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

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

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

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

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

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

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.