Doctor of Philosophy / Department of Special Education, Counseling and Student Affairs / Judith Hughey / The purpose of this phenomenological research study was to describe and to understand the experience of being in a PhotoTherapy group for adolescent females in treatment for self-injurious behaviors. The research question was as follows: (1) What was the essence of the experience of a series of PhotoTherapy group sessions for female adolescents with a history of self-injurious behaviors? After the completion of two semi-structured interviews with 5 participants, the researcher acknowledged the emergence of four themes that expressed the essence of the experience of being a part of a PhotoTherapy group process as an adolescent female in treatment for self-injurious behaviors. The themes were the following: Self, Connection with others, Emotions, Motivations in treatment. These themes developed a description of the interactions, emotions, behaviors and thoughts that occurred throughout the group work process. Self-injury is a complex issue and the literature states a need for creative interventions. The study collaborated the needs in the field of self-injury treatment with the resources available from PhotoTherapy. The study gained perspective and understanding of how the experience of being in a PhotoTherapy group impacted the individual. In mental health and education, counselors can use the data and conclusions from this research to understand the use of PhotoTherapy group work with adolescent girls that self injure. The researcher concludes that counseling professionals have an understanding of creative interventions and the personal experiences endure with the use of creative interventions such as, PhotoTherapy to have a holistic perspective on treatment practices.

