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Self-harm about personality disorder

This symptom is so common among those with personality disorder
that to some health care professionals it has become almost diagnostic of personality disorder. This is a dangerous simplification for, although it is true that many people
who have personality disorder do self-harm, there are many people who self-harm that do not have a personality disorder, and vice versa.
When discussing self-harm, it is important to recognise that this does not include suicidal behaviour. These two are often discussed as if they are varying levels of the same thing. This is a not the case. Self-harm has several functions not related to suicide. It is important to differentiate the two in order to maintain an accurate
assessment of risk and formulate appropriate responses and treatment plans.
For those who suffer from personality disorder, self-harm is a coping mechanism.
For some, far from being life-threatening, self-harm is an attempt to gain sufficient control to avoid committing suicide. Catherine was a woman with a long history of sexual abuse in her childhood.
When these memories were triggered, she would become very distressed and obsessed with self-loathing and self-hatred. If left unabated, this self-hatred would become so distressing that she would see no other way to end the distress
other than suicide. These feelings would become so unbearable that Catherine knew from her experience she would eventually attempt to kill herself to end the pain. The only reliable method she had found to dissipate her obsessive rumination and self-loathing was to burn her arms with cigarettes. As can be seen from the above scenario, for Catherine self-harm was an attempt to stop her from committing suicide. This type of self-harm is a life-saving coping
strategy. It is not surprising therefore that clients are loath to give it up, especially before they have been taught how to develop alternative strategies to use in these situations.
People self-harm for a many reasons; however, most of them are attempts at expressing or enduring strong emotions. It is important when working with people with personality disorder to work with them towards a clear understanding of their
personal beliefs and reasons underpinning the self-harm. Only in this way can you begin to develop alternative strategies that once in place enable the client to reduce the frequency and intensity of their self-harm.
For most, self-harm will decrease or stop of its own accord once alternatives are in place, certainly attempts to stop self-harm before alternatives are in place are doomed to failure as patients will be reluctant to give up their coping strategy until they have an alternative. Initial interventions should therefore be aimed at
limiting the dangerousness of the self-harm and encouraging the client to manage their behaviour rather than stop it.
Some clinicians have speculated that self-harm creates an adrenaline rush causing a sort of high. Others believe that the pain leads to a release of endorphins in the brain, which helps to restore a feeling of calm and well-being. Regardless of the theoretical approach taken, it becomes clear that self-harm is a very complex and
individual process: some clients describe it as self-punishment; others as a release of pressures or to see blood flow or understand their self-harm in terms of ‘letting the evil out’.
To work successfully with self-harm, it is necessary to work collaboratively with the client to understand their underlying schema. Only then can the health care professional hope to develop interventions that will be successful in treating this distressing condition.

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