' A cognitive behavioral therapist might ask, what will harming yourself do to improve your grades on the test? Cognitive therapies in general have been shown to be more effective than traditional supportive talk therapies when treating anxiety conditions because they offer concrete steps for self-improvement on a continuing basis (Reeves 2003, p1.). Patients are also asked to identify things they would like to do in which current behavior patterns prevent them from engaging, such as wearing short-sleeved shirts.
Cognitive and cognitive-behavioral therapy shows a higher success rate in anxiety disorders and OCD than traditional psychotherapy, likely because of its behavioral component. The fact that many DSH patients are diagnosed with BPD may complicate treatment, but BPT responds well in some instances to these therapies, too. BPT patients manifest disordered patterns of relationships, thinking, behavior, and coping mechanisms that contribute to unstable life patterns as well as contribute to the kind negative, anxious, depressed, and compulsive thoughts that lead to self-mutilation. It should be noted that BPT patients have often suffered childhood abuse. Abuse "is reported by 40-71% of inpatients with BPD, and the severity of sexual abuse suffered in childhood has been linked to the severity of the borderline pathology found in adulthood" (Bland et al. 2007, p1). An emphasis present rather than past behavior is not to deny the significance trauma may have in the mental dynamics involved in self-harm and BPT, but is merely a comment on cognitive therapy's established greater effectiveness. Cognitive behavioral therapy helps circumvent some of the black and white thinking that makes treating BPT so difficult: "another challenge for nurses working with patients with BPD is the manipulation and splitting of staff. These patients view the world and people in terms of absolutes. This view leads to the nurses being categorized into two groups: weak or strong, good or bad, independent or dependent. Only a few nurses are considered good. The good nurses are idealized, and the bad nurses are ridiculed and berated. The good and bad nurses can even shift categories as the patient with BPD may idealize them at first and later devalue them" (Bland et al. 2007, p.1). Cognitive therapy challenges and questions such black and white thinking, even though it may be tempting for a more conventional therapist to mull over past tragedies with the patient.
Finally, treating self-harm with pharmaceuticals in conjunction with therapy may prove helpful. BPD patients have shown lower serotonin activity and even some neurological dysfunction comparable to attention deficit hyperactivity disorder (ADHD), learning disabilities and brain wave irregularities similar to patients with head trauma and epilepsy. Depression, anxiety, and OCD patients all show disruptions in serotonin activity, and "all of these factors may contribute to the behaviors found in BPD patients, such as emotional dysregulation, impulse control, and inaccurate perception of social cues" (Bland et al. 2007, p.1). However, there is a final complication in this approach -- adolescents using antidepressants have a higher rate of suicidal ideation than adults. Some adolescents do not developmentally have the regulatory processes in terms of their physical stages of neurological development to control impulses. Even for adolescents who do not self-harm: "the brain of the adolescent is immature -- an impulsive, aggressive, thrill-seeking brain...There are simple reflective exercises that this brain has limited capacity to accomplish" (Rutledge, 2006, p.1). The initial flush of feeling better after the use of antidepressants may precipitate suicidal actions that an adult might be able to better control.
Bland, Ann R., Georgina Tudor & Deborah McNeil Whitehouse (2007, October). Nursing care of inpatients with Borderline Personality Disorder.
Perspectives in Psychiatric Care.
Retrieved from FindArticles.com on February 16, 2009 http://findarticles.com/p/articles/mi_qa3804/is_200710/ai_n21099913?tag=content;col1
Mangnall, Jacqueline & Eleanor Yurkovich. (2008). A literature review of deliberate self-harm.
Perspectives in Psychiatric Care. Retrieved from FindArticles.com on February 16, 2009 at http://findarticles.com/p/articles/mi_qa3804/is_200807/ai_n27997782
Reeves, Thomas. (2003, January). Cognitive therapy and panic attacks.
Mental Health Nursing.
Retrieved from FindArticles.com on February 16, 2009 http://findarticles.com/p/articles/mi_qa3949/is_200301/ai_n9184524/pg_4?tag=content;col1
Rutledge, Barbara. (2006, December). Customize treatment in adolescents with major depression.
Pediatric News. Retrieved from FindArticles.com on February 16, 2009 http://findarticles.com/p/articles/mi_hb4384/is_12_40/ai_n29314467?tag=content;col1
Sullivan, Michele G. (2006). Cognitive-behavioral therapy effective for OCD.
Clinical Psychiatry News. Retrieved from FindArticles.com on February 16, 2009 http://findarticles.com/p/articles/mi_hb4345/is_1_34/ai_n29283379