Introdução: A automutilação é definida como qualquer comportamento intencional envolvendo agressão direta ao próprio corpo sem intenção consciente de suicídio. As formas mais frequentes de automutilação são cortar a própria pele, queimar-se, bater em si mesmo, morder-se e arranharse. Alguns pacientes apresentam rituais de automutilação e passam muito tempo pensando em como executá-la, lembrando sintomas compulsivos, porém com intenso componente de impulsividade. O DSM-IV classifica a automutilação como um dos critérios de diagnósticos para transtornos do controle dos impulsos não classificados em outro local ou Transtorno de Personalidade Borderline. O DSM-V propõe que a automutilação seja uma entidade diagnóstica à parte. A falta de homogeneidade na descrição da automutilação dificulta as pesquisas, tanto epidemiológicas como clínicas. A melhor caracterização clínica e psicopatológica da automutilação é fundamental para que intervenções terapêuticas mais efetivas possam ser desenvolvidas, incluindo novas abordagens psicofarmacológicas. Os objetivos deste estudo foram: fazer uma descrição clínica dos pacientes que procuram tratamento, tendo como principal queixa a automutilação e comparar estes com pacientes com Transtorno Obsessivo-Compulsivo (TOC) quanto a características compulsivas e impulsivas. Métodos: 70 pacientes foram avaliados, sendo 40 pacientes com automutilação e 30 pacientes com TOC. Todos estes pacientes foram avaliados de forma direta com os instrumentos: Entrevista Clínica Estruturada para Transtornos de Eixo I do DSM-IV, versão clínica (SCID-I); Entrevista Clínica Estruturada para Transtornos de Eixo I do DSM-IV, versão clínica, adaptada para Transtornos de Controle de Impulsos; Entrevista Clínica Estruturada para Transtornos de Eixo II, versão clínica (SCID-II); Escala de Sintomas Obsessivo-Compulsivos de Yale-Brown (Y-BOCS); Escala Dimensional para Avaliação de Presença e Gravidade de Sintomas Obsessivo-Compulsivos (DY-BOCS); Escala para Avaliação da Presença e Gravidade de Fenômenos Sensoriais da Universidade de São Paulo (USP-SPS); Questionários de História de Traumas; Escala de Comportamento de Automutilação (FASM); e Barrat Impulsivity Scale (BIS-11). Para comparação das variáveis categóricas, foi utilizado o teste qui-quadrado e para variáveis contínuas, o test-t. Para análise multivariada, foram utilizados os testes ANCOVA ou Regressão Logística Linear. Foi considerado, para todos os testes, o nível de significância 5%. Resultados: A média de idade dos pacientes avaliados foi de 29 anos. Quanto às características clínicas dos pacientes com automutilação, estes iniciaram o comportamento em média aos 17 anos de idade, e apresentavam cinco tipos diferentes de automutilação em média. Os comportamentos mais frequentes foram: cortar a pele (90%), cutucar ferimentos (75%), bater em si mesmo (67,5%). Os motivos mais frequentemente relacionados à automutilação foram para: parar sentimentos ruins (75%), aliviar sensação de vazio (70%), se castigar (70%), sentir algo, mesmo que fosse dor (47,5%) e sentir-se relaxado (40%). Na comparação entre os grupos com automutilação e TOC, quanto às comorbidades do Eixo I, o grupo com automutilação apresentou mais comorbidades com depressão (92,5%, p=0,03) e bulimia (25%, p<0,001). O grupo com TOC apresentou mais fobia social (40%, p<0,001). Os pacientes do grupo com TOC tiveram maior gravidade em todas as medidas do Y-BOCS (média: 26, p<0,001) e DY-BOCS (média 23,1, p=0,01). No grupo com automutilação, 60% dos pacientes referiram a automutilação associada a fenômenos sensoriais. Este grupo teve mais relato de fenômenos sensoriais referente à \"sensação de incompletude\" (45%, p=0,007) e \"sensação de energia interna\" (57,5%, p=0,001). O transtorno de personalidade mais prevalente em ambos os grupos foi Transtorno de Personalidade Obsessivo-Compulsiva. O grupo com automutilação apresentou maior prevalência de Transtorno de Personalidade Histriônica (22,5 %, p=0,02) e Transtorno de Personalidade Borderline (15%, p=0,04). A gravidade da impulsividade foi maior no grupo com automutilação segundo as medidas da BIS-11 para características motoras (média 26,6, p=0,002) e dificuldade para planejamento (média 31, p=0,014). Conclusão: A automutilação e o TOC são transtornos heterogêneos que compartilham características compulsivas e impulsivas. Na automutilação, o componente impulsivo é maior e no TOC, a compulsividade é maior quando comparamos estes dois grupos. Entretanto, a automutilação esteve associada à ocorrência de fenômenos sensoriais, apontando também para a presença de aspectos compulsivos nestes quadros. O Transtorno de Personalidade Borderline não é regra entre os pacientes com automutilação. Outros transtornos de personalidade, inclusive cluster C como o Transtorno de Personalidade Obsessivo-Compulsiva, também podem estar presentes entre pacientes com automutilação, assim como com TOC. Os pacientes adultos com automutilação apresentam este comportamento desde a adolescência e os tipos de automutilação apresentados por estes são de moderada a grave intensidade, além de associarem diferentes tipos de automutilação. Isto evidencia a necessidade de desenvolvimento de instrumentos diagnósticos mais precisos para identificação e tratamento precoce específico para estes quadros, evitando a cronicidade dos mesmos / Introduction: Non-suicidal self-injury (NSSI) is defined as a deliberate and voluntary physical self-injury without any conscious suicidal intent. Common forms of NSSI include cutting, burning, scratching, hitting, biting and interfering with wound healing. Some patients spend a lot of time thinking about how to perform their act doing it always the same way. They remember compulsive symptoms with intense component of impulsivity. The DSM-IV classifies NSSI as one diagnostic criteria for impulsive control disorders not elsewhere classified or as borderline personality disorder. The DSM-V proposes that the NSSI should be classified as a different disorder. The lack of a singular meaning for NSSI makes difficult the clinical and epidemiological researches about the subject. A better clinical and psychopathological definition for NSSI is crucial for the development of more effective therapeutic interventions, including new psychopharmacological treatment. The objective of this study is to describe the clinical features of patients seeking treatment for NSSI and compare their compulsive and impulsive features with patients with Obsessive Compulsive Disorder (OCD). Methods: 70 patients were interviewed, 40 patients who specifically sought treatment for NSSI and 30 patients who sought treatment for OCD. Standardized instruments were used: Structured Clinical Interview for Diagnosis of Axis I, according to DSM-IV and for impulse-control disorders, Structured Clinical Interview for Axis II Disorders (Clinical Version (SCID-II)), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS); Dimensional Yale- Brown Obsessive-Compulsive Scale (DY-BOCS), University of São Paulo Sensory Phenomena Scale (USP-SPS); Trauma History Questionnaire; Functional Assessment of Self-Mutilation (FASM) and Barratt Impulsivity Scale, version-11 (BIS -11). To compare categorical variables the chi-square test was applied. For continuous variables, t-test was applied. For multivariate analysis, the ANCOVA test or Logistic Regression were applied when required. A significance level of 5% was applied for all statistical tests. Results: The mean age of patients was 29 years. The NSSI began at 17 years old, and had 5 different types of NSSI on average. The more common behaviors were: cutting the skin (90%), pick at a wound (75%), beat himself (67.5%). The most often reasons for NSSI were to: stop bad feelings (75%), relieve feeling numb or empty (70%), punish himself (70%), feel something, even if it was pain (47.5%) and feel relaxed (40%). In the comparison between NSSI and OCD groups, the NSSI group presented more axis I comorbidities with depression (92.5%, p = 0.03) and bulimia (25%, p <0.001). The OCD group showed more social phobia (40%, p <0.001). The OCD group had higher severity in all measures of the Y-BOCS (mean: 26, p <0.001) and DY-BOCS (mean 23.1, p = 0.01). In the NSSI group, 60% of the patients reported NSSI associated with sensory phenomena. This group had more reports of sensory phenomena related to the \"incompleteness\" (45%, p = 0.007) and \"internal energy\" (57.5%, p = 0.001). The most prevalent personality disorder in both groups was Obsessive-Compulsive Personality Disorder. The NSSI group had higher prevalence of Histrionic Personality Disorder (22.5%, p = 0.02) and Borderline Personality Disorder (15%, p = 0.04). The severity of impulsivity was higher in the NSSI group according to the measures of the BIS-11 for motor impulsivity (mean 26.6, p = 0.002) and non-planning impulsivity (mean 31, p= 0.014). Conclusion: NSSI and OCD are heterogeneous disorders that share compulsive and impulsive features. In NSSI, the impulsive component is stronger and in OCD the compulsive is stronger when comparing both groups. However, NSSI was associated with the occurrence of sensory phenomena which evidence the presence of compulsive aspects. The borderline personality disorder is not a rule among patients with NSSI. Other personality disorders, including cluster C personality disorders, may also be present among patients with NSSI and OCD, as well. Adult patients with NSSI started this behavior during adolescence. The NSSI symptoms presented were moderate to severe, different types of NSSI were also involved. These results highlights the needs for development of more accurate diagnostic tools for early identification and specific treatment of the NSSI, avoiding chronicity

