Psychology : Negotiated Essay

Review of Interventions for Self-Harm in the context of a diagnosis of Borderline Personality Disorder

A human being’s personality is affected by surroundings and life situations experiences (eEnvironment) and , biologically inherited traits and daily life experiences. Individual personalities may develop into long term maladaptive patterns of behavior and experiences that differ significantly from what is ‘normal’ and expected by human beings toincrease the risk of give rise to vulnerability to developing different personality disorders Wetterborg (2015). The personality disorders may be develop gradually from adolescence to adulthood and may cause distress to the individual or problems in functioning. Without proper evidence based care and treatment personality disorders may affect the way of thinking about oneself and others and emotional response that will affect how an individual will relate to other people and how one controls his or her behavior. Comment by Ibrahim, Jeyda: Could you break this into two sentences? Comment by Ibrahim, Jeyda: Subtitle- Borderline personality disorder

Borderline personality disorder (BPD) is a type of personality disorder characterized by ongoing pattern of varying mood, self-image and changing behavior. (Wetterborg, 2015)

These individuals may have mood swings, and be uncertain of their place in the world and how they see themselves, hence they may have an intense and unstable pattern relationships with other people. BPD is mostly a mental disorder and is recognized by the Statistical Manual of Mental Disorders (DMS) and is thought to affect at least one percent of the population diagnosed and three quarters are women (Daubney, 2015). This may be because of how sexes deal with criticism in different ways with males tending to cast out issues while females internalize or due to different brain functions of the sexes. Comment by Ibrahim, Jeyda: I am not sure what you mean by mostly a mental disorder? Comment by Ibrahim, Jeyda: I think this needs to be a separate sentence

These people view things in extreme cognitive biases? and may quickly change individual opinionhow they feel about people and be a result of tense relationssomeone?. There are many other symptoms relating to borderline personality disorderBPD such as unstable and distorted self-image or sense of self, having dangerous and impulsive behaviors during periods of elevated moods, self-harming behaviors and procuring thoughts of suicidal behaviors among many others. Borderline personality disorderBPD is not usually diagnosed before adolescence and symptoms may improve or even disappear with time. Full range of most symptoms appear during teenage life and early child hood because diagnosis is difficult in children and some people may not have prevalent signs and symptoms until their mid to late life. AfterIf symptoms begin and are not acted upon with treatment or therapy, the symptoms may increase in intensity and frequency and may be triggered by stressful situations to come sporadically during stretches of normal behavior. Comment by Ibrahim, Jeyda: Did you mean don’t appear? Comment by Ibrahim, Jeyda: Subtitle- Pathways in the development of BPD

No one cause has been identified as the general cause of borderline personality disorder although some theories and explanations have been generated to determine what causes and influences borderline disorder. (Schulze, 2016) Comment by Ibrahim, Jeyda: If you have abbreviated this earlier as BPD, you can use BPD throughout.

Developmental explanation shows how people with this type of disorder are often related to a childhood of sexual abuse, emotional abuse, physical abuse, regular domestic violence and cases of neglect ion hence the trauma and suffering may be a key factor of self-harming behaviors or genetic factors from the biological theory increase the likelihood of self-harming behaviors in the presence of a triggering environment. It has also been theorized that brain damage maybe a cause or a chemical dysfunction in the brains of people with borderline personality disorder and self-harm disorder for the patients to harm themselves or begin having suicidal behaviors. Self-mutilation or self-harming can be scary, confusing, and frustrating and treatment for the disorder may be helpful to people with self-mutilation characteristics during treatment which is vital with other personality disorders to create a structure and therapeutic eminent because treatment may be difficult and may take months or even years to improve the clients ability to live more independently without engaging in self-harming activities. (Daubney, 2015) Comment by Ibrahim, Jeyda: Separate out environmental and biological factors Comment by Ibrahim, Jeyda: You need references for the theories you have mentioned Comment by Ibrahim, Jeyda: You have gone into describing symptoms again, best to separate this out and subtitle self-harm or actually interventions for self harm,

Patients who engage in deliberate self-harm partake psychotherapeutic interventions that will give therapist insight to create treatment plans to the requirements of the patient and detect important ingredients for treatmenPsychological treatment can help individuals to formulate their self-harm and inform care planning areas which are triggering self-harm episodest. Cognitive Behavior therapy will works by helping the individual to change the way the patients perceives events thinks and what he or she does in everyday situationshow he or she responds. Cognitive Behavior Therapy analyzes different ways of boosting the state of mind and how to solve problems considering the physical feelings, thoughts, emotions, and action that may trigger self-harm and make it easier to do see the effect on the patient and how it can be changed with time. Cognitive behavior therapy can be done individuallydelivered by awith the therapists ranging from daily toor weekly sessions depending on the severityely of the problem or within a group a group of people that is a self-help group guided by a therapist to help reduce self-harming behavior or thoughts. Comment by Ibrahim, Jeyda: I think you need to explain how or why it does this? Comment by Ibrahim, Jeyda: Reference?

