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Assessment and Treatment of Non-Suicidal Self-Injury


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Table of Contents

Chapter 1. What is self-injury?

Direct self-injury

Indirect self-injury

Self-injury by proxy

Digital self-harm


Typologies of self-injury

Chapter 2. Non-suicidal self-injury - an independent diagnosis? Categorizing self-injurers in non-clinical populations Autonomous diagnosis in DSM-5 Differential diagnoses Chapter 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 Chapter 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 Chapter 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 Diversity in the presentation of self-injury Chapter 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 Good mentalizing Failure of mentalizing deficit and NSSI Dissociation Dissociation and self-injury The biosocial theory and the impact of an invalidating childhood environment Chapter 7. From meaning to function A functional model of NSSI Model for perpetuation self-injuring behaviour Functions of NSSI Chapter 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 Chapter 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 Chapter 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 Chapter 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 Chapter 12. Mentalization-based therapy - keeping mind in mind Treatment structure Case formulation Treatment principles General intervention Intervention hierarchy Elements of MBT Impact of MBT on NSSI Chapter 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 Chapter 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

About the Author

Bo Mohl is Professor of Clinical Psychology at Aalborg University in Denmark. He holds an MA in Literature and Education and an MSc in Psychology. He has published several articles and books about general psychiatry, psychotherapy, sexology and self-injury. He is trained in Group Analysis, MBT and DBT and has been treating self-injuring patients for more than 20 years. He is a member of the International Society for the Study of Self-Injury.

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