The emotions associated with initiating, maintaining, and reinforcing hairpulling disorder (trichotillomania) were studied. Studies conducted have only looked at small community or inpatient samples, and little is known about the interplay of hairpulling subtypes and emotions. For this study, 427 participants completed an online questionnaire around their hairpulling subtype, severity, emotions experienced by hairpulling, and comorbid anxiety and depression. Using the Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version (MIST-A; Flessner, Woods, Franklin, Cashin, & Keuthen, 2008), this is the first study to address the regulation of emotions across subtypes. Participants were divided as either high- or low-focused and either high- or low automatic. Significant differences between hairpulling subtypes and hairpulling severity were reported. Subtypes differed in the severity they experienced emotions; individuals with high-focused pulling reported more intense negative emotions, and a greater number of emotions regulated by pulling. Positive emotions⎯happiness, relief, and calm⎯were also found to play a significant role in reinforcing hairpulling. For high-focused subtypes, negative emotions before- and after-pulling were associated with greater severity, indicating that altering negative emotions via pulling plays an important role for high-focused subtypes. High-focused subtypes also reported higher stress, depression and anxiety than either automatic subtypes or the general population, and were found to have anxiety and depression significantly associated with hairpulling severity and experiencing negative emotions that initiated hairpulling. Clinical and treatment implications, study limitations, and areas of future research are discussed / xviii, 227 leaves ; 29 cm

Bakgrund: Patienter som vårdas på grund av självskadebeteende inom slutenvården har ökat sedan 1990- talet. Det första mötet dessa patienter har med sjukvården är ofta på akutmottagningar, som främst är utformade för att effektivt vårda patienter som är fysiskt sjuka. Patienter som med självskadebeteende har ofta svårt att kommunicera sina känslor till andra. Samtidigt som de upplever att de bemöts negativt av sjuksköterskor i vården. Attityder hos sjuksköterskor påverkar omvårdnaden genom hur de tänker, känner och handlar gentemot patienten. Syfte: Syftet med detta examensarbete är att beskriva akutsjuksköterskors attityder gentemot patienter med ett självskadebeteende. Metod: En allmän litteraturöversikt baserad på 9 vetenskapliga studier varav 6 var kvantitativa och 3 kvalitativa. Studierna valdes ut genom kritisk granskning och utifrån urvalskriterier. De översattes från engelska till svenska och analyserades utifrån attitydbegreppets tre komponter; tankar, känslor och handlingar. Resultat: Resultatet presenterar utifrån följande teman och rubriker: Tankar: sjuksköterskors tankar om självskadebeteende, uppfattningar om att vårda patienter med självskadebeteende, brist på kunskap och kompetens i omvårdnaden av patienter som skadar sig själva. Känslor: starka känslor framkallas i vårdandet av patienter som skadar sig själva, faktorer som påverkar känslorna gentemot patienter med självskadebeteende. Handlingar: patienter med självskadebeteende bortprioriteras på akutmottagningen, brister riktlinjer och bedömningar i vården av patienter med självskadebeteende. Diskussion: Hur tankar, känslor och handlingar hör samman diskuteras utifrån Orlandos interaktionsteori. Att utbildning påverkar attityderna positivt diskuteras, samt en problematisering kring det medicinska fokus som finns på akutmottagningen. Vidare diskuteras praktiska implikationer och vidare forskning. / Background: The numbers of patients that are treated for self-harm in inpatient care have increased since 1990's. The first meeting these patients have with healthcare often take place in the emergency department, which is primarily designed to efficiently care for patients who are physically ill. Patients who engage in self-harm have often difficulties communicating their feelings to others. These patients experience that they are negatively treated by nurses in health care. The attitude of nurses is affecting care by the way they think, feel and act towards the patient Aim: The aim of this literature review is to describe emergency nurses' attitude towards patients with self-injurious behavior. Methods: A general literature review based on 9 scientific studies, of which 6 were quantitative and 3 qualitative studies. The studies were selected through critical review and selection criteria. They were translated from English to Swedish and analyzed by the three components of the attitude concept; thoughts, feelings and actions. Results: The results is presented on the following themes and headlines: Thoughts: nurses thoughts about self-injurious behavior, views of caring for patients with self-injurious behavior, lack of knowledge and skills in the care of patients who harm themselves. Emotions: strong feelings are evoked in the care of patients who harm themselves, factors that affect the feelings towards patients with self-injurious behavior. Actions: Patients who engage in self-harm are deprioritized in the emergency department, deficits in assessment and guidelines regarding the care of patients with self-injurious behavior. Discussion: How thoughts, feelings and actions are associated is discussed based on Orlando's interaction theory. That education affects attitudes positively is discussed as well the problematisation of the medical focus that exists in the emergency department. Furthermore, we discuss practical implications and further research.