A cognitive behavior therapy is a short term intervention and very goal oriented by focusing on what causes self-harm and analyzing them to replace them with positive healthier ways of dealing with situation in their lives. The main goals focused on are usually; developing a positive problem orientation, tTraining in rational problem solving to define and formulate the basis of problem and creating alternative solutions other than self-mutilation and reducing avoidance of problem solving, and impulsive and careless decisions making. (Wetterborg, 2015)

Dialect behavior therapy is another form of treatment and regarded as effective treatment of clients with borderline personality behavior which was specifically created to treat those with the disorder. Dialect behavior therapy assumptions are based on people who self-harminjure behavior are unbearable and the individual with the disorder are doing the best they can and want to improve. The primary goal is to change problem behavior and can be achieved by focusing on changing the emotions and thoughts that precede problem behaviors as well as solving the problem of individuals that contribute to problematic thoughts, feelings and behaviors. It addresses the problem of keeping patients in therapy based on a clear and potentially testable theory of borderline personality disorder and encourages a positive and validating attitude in light of the theory. The therapy is in structured stages with each stage the patient is helped to understand his/her problem and taught necessary skills to enable him/her to deal with the problem and situations more effectively (Dobson, 2019). Comment by Ibrahim, Jeyda: Reference for efficacy studies Comment by Ibrahim, Jeyda: I am not sure this makes sense, You probably want to talk about more the theory based on cognitive, behavioural and attachment models

According to Dobson, (2019, the techniques are extensive and varied addressing especially every aspect of therapy underpinned by a dialectical philosophy that emphasize on balance, flexibly and a systematic approach to the work therapy. This will help theis hoped to help the client deal with any problem that she may have in applying them in life situations that lead to self-mutilation and thoughts of self-mutilation. This method is supported by empirical evidence which suggest that it is successful in reducing self-harm and time spent in psychiatric inpatient treatment. General advice and advice concerning self-mutilation is encouraged and helps to take responsibility for dealing with life’s problems him/herself. (Daubney, 2015) Comment by Ibrahim, Jeyda: Perhaps at the beginning of the whole treatment section you could put what is recommended by the nice guidelines for self-harm to give an overview before describing each approach individually

The course of dialect behavior therapy over time is organized into a number of stages and structured in terms of hierarchies of targets at each stage, this is because patients with borderline personality disorder or self-harm disorder may present multiple problems for the therapist in deciding what to focus on and when. The pretreatment stage focuses on assessment of the patient’s behavior and triggers that cause self-mutilation and commitment of the patient to therapy and stop self-injury. It is a stage for orientation of the patient to therapy to get to know the structures therapists, what is expected and a general introduction to dialect behavioral therapy. The first stage of dialect behavioral therapy focuses on therapy interfering behaviors and behaviors of the patients that interfere with the quality of his/her life and how to try and develop the necessary skills and method to resolve this problem. Focus may be on suicidal behavior and thoughts that will harm the patient or become fatal. Comment by Ibrahim, Jeyda: Self-harm is not a disorder Comment by Ibrahim, Jeyda: I would re word this

Coaching and training for skills to handle self-injurious behavior or life threatening thoughts help the patients stay motivated in treatment despite the tremendous difficulties they may face. The second stage of dialectical behavioral therapy focusesd on post-traumatic stress related problems that triggers borderline personality disorder and enhance self-injurious behavior in the patient. This These are stressful situations to the patients that may have activated self-injury in the past or drive self-suicidal actions o or harmful thought. (Wetterborg, 2015)

Stage three of dialectical behavior therapy focuses on the self-esteem of the patient and individual treatment goals made by the patient or the patient and the therapist together working on the motivation of the patient is an important priority to help him have the drive to keep on with therapy and try hard to achieve his/her goals. This stage have targets behaviors and must be brought into control before moving onto the next phase. This These stages are designed d to increase dialectical thinking having hierarchy targets instituted to make therapy effective and achieve goals. Some targets such as dDecreasing suicidal behavior, decreasing therapy interfering behavior, decreasing behavior that interfere with quality of life, increasing behavioral skills, improving self-esteem and decreasing behavior related to post traumatic stress help increase dialectical thinking and help the patients less prone self-injury. If in between the therapy sessions, self-ham or any other incidences have occurred, the therapist must deal with this first before moving to anything else (Bateman, 2015) Comment by Ibrahim, Jeyda: This sentence needs to be broken down