Young adults of college age are at particular risk for psychopathology, non-suicidal self-injury (NSSI) and consequent suicidal behavior, perhaps in a continuum of increasing severity. However, not all persons who experience psychopathological symptoms, or who self-harm, go on to engage in suicidal behavior, perhaps due to protective factors such as self-compassion that buffer this progression. We examined the mediating effect of NSSI on the relation between anxiety/depressive symptoms and suicide risk, and the moderating role of self-compassion on these linkages. Our collegiate sample (N=338) completed: Beck Depression Inventory, Beck Anxiety Inventory, Self-Harm Inventory, Suicidal Behavior Questionnaire-Revised, and the Self-Compassion Scale. Students with greater psychopathology reported more engagement in NSSI and, consequently, more suicide risk; self-compassion weakened the psychopathology-NSSI linkage. Therapeutically addressing risk factors for suicidal behavior (e.g., psychopathology, NSSI), and promoting self-compassion, may halt progression from symptomology to self-harm, thereby ultimately reducing suicide risk in college students.

No description available.

No description available.

Self-injury is a significant issue with a variety of psychological, social, legal and ethical consequences and implications (Froeschle & Moyer, 2004; McAllister, 2003; Nock & Mendes, 2008; White Kress, Drouhard, & Costin, 2006). Self-injurious behavior is commonly associated with the cutting, bruising or burning of the skin. It also can include trichotillomania, interfering with wound healing and extreme nail biting (Klonsky & Olino, 2008; Zila & Kiselica, 2001). In assessing severity, it is important to note that self-inflicted wounds typically do not require any medical attention, as those who engage in self-injury will usually care for any open wounds in order to prevent infection (Walsh, 2006). The typical duration of a self-injurious act is usually less than 30 minutes, resulting in immediate relief from the emotional turmoil precipitating the behavior (Alderman, 1997; Gratz, 2007). It is difficult to estimate the prevalence of self-injury for many reasons. Nock (2009) noted that reports indicating increased estimates in this behavior derive from “anecdotal reports and estimates from small cross-sectional studies” (p. 81). Given the many ethical and legal ramifications involved in working with clients that self-injure, it is important to understand how self-injury typically manifests itself, how it affects differing populations based on gender and cultural differences, and the level of danger it truly represents to the person choosing to utilize it.