[Truncated abstract]The overall aim of the research reported in this thesis was to develop and validate an instrument that would identify children among the general population at risk of self-harm. To achieve this, four separate yet interrelated studies were conducted. Study One, which sought to explore the risk factors of self-harm in children comprised a series of focus interviews with three paediatricians and 24 mothers of children who had self-harmed or who had verbalized self-harm ideation. The findings revealed that prior to the onset of self-harming or self-harm ideation these children reportedly manifested other problem behaviours that prompted their mothers to seek specialist advice from a paediatrician. The majority of these problem behaviours were characteristic of externalizing problems, either in the form of conduct problems, aggressive behaviours or impulsiveness. Conversely, some problem behaviours were characteristic of internalizing problems such as anxiety and depression. These findings provided valuable information which in addition to the current literature created the conceptual framework for the subsequent studies. Study Two incorporated the information obtained from Study One, along with that obtained from a review of existing instruments that measure self-harm or suicide, to develop a new instrument specifically designed to assess the risk of children in the general population developing self-harming behaviours. Initially, 159 items were generated and using the extant knowledge regarding the risk factors of self-harm as a guide, the items were categorized into risk factors of anxiety, depression, low self- ii worth, social difficulty, social withdrawal, helplessness, hopelessness, atypical cognition, emotional lability, impulsivity, self-harming ideation and self-harm. ... Study Four comprised four interrelated investigations, the purposes of which were to (i) examine the prevalence rates of self-harming ideation and self-harm among young school aged children in the general population; (ii) investigate differences of risk of self-harm between the referred group and community comparison group; (iii) examine the relationship between impulsivity and risk of self-harm in these children and, (iv) examine the relationship between executive function and risk of self-harm among these children. The results from these investigations revealed that approximately 3.5% of children aged between 6 to12 years in the general population manifest self-harming ideations and approximately 2.5% actually self-harm. No significant age or gender differences were found. Children that presented with a higher level of risk of self-harm also presented with a complex array of internalizing and externalizing problem behaviours. Furthermore, children who displayed significantly higher levels of hyperactive-impulsive symptomatology scored higher on the SHRAC instrument, as did the children who had higher levels of executive functioning impairment. The findings are discussed and interpreted in line with the current research literature and are used to make suggestions for future research.

Thesis (Ph.D.)--University of Western Australia, 2007.

Thesis (M.S.)--State University of New York at Binghamton, Department of Psychology, 2009. / Includes bibliographical references.

Thesis (M.N. (Clinical))--Victoria University of Wellington, 2009. / Includes bibliographical references.

Självskadebeteenden beskrivs i forskning som komplexa och svåra att förstå, bemöta och behandla. Ett flertal studier påpekar bristen på kunskap inom området samt information om och vägledning i hur man bör bemöta dessa beteenden. Ett flertal studier belyser självskadande individers negativa erfarenheter av omsorgspersonalens bemötande. Syftet med nuvarande studien är att få en djupare förståelse för hur omsorgspersonal bemöter de individer som har ett självskadebeteende. Fokus ligger på hur personalen upplever att de agerar direkt när självskadan sker. Även hur personalen påverkas av att arbeta med självskadande individer undersöks. Studien är kvalitativ med en fenomenologisk metodansats. Fyra kvinnliga anställda inom omsorgen har intervjuats. I analysen som hade en fenomenlogisk utgångspunkt framträdde sex teman: förhållningssätt, visar omsorgspersonalens olika bemötande till individers självskadebeteenden. Förhållningssättet varierar utifrån situationerna som uppstår samt självskadans allvarlighetsgrad står för denna variation. Strategi, visar hur personalen arbetar med olika strategier i olika skeden vid självskador. Som kan bestå av sysselsättning, omplåstring och genom samtal beroende på individernas aktuella situation. Svårigheter - de komplexa situationerna, beskriver omsorgspersonalens upplevelse av att det är svårt att bemöta självskadebeteenden. Skapa förtroende, framhöll vikten av att det fanns en bra kommunikation. Självskadebeteende väcker känslor, beskrev personalens känslor av rädsla, osäkerhet, oro och frustration som uppstår i mötet med individernas självskador. Slutligen visar behovet av att öka kunskaperna om personalens sätt att bemöta självskadebeteenden är ett lämpligt agerande. / In research, self-injuring is described as complex, hard to understand and treat. Several studies are pointing to the lack of knowledge within the area, and also to information and guidance on how to deal with these behaviors. There are a handful of studies, which sheds light on individuals who have felt that care providers have treated them with negative attitudes. The purpose of the present study is to get a deeper understanding of how care providers approach individuals who self-injure. The main focus lies on how care providers experience how they themselves act when self-injuring occurs. It is also explored how care providers are affected while working with people who self-injuries. The study is qualitative with a phenomenological method. Four female care providers have been interviewed. In the analysis that had a phenomenological outset, six themes came forth: approach, shows the care provider´s different approaches to individuals who self-injures. The approach varies depending on the situations that arises, and also the severity of the self-injuring. Strategy, which illuminates how care providers works with different strategies in different stages of self-injuring, which can consist of activities, care and through conversation depending on the individual´s current situation. Hardships - the complex situation, which made clear that care providers experience hardships while treating people who self-injures. Creating trust, sheds light on the importance of a good communication. Self-injuring has an emotional impact, describes the care provider´s feelings of fear, insecurity, worry and frustration which arises while treating individuals who self-harm. Lastly the theme of the need for increased knowledge discusses if the care provider´s experiences their own way of treating people whom self-harm as appropriate behavior.

