E-Book, Englisch, 98 Seiten
Klonsky / Muehlenkamp / Lewis Nonsuicidal Self-Injury
1. Auflage 2012
ISBN: 978-1-61334-337-1
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark
E-Book, Englisch, 98 Seiten
Reihe: Advances in Psychotherapy - Evidence-Based Practice
ISBN: 978-1-61334-337-1
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark
Practical and expert guidance on how to identify and treat nonsuicidal self-injury - an often misunderstood, but increasingly frequent phenomenon
Nonsuicidal self-injury (NSSI) is a baffling, troubling, and hard to treat phenomenon that has increased markedly in recent years. Key issues in diagnosing and treating NSSI adequately include differentiating it from attempted suicide and other mental disorders, as well as understanding the motivations for self-injury and the context in which it occurs.
This accessible and practical book provides therapists and students with a clear understanding of these key issues, as well as of suitable assessment techniques. It then goes on to delineate research-informed treatment approaches for NSSI, with an emphasis on functional assessment, emotion regulation, and problem solving, including motivational interviewing, interpersonal skills, CBT, DBT, behavioral management strategies, delay behaviors, exercise, family therapy, risk management, and medication, as well as how to successfully combine methods.
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2 Theories and Models of the Disorder (p. 29-30)
Perhaps because NSSI has only received significant research attention during the past 10 years, the field lacks an authoritative model regarding the etiology, course, and cessation of NSSI. However, we have learned a lot about the behavior in recent years, and much can be said about the variables that play central roles in NSSI. These perspectives can be divided into three types – psychological, social, and biological – and are described below.
2.1 Psychological
Psychological models of NSSI focus on the psychological variables that dispose individuals to try NSSI and continue the behavior over time. Emotion dysregulation and self-derogation appear to play particularly prominent roles in NSSI.
2.1.1 Emotion Dysregulation
It is useful to view NSSI as a disorder of emotion dysregulation. Several studies suggest that self-injurers experience more frequent and intense negative emotions than noninjurers. Self-injurers score higher on measures of negative temperament (Klonsky et al., 2003) and depression and anxiety (Andover et al., 2005), and have difficulties with emotion regulation (Gratz & Roemer, 2004). People who must constantly struggle with overwhelming negative emotions are likely to try many ways to cope, including methods that other people might not think to try. Substantial evidence suggests that NSSI is most often performed to cope with overwhelming negative emotions (Klonsky, 2007). Intense emotions such as anxiety, frustration, and anger often precede NSSI, and self-injurers report quick decreases in the intensity of these emotions as a result of engaging in NSSI (Klonsky, 2009; Lewis & Santor, 2008). Conversely, people report that engaging in NSSI increases feelings such as calm and relaxation. Moreover, those who report the greatest reductions in negative emotions are also the ones who engage in NSSI most frequently (Klonsky, 2009). In sum, NSSI is performed by people who experience frequent negative emotions as a way to quickly alleviate these emotions. From this perspective, it is useful to view NSSI as a disorder of emotion regulation. It is worth noting that recent research has helped clarify the types of negative emotions most likely to prompt and reinforce NSSI. Broadly speaking, emotion can be understood in terms of two dimensions: (1) valence (unpleasant versus pleasant), and (2) arousal (higher versus lower). Klonsky (2009) found that high-arousal negative emotions such as anxiety, anger, and frustration were more likely to prompt NSSI, and more likely to be reduced after NSSI, as compared with low-arousal negative emotions such as sadness, loneliness, or hopelessness. Therefore, NSSI might be best viewed as a means of reducing high-arousal negative emotions, and replacing them with low-arousal positive emotions such as calm and relief.
2.1.2 Self-Derogation
Self-derogation is another key feature in NSSI. Like emotion dysregulation, self-derogation is reflected in both the personality traits of those who self-injure and the functions of NSSI. Regarding personality characteristics, compared with noninjurers, individuals who self-injure consistently report higher levels of self-derogation and related variables such as self-criticism and low self-esteem (Glassman et al., 2007; Klonsky et al., 2003; Lundh et al., 2007; Soloff et al., 1994). Regarding functions, a majority of individuals who self-injure endorse reasons such as “to punish myself” or “to express anger at myself” (Klonsky, 2007). Therefore, self-derogation helps explain both who self-injures and why.
Self-derogation might also help to explain why some people choose NSSI as a means to cope with negative emotions, but others do not. As indicated in Section 2.1.1, those who self-injure experience frequent and intense negative emotions, and use NSSI to cope with these negative emotions. Yet, there are many adaptive (e.g., talk to a friend) and maladaptive (e.g., aggressive outbursts) ways to cope with negative emotions, and many who struggle with negative emotions do not turn to NSSI. Self-derogation may be the variable that leads some but not others to NSSI. Those who experience high negative emotionality but normative or low self-derogation may be more likely to blame or be aggressive against others when feeling upset. In contrast, NSSI may be a comfortable fit for those who blame themselves when feeling upset, and an even better fit for those with strong desires to harm themselves when feeling upset. Therefore, some have suggested that the combination of emotion dysregulation and self-derogation might represent the highest risk for the development of persistent NSSI (Klonsky & Muehlenkamp, 2007).