According to Schulze (2016), the dialectical behavior therapy sessions are also categorized into four, with client experiencing three categories. The individual therapy which is a live therapy with dialectical behavioral therapy therapist to help the patient work on self-damaging behaviors and make sure he or she is following skills learned to avoid stress and self-injury. Group work helps the patient work on social skill as sand teach new skills from the dialectic behavior therapy modules and the most effective ways of implementing them. A telephone support may come in desperate moments when the patients is having self-injury thoughts or urges , the patient may call the therapist or a member of the group team to discuss the urge or thoughts and how to avoid a situation of self-injury or risking ones quality of life. (Daubney, 2015)

The last part is for the therapist and hasto be a part of a consultation group to help him/her keep in track and help remain non judge mental and validating of the person’s thoughts and feelings. This would be a therapist groupgroup of therapists who have trained in dialectical behavior therapy. Dialectical behavior therapy requires the patient to become mindful of the skills and advice being advised to them to be able to optimally gain from the therapy and be able to reduce or even stop self-harming behaviors which may be achieved by engaging in open discussions group therapies or discussions with the therapist during the different stages to enable understanding of the activities being undertaken and their importance in reducing self-harming disorder and borderline personality disorder. (Schulze, 2016)

Another important skill to develop is stress perseverance and enables the patient to be able to accepting and finding meaning to be able to stand durations in the patient’s daily life with distress. By learning to deal with stressful situations and having the tolerance to bear emotional pain will help the patient become consciously aware of his or her situations and accept them the way they are to help reduce instance of self-mutilation due to circumstances that are distressful and events in the life of individuals. A vital focus in stress perseverance is radical acceptance by Lienhan which describes radical acceptance as a tool to enable an individual to free ones feelings and mental capacity from tormenting incidences and suffering and needs an individual to make a choice to stop fighting with reality. (Daubney, 2015)

This skill of letting go enhances the ability of a person to easily favor acceptance without any judgment or self-evaluation, or the circumstances in general. Emphasis on the acceptance of reality rather than reality approval which will create an understanding of the controllable versus factors that are uncontrollable and help facilitate manageability of emotional pain. Interpersonal efficiency skills that are used in dialectical behavior therapy sessions focus on making the assertiveness of the patient to grow and being able to say no , making requests and coping with problems. (Schulze, 2016)

This will improve the social connections of the patient to create better relations and allow the individual to increase their chances of achieving their goals, while maintaining self-respect and maintaining good relationships. This will help avoid distressful situations to the patient by keeping good relations and in turn reduce incidence of self-mutilation or thoughts of self-mutilation. Emotional regulation of feelings is also an important skill in dialectical behavior therapy and assists individuals to reduce their vulnerability to an emotional state of mind. To help make clear and unclouded decisions that lead an individual to self-harm behaviors and can be achieved by having techniques to recognize and label emotions ,finding emotional and mental barriers to help increase emotional perseverance and apply distress tolerance skills. (Wetterborg, 2015). Comment by Ibrahim, Jeyda: What will? Think this needs to be with previous paragraph Comment by Ibrahim, Jeyda: Needs to be restructed

This skill set is quite important to enable acceptance and find ways to increase positive emotional events through healthy living and participation in activities that increase self-confidence. Dialectical behavior therapy is an effective treatment for borderline patients however the program is quite intense and difficult and requires high perseverance and commitment to the program for patients to start seeing results . Comment by Ibrahim, Jeyda: Which skill set?

Psychodynamic or cognitive analytical therapy is another type of treatment to borderline disorder and self-harming disorder and particularly effective inwhen reducing feelings of anxiety or depression that are mostly related to self-mutilation and other types of mental disorders and focusses on repeating patterns of what? that develops fromwere gain from past childhood experiences to help cope with emotional difficulties and deprivations. Discussing how ones past experiences might be affecting how the individual feels in the present days and the therapist might be able to make connections between significant events or periods in the patient’s life one can be able to begin making positive changes to affect how one is feeling in the present day and help reduce stressful situations brought about by past experiences, occupations, acquaintances or traumatic events. (Wetterborg, 2015). Comment by Ibrahim, Jeyda: These are two different types Comment by Ibrahim, Jeyda: This sentence is very long