No description available.

Bakgrund: Självskadebeteende är inte en sjukdom utan ett beteende som innefattar repetitivt självskada. Självskadebeteende är ett växande folkhälsoproblem i vårt samhälle som oftast förekommer bland personer med psykisk ohälsa. Det är av stor betydelse att lyfta de upplevelser personer med självskadebeteende har vid vårdsökande, för att möjliggöra personcentrerad stöd och behandling för denna patientgrupp. Som sjuksköterska är det viktigt att ha ett etiskt förhållningssätt samt en helhetssyn som inkluderar personens psykiska mående relaterat till självskadebeteendet och inte enbart behandla den fysiska skadan. Syfte: Syftet var att beskriva hur personer med självskadebeteende upplevde vårdkontakten inom somatisk samt psykiatrisk öppen-och slutenvård efter självskada.  Metod: Studiens forskningsmetod var en litteraturöversikt. I de akademiska databaserna PubMed, CINAHL Complete och Psychology and Behavioral Sciences Collection utfördes artikelsökningar. Tolv kvalitativa artiklar hittades samt användes till resultatet. Resultatet delades in i tre huvudteman med fyra tillhörande underteman. Resultat: Resultatets teman bestod av tre huvudteman: “Vårdrelationen”, “Vägledning och stöd” och “Nödvändiga förbättringar”. Resultatet visade att de flesta personer med självskadebeteende hade en negativ upplevelse av sjukvårdspersonalens bemötande samt känslan av att vården var begränsad. Detta gav en negativ självkänsla samt påverkade förtroendet till vården. Slutsats: Personer med självskadebeteende upplevde ofta stigmatisering, försummelse samt brist på empati och medmänsklighet av sjukvårdspersonalen. När upplevelsen av vården var negativ och dömande upplevde personer med självskadebeteende skam och skuld vilket hindrade de att uppsöka vård. Ett bemötande från sjukvårdspersonalen som upplevdes empatiskt och omsorgsfullt stärkte personen samt förbättrade livskvalitén. Sjuksköterskan bör skapa en stödjande vårdmiljö fri från stigmatisering kring personer med självskadebeteende. / Background: Self-injurious behavior is not an illness but a behavior that include repetitive self-injury. Self-injurious behavior is a growing public health problem in our society that usually take place among people with mental illness. It is very important to raise the experience from people with self-injurious behavior, when they are seeking for healthcare, to make it possible to ensure patient focused care, support and treatment for them. It is important to have an ethical and holistic view as a nurse and to include the person´s mental health and not only the physical self-injury.     Aim: The aim was to describe how people with self-injurious behavior experiences the contact in somatic and psychiatric outpatient and inpatient care after self-injury.   Method: The research method of the study was a literature review. The article searching was made in academic databases, PubMed, CINAHL Complete and Psychology and Behavioral Sciences Collection. For the result, there were twelve qualitative articles found and used. From the result three main themes with four sub themes were created. Results: The results include three main themes “Relationships of care”, “Guiding and support” and “Necessary improvement”. The results showed that the most people with self-injurious behavior had a negative experience of health care staff's approach and the feeling that the care was limited. This led to negative self-esteem and affected the trust for the care.            Conclusion: People with self-injurious behavior experiences stigma, neglect and lack of empathy and compassion of healthcare staff. When the experiences of care was negative and judgmental, people with self-injurious behavior felt shame and guilt, which prevented them from seeking care. A treatment characterized by empathy and carefulness improved quality of life and strengthened the person. The nurse should create a supportive environment for people with self- injurious behavior, without stigma.

Of the several techniques reported for the treatment of self-injurious behavior, response-contingent aversive stimu-lation and overcorrection seem to be the most successful. However, many procedures are precluded from use by legal or other restrictions. Thus, many procedures that are both ethnically and aesthetically tolerable to practitioners and the public must be developed. Facial screening (Lutkzer & Spencer, Note 1; Zegiob, Becker & Bristow, Note 2; Lutzker, Note 3), applying a terrycloth bib to cover the face contingent upon self-injurious behavior, has been shown to be effective. The purpose of this study was to investigate the parameters of facial screening with two subjects. Specifically investigated were: a) the role of non-contingent v~. contingent facial screening in therapy and extra-therapy setting; and b) the role of opaque vs. translucent bibs. In the first study, using a multiple baseline design, it was found that non-contingent facial screening was effective only after a history of pairing with contingent facial screening. While non-contingent facial screening reduced self-injurious behavior in two settings, it did not eliminate self-injurious behavior in all three settings in which it was observed. In the second study a reversal design-component analysis was used to compare a translucent to an opaque bib. The translucent bib was ineffective in reducing the self-injurious behavior while the opaque bib eliminated self-injurious behavior as long as facial screening was applied consistently.