Assessment and Treatment of Non-Suicidal Self-Injury: A Clinical Perspective

Cover
Half Title
Title
Copyright
Contents
List of illustrations
Introduction
1 What is non-suicidal self-injury?
	Direct self-injury
	Indirect self-injury
	Self-injury by proxy
	Digital self-harm
	Terminology
	Typologies of self-injury
2 Non-suicidal self-injury - an autonomous diagnosis?
	Categorizing self-injurers in non-clinical populations
	Autonomous diagnosis in DSM-5
	Differential diagnoses
3 Epidemiology and gender differences
	Prevalence in different age groups
	Onset, course and prognosis
	Gender differences
	Women cut; men hit themselves
	A literary example of a man who self-injures
4 Self-injury as a sign of the times?
	Historical descriptions of self-injury
	Skin
	Late modern society
	When perfect becomes the new normal
	Self-injury as social pathology
	Demedicalizing and normalizing self-injury
	Social media
5 Historical theories and new models for understanding non-suicidal self-injury
	Historical theories
	Emotion dysregulation and three theoretical models
	The Benefits and Barriers Model
	Vulnerability and resilience factors for the development of self-injurious behaviour
	Risk factors
	Resilience factors
6 Attachment, affect regulation and growing up in an invalidating environment
	Attachment
	Internal working models
	The Strange Situation and patterns of attachment
	Mind in mind and affect regulation
	Congruent and marked mirroring
	The alien self
	Mentalizing
	Mentalizing, mindfulness and validation
	Developing a mentalizing capacity
	Failure of mentalizing and NSSI
	Good mentalizing
	Dissociation
	Dissociation and self-injury
	The biosocial theory and the impact of an invalidating childhood environment
7 From meaning to function
	A functional model of NSSI
	Functions of NSSI
	Model of perpetuating self-injuring behaviour
8 Pathophysiology and neurobiological perspectives on self-injury
	The role of neurotransmitters in NSSI
	Adrenalin, noradrenalin and cortisol
	The low road and the high road
	Endogenous opioids
	Serotonin
	Other neurotransmitters
9 Assessment of patients with non-suicidal self-injury
	Therapeutic contact with the self-injuring patient
	Assessing patients with self-injury
	Assessment instruments
	Motivation for treatment
	Levels of treatment
	Prioritizing treatment focus
10 Treatment of non-suicidal self-injury - an overview
	Problem-Solving Therapy (PST)
	Manual-Assisted Cognitive Therapy (MACT)
	Emotion Regulation Group Therapy (ERGT)
	Mobile apps
	Family therapy
	Physical exercise
	Medical treatment
	Core elements in the psychotherapeutic treatment of NSSI
11 Dialectical Behaviour Therapy
	Dialectical dilemmas
	Treatment structure
	The five stages of DBT
	Validation
	Change strategies
	Crisis card
	Contact between patient and therapist
	Effect of DBT on NSSI
12 Mentalization-Based Therapy - keeping mind in mind
	Treatment structure
	Case formulation
	Treatment principles
	General intervention
	Intervention hierarchy
	Elements of MBT
	Effect of MBT on NSSI
13 Treating self-injury during hospitalization
	Emotional dysregulation during hospitalization
	Sedatives
	Self-injury by proxy - mechanical restraints
	The spiral of self-injury - the 'tacit dialogue'
	Reactions that may exacerbate self-injuring behaviour
	NSSI and peer influence
	Principles of a non-confrontational culture
	The practical organization of the treatment
14 When a loved one self-injures
	Walking on eggshells
	Accepting the difficult situation
	Survivor's guilt
	Neutral topics
	Talk about it
	Educate yourself online and via the literature
	Parental burnout
	Parental relations — GIVE
	Scars
References
Index