The chances of positive outcome increase for self-harm recovery happens by establishing a trusting relationship between the patient and clinicians at therapy, providing treatment for any existing mental issues that may be contributing to the desire of self-mutilation or suicidal thoughts as well as support and help from friends. A licensed mental health professional i.e. psychiatrist, psychologist or clinical social worker experienced in diagnosis and treatment of borderline personality disorder can assess test symptoms offor the disorder by conducting a thorough interview including a discussion about symptoms or perform a careful and thorough medical exam to self-harming patient which will help determine the extent of self-harm behavior in the individual or ask about family medical histories if any including history of mental illness ,to find out the prevalence of borderline personality disorder before finding a way to administer psychodynamic therapy to help reduce self-harm disorder. (Schulze, 2016) Comment by Ibrahim, Jeyda: This should be a separate sentence Comment by Ibrahim, Jeyda: Why just psychodynamic

Medication treatment for self-mutilation on self-harm is not frequent but patients who have self-harm disorder require medication for co-occurring disorder such as depression that follow suite. Self-injure treatment centers and programs are also available in case of need for intensive treatment and care of the patient. The treatment center may exist to specifically deal with self-harm disorder or may treat other mental issues but are a good place to have a peaceful environment and keep patient from committing suicide or hurting themselves .The treatment centers provide inpatient treatment programme where the patient stays for the whole week to help him with disorder, intensive outpatient programs to help patients come in for sessions and in desperate times to stop their urge of self-injure or suicide thoughts and group psycho therapy in different times of the week . This is to have self-injury evaluations for proper program placement education and support, medication and case management and aftercare planning of help the patients after finishing his/her program and session at the treatment center (Schulze, 2016) Comment by Ibrahim, Jeyda: Are these centres in America? Needs referencing

The treatment center has a qualified team of care givers who will be able to give therapy, monitor and administer medication when needed. This may include psychiatrist, clinical therapists, and registered nurses among others.

Mentalization base therapy is another form of treatment for patients with borderline personality disorder and may also treat self-harm behavior. This is a psychodynamic approach and helps with analyzing thoughts and try to figure out how the thoughts are different from others and harmful to the individual. This will help the individual understand the motive behind the actions of others by understanding their mental states. This process is to enable an individual with self-harm disorder be more attuned to his/her emotions, thoughts and means by trying to understand the person mental state and the person mental actions. (Wetterborg, 2015).

The therapist using Mentalization based therapy will focus more on the past and present relationship of the patient to try and help the patient decrease self-harm behavior or thoughts and can be used both during group therapy and individual treatment. This therapy may be used in conjunction with medication management to increase effectiveness. The Mentalization based therapy helps patients become emotionally better to have decreased levels of deliberate self-harm, suicide, anxiety and depression to function better socially (Bateman, 2015)

In summarytion of the document this review borderline personality behavior is one of the ten personality disorders recognized by the Diagnostic and Statistical Manual of Mental disorders (DMS) which may highly involve self-harming behavioral not well tended or treated .Borderline personality behavior develops from early teenage life to late midlife of adulthood and symptoms may increase in frequency severity and range as years are going by when left untreated. Causes can be attributed to Developmental theory that focusses on past life experiences and any abuse that might have taken place either physical like sexual abuse or mental abuse such as neglect that also has lingering emotional effects or Biological theory that explains causes are attributed to genetic traits and inherited genes that enhance self harm disorder or borderline personality disorder. Treatment options include Psychotherapy with relevant therapies to treat the disorder such as cognitive behavior therapy that focuses on here and now problems things the person with the disorder finds difficult, Cognitive Analytical Therapy that which focusses on repeating patterns from childhood experience. (Schulze, 2016) Comment by Ibrahim, Jeyda: Usually a combination of both

Dialectical Behavior therapy focuses on how to meet the needs of Borderline Personality Behavior patients with three stages and structured sessions to help reduce self-mutilation behavior. Other treatments include treatment in treatment centers, medication treatment, and Mentalization Based Therapy. Comment by Ibrahim, Jeyda: You may want to also write which has been shown to be more effective or which is in the NICE guidelines. A recent reference for this would be good.

References

Bateman, A. W. (2015). Treatment of personality disorder.The Lancet, 385(9969), 735-743.

Dobson, K. S. (2019). Handbook of cognitive-behavioral Therapies. Guilford Publications.

Daubney, M. (2015). Mentalization-based therapy (MBT): An overview. Australasian Psychiatry, 23(2), 132-135

Schulze, L. (2016). Neural correlates of disturbed emotion Processing in borderline personality disorder: a multimodal meta-analysis. Biological psychiatry, 79(2), 97-106.

Wetterborg, D., (2015). Borderline Personality disorder: prevalence and psychiatric Comorbidity among male offenders on probation in Sweden. Comprehensive psychiatry, 62, 63-70.