Adults of college age are at particular risk for psychopathology, non-suicidal self-injury (NSSI), and suicidal behavior, but protective factors (e.g., self-compassion) may buffer risk. We examined the mediating effect of NSSI on the relation between anxiety/depressive symptoms and suicide risk, and the moderating role of self-compassion. Students (N = 338) with greater psychopathology reported more engagement in NSSI and, consequently, more suicide risk; self-compassion weakened the psychopathology-NSSI linkage. Therapeutically addressing psychopathology and NSSI, perhaps via Cognitive Behavioral Therapy, and promoting self-compassion via compassion-focused and mindful self-compassion therapy, may halt progression from symptomology to self-harm, ultimately reducing suicide risk in college students.

Self-injury in correctional facilities is an increasing problem. Healthcare staff are tasked with responding to and treating self-injurious inmates. Research concerning the perceptions of prison self-injury depended on the experiences of professional healthcare staff and showed that specialized training reduced anxiety and altered perceptions. The perceptions of nonprofessional healthcare staff regarding inmate self-injury have not been studied. The purpose of this research was to understand the perceptions of inmate self-injury maintained by untrained healthcare staff through evaluation of their expressed experiences with self-injuring inmates. The research was based on the humanistic nursing theory. A phenomenological approach guided interviews of 8 healthcare staff having direct contact with inmates who self-injure. Participants had a past or present employment status with a State of Georgia Department of Corrections North Region correctional facility. Data were reviewed and coded to best reflect what it means to be a nonprofessionally trained healthcare member responding to inmate self-injury. Nonprofessional healthcare staff perceived that various experiences affected their level of ease and certainty, they operated as preservers of life and active listeners, felt that other healthcare staff held negative opinions, and were very helpful and supporting. Staff perceived that challenges prevented their success in managing self-injury. Last, nonprofessional staff perceived themselves as very helpful and therapeutic. This study promotes social change by encouraging staff to share knowledge, experience, and practical help with each other while building cohesive and collaborative relationships.

<p>Syftet med arbetet var att belysa omvårdnadspersonalens upplevelser av patienter med självskadande beteende samt vården av dem. Arbetet hade en beskrivande design, 21 sjuksköterskor och skötare/undersköterskor från somatisk och psykiatrisk akutmottagning deltog i arbetet. Data samlades in via semistrukturerade intervjuer och analyserades utifrån kvalitativ innehållsanalys. Resultatet redovisas i form av tre kategorier som bildades utifrån följande koder. Kategorin ”emotionella problem” bildades utifrån koderna frustration, irritation, sympati, manipulation, vanmakt över onåbara patienter, maktlöshet, oro och beskriver omvårdnadspersonalens upplevelser av patienter med självskadande beteende. Patienter med självskadande beteende väcker mycket emotioner, både positiva och negativa. I arbetet framkom mest negativa emotioner omkring den här patientkategorin. Kategorin ”omvårdnadsproblem” framkom ur koderna hjälplöshet angående vården, tidsbrist, resursbrist, patienten vill inte ha hjälp, kroniskt beteende och beskriver upplevelsen av vården av patienter med självskadande beteende. Vården av en självskadande patient beskrivs av omvårdnadspersonalen som krävande och otillräcklig. Kategorin ”kompetensbrist” har växt fram ur koderna behov av riktlinjer och strikta ramar, förståelse för patienten, otillräcklig kunskap, negativa attityder, splittring inom arbetsgruppen och beskriver också vården av patienter med självskadande beteende. Omvårdnadspersonalen berättade att de saknar tillräcklig kunskap för att ge en optimal vård. På grund av kunskapsbrist uppstår många problem och oförståelse för patientens beteende som även påverkar vården av dem.</p> / <p>The aim of this study was to describe the experiences of psychiatric healthcare workers in regards to their meeting and treatment of patients with self-destructive behavior. This study had a descriptive design and 21 registered nurses and practical nurses participated, from both somatic and psychiatric emergency wards. Data was collected via semi-structured interviews and analyzed from a qualitative content analysis. The results are presented from the categories that were formed by fallowing codes. The category “emotional difficulties” come from the codes: frustration, irritation, sympathy, manipulation, powerlessness over uncommunicative patients, powerlessness, anxiety, and describes the healthcare workers’ experiences of these selfdestructive patients. Self-destructive patients elicit very strong emotions amongst others, both positive and negative. The predominant feeling shown in this study concerning this category of patient was negative. The category “nursing difficulties” was drawn from the codes: helplessness in regards to the care, lack of time, lack of resources, the patient not wanting help, chronic behavior, and describes the experiences of caring for self-destructive patients. Caring for self-destructive patients is described by healthcare personnel as demanding and inadequate. The category “lack of skills” has emerged from the codes: the need for guidelines and strict rules, understanding the patient, inadequate knowledge, negative attitudes, divisions in the workgroup, and describes the care of self-destructive patients. Healthcare personnel said that they lacked the necessary training needed to give optimal care. Many problems and misunderstandings of self-destructive patients’ behavior arise on account of this lack of education/information and this affects the quality of care that they receive.</p>

