra situationen.