Therapeutic Intervention Essay

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Self-harming Behavior and Young People

PART A

Young people engaging in self-harming behaviors is referred to as non-suicidal self-injury: this is deliberate, concerted harm to the physical body, without the desire to commit suicide (Klonsky, 2010). Young people often engage in these behaviors through the cutting of the top layer of the skin, hitting, or cutting. Many professionals within the field of mental health find this behaviour very distressing, as there’s such a clear connection to suicide. “Some argue that self-injury should constitute its own diagnostic syndrome in light of the behavior’s clinical significance and presence across multiple disorders” (Klonsky, 2010). Though it is worth noting that self-harming behaviors does manifest with a range of conditions, from eating disorders, to personality disorders, to drug addiction and anxiety issues (Klonsky, 2010). Self-harm is also referred to as “non-suicidal self-injurious behaviour” (NSSI) and the Center for Disease Control cites that suicide is the third main leading cause of death (Klonsky, 2010). According to the CDC’s research, “…19% engage in NSSI, 13% seriously consider suicide, and 6% attempt suicide” (Klonsky, 2010). Determining the exact rates of self-harm can be tricky as they can widely vary, due to the way in which researchers frame their questions. Based on general estimations, those between 2% and 6% of people will engage in self-harming behavior at some junction during their lifetime (ptsd.va.gov).

However, among young people the rates definitely exceed this, hitting the 13% to 35% range (ptsd.va.gov). People who have long-standing mental and emotional health problems and suffer from PTSD are more likely to engage in self-harming behaviors (ptsd.va.gov). It is unclear to the mental health community if these actions are more common in females or males. Some researchers have suggested that the behavior more commonly manifests in adolescent girls; for example in a study with 1802 participants “…with 149 (8%) reporting self-harm, More girls (95/947 [10%]) than boys (54/855 [6%]) reported self-harm (risk ratio 1·6, 95% CI 1·2–2·2)” (Moran et al., 2012). This same study reported a reduction in self-harming behaviors in later adolescence, but that there remained a stronger continuity in girls than in boys (Moran et al., 2012). While this research should be taken into consideration, further studies are needed before one can conclude that this behavior is more prevalent in girls. Self-harming behaviors of young people are deeply concerning, and are an aggravated enough problem that there needs to be a better understanding of the problem and more strategic interventions to address it when it does begin to manifest.

There is an element to this behavior that is puzzling to mental health professionals. Such as why certain depressed, anxious people engage in this behavior when others do not. Still most professionals consider this behavior a disturbing gateway to suicide (Whitlock et al., 2013). However, the research has demonstrated that those who engage in self-harming actions have negative feelings and thoughts more often and at a higher number than the average depressed person (ptsd.va.gov) (Portzky et al., 2008).

One of the risk factors in this behavior is childhood abuse, namely childhood sexual abuse. Another research study found that when women reported incidents of childhood sexual abuse it usually occurred in conjunction with other forms of abuse such as long periods of time left alone, emotional abuse and physical abuse (Gladstone et al., 2004). However, women who experienced childhood sexual abuse were ones who either had tried to kill themselves or occupied themselves with intentional self-harm (Gladstone et al., 2004). Hence, mental health professionals need to be very diligent about identifying childhood sexual abuse in their patients. “Depressed women with a childhood sexual abuse history constitute a subgroup of patients who may require tailored interventions to combat both depression recurrence and harmful and self-defeating coping strategies” (Gladstone et al., 2004).

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Furthermore, it is important that a therapist properly understand that aside from the abuse, this behavior is caused by a desire to cope. Self-harm is a coping mechanism, one that allows the victim to feel a sense of release, such as a release of tension, and for the victim to feel as is abuse is happening but they are controlling it. It allows them to reframe the abuse they suffered in a way that they are in charge of the abuse suffered.

For mental health professionals, early intervention is crucial, particularly when working with clients who exhibit particular signs such as: “sexually permissive attitudes, sexual preoccupation, persisting pathological dissociation, and PTSD” (Noll et al., 2003). Therapists and mental health experts can conclude that childhood sexual abuse is something that can create devastating, lasting damage. The correlation between sexual abuse and self-harm is high enough that if a client engages in self-harming behaviors, a therapist must definitely find out what types of abuse occurred in childhood, as there were likely to have been some.

When a person engages in self-harm, they are likely to describe a range of feelings, thoughts, moods, and overall intentions. This wide spectrum of change means that it can be more challenging for mental health professionals to address or intervene in the reasons that people seek out self-harming actions. For some patients, self-harm is a distraction. For other patients, it’s a form of punishment. For others, it offers them a sense of release and a minimization of tension and anxiety. And still others it gives them a sense of safety and of feeling protected. A person who engages in self-harm might feel more relaxed, whereas a different person might feel a greater sense of shame. Some patients might feel more at peace and contemplative after engaging in this behavior. Yet other people might feel more agitated and talkative. The onus is on the mental health care community to seek out deeper understanding on the changes in behavior, cognition, mood and physical functioning and communication that occurs before and after people engage in this behavior.

PART B

While pharmacological approaches are popular and prevalent (Ougrin et al., 2015), the non-pharmacological approach that I would suggest to help people in the relevant population would be twofold. The first would be to address the compulsive urge to feel pain. Having the patient wear a rubber band around the wrist can assist with this, and when the patient has an urge to cut, burn or hit him or herself, they can snap the bracelet against their wrist (Young, 2010). Alternatives to the rubber band that can sometimes be effective are rubbing an ice cube on the skin, or taking a cold shower. The first prong of this therapeutic approach is designed to distract the mind and the nervous system for that insatiable need to feel pain. Feeling a small amount of physical discomfort can often be adequate to satiate the body from more intense outlets of self-harm. Psychotherapy should be used to deal with the issues that are motivating this behaviour and the feelings attached to them. This type of therapy should be tailored to meet the specific needs of the individual. However, when the patient is in the throes of a bad day or a bad moment where feelings have become unmanageable and the urge to engage in self-injury is strong, a rubber band isn’t….....

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