En indre smerte. Selvskadende adfærd og behandling

Student thesis: Master Thesis and HD Thesis

  • Kristina Lyager Eskesen
4. term, Psychology, Master (Master Programme)
The aim of this study is to investigate and gain a further insight into the phenomenon of self-mutilation, which seems to be a pervasive problem in society. This is a broad and complex subject and self-mutilation can be approached from many different perspectives. In this study self-mutilation is defined as: minor to moderate repetitive self-inflicted physical injury without apparent suicidal intent. Furthermore self-mutilation is socially unacceptable even within subcultures. Because the distinction between normality and pathology is socially dependent this study must be understood within a cultural context. The methods of self-mutilation seem to vary as well as the function and severity of the behaviour. Existing research on self-mutilation seems to fall into different categories. Therefore a model is proposed that includes four categories: One main category: The physiology of pain and three subcategories Mutilation as a ritual phenomenon, Self-mutilation as an unfortunate way of coping and Pathological self-mutilation. Patients belonging to the last subcategory are assumed to be in need of treatment. The main category The physiology of pain highlights the universal physiological response triggered by pain inducing stimuli to the body while the three subcategories involves different groups of mutilation ranging from social acceptable behaviour to pathological behaviour. The subcategory Mutilation as a ritual phenomenon includes socially acceptable body modifications as tattoos, body piercing etc. Moreover there seems to be a significant number of adolescents who engage in mildly harmful behaviour for a period of time to deal with overwhelming life issues. The subcategory including this group of adolescents is called Self-mutilation as an unfortunate way of coping and the individuals within this category are viewed as higher functioning individual compared to the subcategory of Pathological Self-mutilation. Pathological self-mutilation can be diagnosed according to ICD-10 and DSM-IV-TR who view self-mutilation as a symptom for severer pathology as for example borderline personality disorder. However these systems of classification seem unable to catch the complete range of the pathological self-mutilation and correlated symptoms. Therefore an alternative typology, the typology of Favazza, is sought as it offers a broader frame of understanding different forms of self-mutilation. However the distinction between the three subcategories is not straight forward do to the diversity of norms in society. In the proposed model only the subcategory of Patological self-mutilation was thought to be associated with psychological treatment. However in further exploration of the phenomenon of self-mutilation the categories Mutilation as a ritual phenomenon and Self-mutilation as an unfortunate way of coping in some instances correlate with mild clinical symptoms. Therefore the proposed model has to include the possibility that more groups are in a need of treatment than first assumed. The clinical focus on therapeutic interventions in this study is exemplified by the evidence based treatment programme dialectical behaviour therapy developed to treat chronically parasuicidal individuals who meet the criteria for borderline personality disorder. Dialectical behaviour therapy is a manual and principle based treatment with defined stages and target of behaviour. This treatment programme consists of individual treatment, training of skills in groups, telephone consultation and supervision on a weekly basis. The individual therapy provides the relationship and context in which the patient uses new skills to gain control over self-mutilation. Under normal circumstances the treatment is a one year outpatient treatment. Theoretically and technically the treatment draws on dialectical philosophy, zenbuddhistic practice, biosocial theory of pathology, behavioural and cognitive theory. In this study focus is primarily on individual treatment but it is suggested that the different groups of self-mutilation can profit from modified dialectical behaviour therapy programmes for example group therapy including only adolescents with mild self-mutilation and no other or mild co morbid pathological symptoms.
Publication date2009
Number of pages80
Publishing institutionAAU
ID: 17600520