Psychiatry - November 2008 - (Page 25)

CASE EXAMPLE, CONTINUED Several months later, Tina reflected about the changes she had made. Being a teenager was challenging, and when she experienced emotional pain, she still considered doing something physical to make it stop. But Tina had learned other things that helped, and she no longer felt like she had to act on her impulses. She knew that cutting might stop the feeling for awhile, but it would not solve her problems. She could talk to herself, to her family, and to her friends more than she could before. Tina felt like she was on the right path for her. 3. 4. 5 CONCLUSION Self harm among adolescents is common and the rate may be increasing. While many adolescents with NSSI may not have severe psychopathology, teenagers presenting with self-harming behaviors should have a thorough psychiatric assessment that includes screening for suicidal ideation and risk factors. Family and other interpersonal supports are important in formulating and implementing treatment recommendations. Pharmacological treatment should focus on treating underlying psychiatric disorders. Psychotherapeutic treatment should be recommended to assist the adolescent in understanding NSSI and utilizing more adaptive coping strategies. Adolescents with more severe and chronic symptoms should be referred to a DBT program when available. 6. 7. 8. 9. 10. REFERENCES 1. Yates TM, Tracy AJ, Luthar SS. Nonsuicidal self-injury among “privileged” youths: longitudinal and cross-sectional approaches to developmental process. J Consult Clin Psychol. 2008;76(1):52–62. Lloyd-Richardson EE, Perrine N, Dierker L, Kelley ML. Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychol Med. 2007 11. 2. 12. 13. Aug;37(8):1183–1192. Epub 2007 Mar 12. Jacobson CM, Gould M. The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: A critical review of the literature. Arch Suicide Res. 2007;11(2):129–147. Muehlenkamp JJ, Gutierrez PM. An investigation of differences between self-injurious behavior and suicide attempts in a sample of adolescents. Suicide LifeThreatening Behav. 2004;34(1):12–23. Whitlock J, Eckenrode J, Silverman D. Self-injurous behaviors in a college population. Pediatrics. 2006;117(6):1939–1948. Rodham K, Hawton K, Evans E. Reasons for deliberate self-harm: Comparison of self-poisoners and self-cutters in a community sample of adolescents. J Am Acad Child Adolesc Psychiatry. 2004;43(1):80–87. Nock MK, Prinstein MJ. Contextual features and behavioral functions of self-mutilation among adolescents. J Abnorm Psychol. 2005; 114(1):140–146. Nixon MK, Cloutier PF, Aggarwal S. Affect regulation and addictive aspects of repetitive self-injury in hospitalized adolescents. J Am Acad Child Adolesc Psychiatry. 2002; 41:1333–1341. Kumar G, Pepe D, Steer RA. Adolescent psychiatric inpatients’ self-reported reasons for cutting themselves. J Nerv Ment Dis. 2004;192(12):830–836. Laye-Gindhu A, Schonert-Reichl KA. Nonsuicidal self-harm among community adolescents: understanding the “whats” and “whys” of self-harm. J Youth Adolesc. 2005;34(5):447-457. Favazza AR. Self-injurious behavior in college students. Pediatrics. 2006;117(6):2283–2284. Kahng SW, Iwata BA, Lewin AB. Behavioral treatment of self-injury, 1964 to 2000. Am J Ment Retard. 2002;107(3):212–221. Paul T, Shroeter K, Dahme B, Nutzinger DO. Self-injurious 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. behavior in women with eating disorders. Am J Psychiatry. 2002; 159:408–411. Bjärehed J, Lundh LG. Deliberate self-harm in 14-year-old adolescents: how frequent is it, and how is it associated with psychopathology, relationship variables, and styles of emotional regulation? Cognit Behav Ther. 2008;37(1):26–37. Paris J. Understanding selfmutilation in borderline personality disorder. Harv Rev Psychiatry. 2005;13(3):179–185. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Press, Inc., 2000. Nock MK, Joiner TE, Gordon KH, et al. Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts. Psychiatry Res. 2006;144:65–72. Gollust SE, Eisenberg D, Golberstein E. Prevalence and correlates of self-injury among university students. J Am Coll Health. 2008;56(5):491–498. Linehan MM. Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford, 1993. Gratz KL. Risk factors for and functions of deliberate self-harm: an empirical and conceptual review. Clin Psychol Sci Prac. 2003;10(2):192–205. Evans E, Hawton K, Rodham K. In what ways are adolescents who engage in self-harm or experience thoughts of self-harm different in terms of help-seeking, communication and coping strategies? J Adolesc. 2005;28:573–587. Hawton K, Rodham K, Evans E, Weatherall R. Deliberate self harm in adolescents: self report survey in schools in England. BMJ. 2002;325:1207–1211. Young R, Sweeting H, West P. Prevalence of deliberate self harm and attempted suicide within contemporary Goth youth [NOVEMBER] Psychiatry 2008 25

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Psychiatry - November 2008 Editor's Message Editorial Advisory Board Contents PsychRx Letters to the Editor Measuring Adverse Events in Psychiatry Nonsuicidal Self Injury in Adolescents Relative Tolerability of Alzheimer's Disease Treatments Biracial Identity Development and Recommendations in Therapy Depression and Cardiovascular Disease: Just an Urban Legend? Three Risk Management Basics Journal Watch Classified Advertising Information for Authors

Psychiatry - November 2008

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