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There is considerable uncertainty about which forms of psychosocial and physical treatments of patients who harm themselves are most effective and as such further clinical studies are required.[60] Psychiatric and personality disorders are common in individuals who self-harm and as a result self-harm may be an indicator of depression and/or other psychological problems.[8] Many people who self-harm suffer from moderate or severe clinical depression and therefore treatment with antidepressant drugs may often be effective in treating these patients.[8] Cognitive behavioural therapy may also be used (where the resources are available) to assist those with Axis I diagnoses, such as depression, schizophrenia, and bipolar disorder. Dialectical behaviour therapy (DBT) can be very successful for those individuals exhibiting a personality disorder, and could potentially be used for those with other mental illnesses who exhibit self-harming behaviour. Diagnosis and treatment of the causes of self-harm is thought by many to be the best approach to treating self-harm.[11] But in some cases, particularly in clients with a personality disorder, this is not very effective, so more clinicians are starting to take a DBT approach in order to reduce the behaviour itself. People who rely on habitual self-harm are sometimes psychiatrically hospitalised, based on their stability, their ability and especially their willingness to get help.[61] In adolescents multisystem therapy shows promise.[62] In individuals with developmental disabilities, occurrence of self-harm is often demonstrated to be related to its effects on the environment, such as obtaining attention or desired materials or escaping demands. As developmentally disabled individuals often have communication or social deficits, self-harm may be their way of obtaining these things which they are otherwise unable to obtain in a socially appropriate way (such as by asking). One approach for treating self-harm thus is to teach an alternative, appropriate response which obtains the same result as the self-harm.[63][64][65] Additionally, the use of positive punishment apparatus such as the Self-Injurious Behavior Inhibiting System (SIBIS) can reduce the rate at which children with developmental disabilities engage in self-injurious behavior.[66] Avoidance techniques Generating alternative behaviours that the sufferer can engage in instead of self-harm is one successful behavioural method that is employed to avoid self-harm.[67] Techniques, aimed at keeping busy, may include journaling, taking a walk, participating in sports or exercise or being around friends when the sufferer has the urge to harm themselves.[16] The removal of objects used for self-harm from easy reach is also helpful for resisting self-harming urges.[16] The provision of a card that allows sufferers to make emergency contact with counselling services should the urge to self-harm arise may also help prevent the act of self-harm.[60] Alternative and safer methods of self-harm that do not lead to permanent damage, for example the snapping of a rubber band on the wrist, may also help calm the urge to self-harm.[16] Using biofeedback may help raise self-awareness in the sufferer of certain pre-occupations or particular mental state or mood that precede bouts of self-harming behaviour,[68] and help the sufferer identify techniques to avoid those pre-occupations before they lead to self-harm. Any avoidance or coping strategy must be appropriate to the individual's motivation and reason for harming.[69] |
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