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Self-injurious behaviour and deliberate self-harm
Published in Tim Riding, Caron Swann, Bob Swann, Colin Dale, The Handbook of Forensic Learning Disabilities, 2021
This disorder is characterised by instability in interpersonal relationships, self-image and emotions, and marked impulsivity. A diagnosis of borderline personality disorder has a very strong association with self-harm. This is hardly surprising, as self-destructive behaviour is a criterion for the diagnosis of the disorder, and many of the predisposing factors for the development of borderline personality disorder are also recognised as being associated with the development of self-harming behaviour. DSM-IV21lists the diagnostic criteria, including the following:recurrent suicidal behaviour, gestures or threats, or self-mutilating behaviourimpulsivity in at least two areas that are potentially self-damaging (e.g. spending, sexual activity, substance abuse, reckless driving, binge eating).
Deaddictive Mechanisms
Published in Albert A. Kurland, S. Joseph Mulé, Psychiatric Aspects of Opiate Dependence, 2019
Albert A. Kurland, S. Joseph Mulé
A major clinical problem in managing such patients has been the necessity of coping with their self-destructive behavior. This need has given rise to the use of parole, commitment to a hospital, or participation in a therapeutic community such as Synanon.® Clinical experience has repeatedly demonstrated that sociopaths are too immature for the therapist to merely indicate that a given behavior is self-detrimental and then to stand by helpless when they do it. The therapist’s inability to prevent these behaviors is frequently misinterpreted by the sociopaths as a lack of concern. At the same time, the self-detrimental behavior, if unchecked, causes apprehension in those entrusted with their supervision, consequently resulting in restrictions on these individuals.
The Ways We Suffer
Published in Mark B. Constantian, Childhood Abuse, Body Shame, and Addictive Plastic Surgery, 2018
Additional supporting data for Miller’s clinical scenario is not hard to find and predictably disturbing. Van der Kolk, Perry, and Herman followed 74 patients over a four-year span and correlated suicide attempts and deliberate self- injury with childhood sexual and physical abuse, among which the correlation with sexual abuse was the strongest.64 The more severe the abuse history, the more likely patients were to continue self-destructive behavior even after treatment. Similarly, the more severe the trauma, the earlier cutting began and the more extensive it was; as the children grew, suicide attempts and anorexia followed milder forms of self-injury.
A borderline focused Reflective Functioning measure – Interrater reliability of the Mentalization Breakdown Interview
Published in Nordic Journal of Psychiatry, 2023
Dag Anders Ulvestad, Merete Selsbakk Johansen, Elfrida Hartveit Kvarstein, Geir Pedersen, Theresa Wilberg
In borderline personality disorder (BPD), impaired mentalizing capacity is assumed to underlie core problems such as poor affect regulation, impulse control problems, and incoherent internal representations of self and others [6,7]. The mentalizing impairments in patients with BPD are characterized by significant fluctuations, primarily in attachment contexts, sometimes evolving into major mentalizing breakdowns. Such mentalizing breakdowns can lead to severe relational problems, self-destructive behavior, violence, or substance misuse and appear as obvious targets in therapy for this condition. For instance, Mentalization-Based Therapy (MBT) is an evidence-based manualized psychodynamic psychotherapy for patients with BPD which focuses specifically on the patients’ mentalizing difficulties [7].
The Democratization of Facial Feminization Surgery and the Removal of Artificial Barriers
Published in The American Journal of Bioethics, 2018
In their article, Dubov and Fraenkel argue that “It is unjust to deny coverage of FFS as this policy decision will perpetuate harms and disadvantages faced by transgender people” (Dubov and Fraenkel 2018, XX). These harms include a higher propensity of depression, self-destructive behavior, identity threat, and even suicide, all of which can be considered to be states of ill health according to Daniels’s concept of normal functioning, as it is not statistically normal to live one’s life with such factors. Yet when FFS has been made available and accessed by those with gender dysmorphia, it is claimed that the procedure could “significantly enhance the quality of life and reduce the psychosocial sequelae faced by transgender women, who are often marginalized and discriminated against in health care and society” (Dubov and Fraenkel 2018, XX). As such, through the creation of an environment that restricts the provision of FFS, be that via a lack of insurance coverage, an absence of resources and expertise, or a social prejudice against those disadvantaged as a result of the inability to “pass” as their target gender, artificial barriers are created that unjustly isolate members of the Trans community and relegate them to experience unnecessary perpetual ill health. Yet when these barriers are removed and procedures such as FFS are made available, instances of ill health, as argued by Dubov and Fraenkel, decrease, and well-being such as being in congruence with one’s physical embodiment, a feeling that the majority of individuals have, and that arguably is a part of “normal functioning,” increases.
Patterns of Non-Suicidal Self-Injury and Their Relationship with Suicide Attempts in Youth with Borderline Personality Disorder
Published in Archives of Suicide Research, 2018
Holly E. Andrewes, Carol Hulbert, Susan M. Cotton, Jennifer Betts, Andrew M. Chanen
The association between patterns of NSSI and the aforementioned risk is yet to be investigated. There is, however, evidence of this association within research investigating alcohol consumption, an alternative form of self-destructive behavior. Research investigating different profiles of drinking found that, compared with steady drinking (low volumes of alcohol consistently and routinely consumed), binge drinking patterns (heavy alcohol consumed over a short time frame) were associated with higher rates of risk-taking behavior (Luo, Konishi, Tsuang, & Wan, 2006) as well as greater physical, legal, social, and psychological consequences (Epstein, Labouvie, McCrady, Swingle, & Wern, 2004). Given their similarities in function, steady and binge drinking might be analogous to habitual and reactive or random patterns of NSSI, respectively. Consequently, NSSI occurring within a random pattern might be associated with higher levels of risk, such as greater levels of NSSI severity and rates of suicide attempts. In support of this hypothesis, suicide attempts are enacted within a non-habitual or random pattern (Platt et al., 1992). It is therefore possible that when NSSI mimics this pattern, it might be more severe and likely to co-occur with, or precede, a suicide attempt.