SELF-INJURIOUS BEHAVIOR (SIB) AND YOUTH

Self-Injurious Behavior and Youth

Abstract

Self-Injurious Behavior (SIB) among adolescents is a serious and prevalent problem. This article reviews the epidemiological data as well as the existing treatments for adolescents who engage in (SIB). The authors also present the unique features of dialectical behavior therapy, the gold-standard evidence-based treatment for adults who engage in (SIB) and discuss its promise as an effective treatment for adolescents who engage in (SIB). Finally, the authors present a clinical vignette of an adolescent engaging in (SIB) and how DBT works to target this maladaptive behavior. This paper reviews first the epidemiological data and then the existing treatments for adolescents engaging in non-suicidal self-injurious behavior (SIB). Next, the authors present the unique features of one particular therapy, called dialectical behavior therapy, for adolescents who engage in (SIB). Finally, the paper concludes with a clinical vignette in which dialectical behavior therapy is applied to an adolescent engaging in (SIB).

Table of Contents

ABSTRACTII

CHAPTER 1: INTRODUCTION1

Background of the study2

Aims and objectives of the study5

Hypotheses5

Purpose of the study6

Statement of the Problem6

Scope of the Study7

Definition of the term10

CHAPTER II: LITERATURE REVIEW14

WHO SELF-INJURES?14

Age of Onset14

Forms of Self-Injury15

Prevalence15

Gender16

Ethnicity16

Psychological Characteristics17

Negative emotionality17

Deficits in emotion skills17

Self-derogation18

Psychiatric Diagnosis18

Childhood Abuse20

Suicide21

WHY DO PEOPLE SELF-INJURE?21

Affect Regulation22

Self-Punishment22

Interpersonal Influence23

Antidissociation23

Antisuicide23

Sensation Seeking24

Interpersonal Boundaries24

Implications of Different Functions24

DIFFICULTIES WITH DIAGNOSTIC CLASSIFICATION25

Research methodology bias26

Comorbidity and SIB27

Gender bias in psychodiagnosis29

WHAT TREATMENTS HAVE DEMONSTRATED EFFECTIVENESS?30

Cognitive-Behavioral Therapies31

Psychodynamic Therapies32

Pharmacotherapy34

Conceptual bias across gender37

Precipitating and risk factors40

IMPLICATIONS FOR THERAPEUTIC PRACTICE40

Outcome studies42

Dialectical behavior therapy43

Problem-solving therapy44

DIFFERENTIATING SIB AND SUICIDE ATTEMPTS45

THEORETICAL CONCEPTUALIZATIONS46

Psychoanalytic perspectives on SIB46

Neo-analytic perspectives on SIB48

The object relations perspective48

The attachment perspective50

The psychosomatic perspective52

Behavioral perspectives on SIB53

Biological perspectives on SIB54

The serotonin hypothesis55

The endogenous opioid hypothesis56

CHAPTER III: METHODOLOGY58

SAMPLE58

DESIGN58

MEASURES58

Self-injurious behavior58

Types of SIB59

Reasons for SIB59

Triggers of SIB60

Blockers of SIB60

Outcomes of SIB60

PROCEDURE60

DATA ANALYSIS61

CHAPTER IV: RESULTS AND DISCUSSION62

RESULTS62

Substance use profile62

Prevalence of SIB62

Types of SIB63

Reasons for SIB64

SIB triggers64

SIB blockers65

SIB outcomes65

Relationship between SIB parameters65

Traumatic life events (TLEs)66

Alexithymia67

Alexithymia and traumatic life events68

Predictors of SIB68

DISCUSSION69

CHAPTER V: CONCLUSION74

REFERENCES77

Chapter 1: Introduction

There is an extensive literature on self-injurious behavior (SIB), scattered widely within the domains of psychiatric and mental health journals. Most clinical writings are grounded in medical-based models, placing emphasis on categorization and a tendency to view the person as a symptom of their problematic behavior. This does not accord easily with the more humanistic roots of counselling psychology and its primacy on the psychotherapeutic relationship. Counselling psychologists and psychotherapists working with clients along a continuum from outpatient settings to inpatient care are likely to come across adolescent self-harm in a multitude of forms. In order to plan and provide effective interventions, an 'integrative conceptual framework' must draw from a multitude of theories and resources available.

Therapists are in a position to 'clear a space' for additional alternative investigations. These may include theories and 'readings' of social reality, which collectively offer fresh possibilities for psychological research and practice (Neimeyer, 1998). Emphasis on and concern for clients' perceptions and their internal events, further highlight the ways in which individual experiences cannot be separated from social, cultural and historical processes, particularly those of gender biased constructs and contexts.

This paper will present a synthesis of the literature, describing ...