Syftet med arbetet var att belysa omvårdnadspersonalens upplevelser av patienter med självskadande beteende samt vården av dem. Arbetet hade en beskrivande design, 21 sjuksköterskor och skötare/undersköterskor från somatisk och psykiatrisk akutmottagning deltog i arbetet. Data samlades in via semistrukturerade intervjuer och analyserades utifrån kvalitativ innehållsanalys. Resultatet redovisas i form av tre kategorier som bildades utifrån följande koder. Kategorin ”emotionella problem” bildades utifrån koderna frustration, irritation, sympati, manipulation, vanmakt över onåbara patienter, maktlöshet, oro och beskriver omvårdnadspersonalens upplevelser av patienter med självskadande beteende. Patienter med självskadande beteende väcker mycket emotioner, både positiva och negativa. I arbetet framkom mest negativa emotioner omkring den här patientkategorin. Kategorin ”omvårdnadsproblem” framkom ur koderna hjälplöshet angående vården, tidsbrist, resursbrist, patienten vill inte ha hjälp, kroniskt beteende och beskriver upplevelsen av vården av patienter med självskadande beteende. Vården av en självskadande patient beskrivs av omvårdnadspersonalen som krävande och otillräcklig. Kategorin ”kompetensbrist” har växt fram ur koderna behov av riktlinjer och strikta ramar, förståelse för patienten, otillräcklig kunskap, negativa attityder, splittring inom arbetsgruppen och beskriver också vården av patienter med självskadande beteende. Omvårdnadspersonalen berättade att de saknar tillräcklig kunskap för att ge en optimal vård. På grund av kunskapsbrist uppstår många problem och oförståelse för patientens beteende som även påverkar vården av dem. / The aim of this study was to describe the experiences of psychiatric healthcare workers in regards to their meeting and treatment of patients with self-destructive behavior. This study had a descriptive design and 21 registered nurses and practical nurses participated, from both somatic and psychiatric emergency wards. Data was collected via semi-structured interviews and analyzed from a qualitative content analysis. The results are presented from the categories that were formed by fallowing codes. The category “emotional difficulties” come from the codes: frustration, irritation, sympathy, manipulation, powerlessness over uncommunicative patients, powerlessness, anxiety, and describes the healthcare workers’ experiences of these selfdestructive patients. Self-destructive patients elicit very strong emotions amongst others, both positive and negative. The predominant feeling shown in this study concerning this category of patient was negative. The category “nursing difficulties” was drawn from the codes: helplessness in regards to the care, lack of time, lack of resources, the patient not wanting help, chronic behavior, and describes the experiences of caring for self-destructive patients. Caring for self-destructive patients is described by healthcare personnel as demanding and inadequate. The category “lack of skills” has emerged from the codes: the need for guidelines and strict rules, understanding the patient, inadequate knowledge, negative attitudes, divisions in the workgroup, and describes the care of self-destructive patients. Healthcare personnel said that they lacked the necessary training needed to give optimal care. Many problems and misunderstandings of self-destructive patients’ behavior arise on account of this lack of education/information and this affects the quality of care that they receive.