Psychiatric Clinic Alliance KRK

What is self-harmful behavior

So what is self-harm? There are several definitions, here are some of them:

Self-harm is the intentional infliction of bodily harm for internal reasons without suicidal intent. It is a behavior that combines acts of violence against the body and hidden ways of harming oneself, regulated by unconscious processes and associated with insufficient care of oneself and one's body. Self-harm includes actions indirectly aimed at self-destruction (including hidden forms associated with avoiding danger, increasing risk, seeking extreme experiences, or avoiding depression) (N. Farberow).

Self-harmful behavior occurs across different age and social groups. These can be both children and adults, men and women, single people and people from wealthy families, unemployed and successful in business, emotional and outwardly calm. Perhaps they all have only one thing in common: the inability to talk about their feelings and experiences or the reluctance to talk about it for fear of being misunderstood.

Armado Favazza in his work writes about the causes of self-harm: “Because it brings temporary relief from various symptoms such as anxiety, depersonalization and despair... evidence of recovery.” The highest level of auto-aggressive behavior is observed in adolescence from 10 to 24 years. The peak falls on girls 13-16 years old, boys 12-18 years old. Experts explain the increase in manifestations of this type of behavior in adolescents by the specific growth of modern adolescents, due to the intensive development and influence of information and communication technologies, and increased public interest in forms of culturally sanctioned risky behavior.

Causes of pathomymia

The main character traits predisposing to the occurrence of this disease are:

infantilism;
high emotional sensitivity;
imbalance;
low self-esteem;
anxiety;
spiritual emptiness and lack of joy;
tendency to aggression and self-injury.

Treatment of pathomymia requires identification of the cause of its occurrence. And the effectiveness of therapy in Dr. Isaev’s clinic is achieved through the integrated use of all possible techniques.

Diseases

Patomimia is often observed with the following deviations:

Psychogenic disorders. The cause is post-traumatic disorder, deep depression, some types of neuroses, including obsessive-compulsive disorder. By harming himself, the patient tries to switch attention from internal experiences to external sensations.
Personality disorder. Any form of psychopathy is accompanied by a lack of self-control and self-criticism. Patomimia in this form of the disease is marked by severe impulsivity and constant severe anxiety.
Hysteria. A person with such a deviation obviously or unconsciously wants to attract attention to himself or relieve internal tension. And one of these ways is self-harm. As a result, when pain occurs, it receives hidden benefits in the form of increased attention and other conditions.
Organic diseases affecting the central nervous system. Pathomimia accompanies neuroinfection. It may also be a manifestation of complications after a stroke or head injury. In this case, aggression towards oneself takes on very cruel and rude forms, is temporarily controlled with the help of medications and completely disappears only after the root cause is eliminated.
Schizophrenia. It can manifest itself in various forms of pathomimia, sometimes causing significant and disfiguring damage to the patient. Factitious dermatosis can be caused by delusions and resulting hallucinations. For example, a person thinks that worms are crawling under his skin and tries to remove them from there.
Alcohol and drug addiction.
Endocrine disorders and genetic predisposition.
Autism, mental retardation, other types of mental retardation.

Some describe self-harm as a way to:

express what is difficult to express in words,
bring some feelings and thoughts into reality,
make emotional pain physical,
get rid of unbearable experiences and thoughts,
regain a sense of control,
moving away from traumatic memories
there is something in life that you can rely on,
punish yourself - for inappropriate behavior, feelings or thoughts,
stop feeling numb, detached and disconnected from reality,
create a reason to take care of yourself and your body,
express suicidal thoughts and intentions without committing them.

While there are good reasons for self-harm, it is important to know that it is quite risky and dangerous. Once a person becomes addicted to it, it takes a lot of time and energy to stop.

What is parasuicidal behavior

Let's understand what parasuicidal behavior is. What are its reasons and what approach can a psychologist choose to help such a client.

In 1977, the term “parasuicide” appeared (Kreitman, 1977) meaning:

behavior involving intentional, non-fatal injury that results in injury, illness or risk of death;
any use of medications or other chemicals that are not prescribed for use or are used in high doses with the expressed intent of self-harm or suicide.

The emotional picture of people with parasuicidal traits is characterized by chronic emotional instability and negative self-views. Their behavior is characterized by hostility and irritability, which is why cases of depression and completed suicide are not uncommon. In relationships with others, such people are often demanding and conflictual, which makes them feel even more lonely, since they do not find support. Almost every such person will say that his main problem is difficulties in communicating with people. Often their thinking is black and white, so any difficulties take on a negative and tragic connotation. Such people do not know how to manage their emotional state and regulate it by cutting, damaging or using chemicals.

Self-harm and suicidal behavior in children

According to the Center's medical psychologist. G.E. Sukhareva Mikhail Alexandrov, it is important to pay attention to the fact that self-harm can manifest itself not only in children or adolescents, but also in a person of any age, gender, position in society, social affiliation. The damage can be done with or without suicide. In some cases, self-harm is a symptom of a mental disorder that is important to treat and manage with the help of a psychiatrist.

Unfortunately, children and adolescents cannot always cope with difficult emotional experiences, especially if something painful happens in their childhood life (divorce of parents, death of loved ones, bullying, big quarrels with friends, etc.). Then some of them try to replace mental pain with physical pain.

It is important for parents to remember that self-harming behavior in a child is never normal. It requires attention, immediate response and correction, since there is a real threat to life and health.

There are various modern theories that try to explain the causes of self-harm and suicidal behavior. One of these theories is the biopsychosocial model, according to which the occurrence of symptoms is always influenced by a combination of factors - biological, psychological and social at the same time. Therefore, in the treatment of such a problem there must be a combination of specialists working with human biology, his psyche and psychological state, as well as with the environment.

Suicidal behavior in children and adolescents

Some time ago, a special term “escape” appeared among teenagers, which can be translated into Russian as “death gracefully.” I pressed the button and exited the program, just like on a computer. The appearance of such slang expressions, as a rule, indicates the special relevance of the topic of life and death among modern teenagers.

According to Anastasia Ilyina, medical and family psychologist at VIGE Sukharev, in 80% of cases, a suicide attempt is carried out at home and, as a rule, in the afternoon or evening. In most cases, suicide is a cry for help from loved ones. Surprisingly, teenagers decide to commit suicide, but at the same time they desperately want to contact family and friends at any cost to get support, help or express their disagreement with something.

Suicidal behavior, as a rule, rarely occurs immediately and impulsively. In order for a person to come to suicidal thoughts, much less switch to active actions, it takes time, as well as a deterioration in the internal state or external situation. Each of these stages can last from a few minutes to several months, and sometimes years.

The following stages of development of suicidal behavior are distinguished:

Anti-vital experience. That is, a teenager can think or say out loud phrases, for example, “my life has lost its meaning,” “everything is bad,” “nobody needs me,” “nobody is interested in me,” “life as an existence.” ", etc.
Passive suicidal thoughts. The teenager has thoughts: “I want to fall asleep and never wake up,” “I want to be hit by a car,” “If I weren’t there...”, etc.
Active suicidal thoughts. The teenager begins to become interested and seek information about methods of suicide, the process, the disadvantages and advantages of a particular method, etc.
Suicide plans, formation of intentions. The teenager develops an action plan: determines the place, time and method. Searches for and prepares means for its implementation, and a decision on action is made.
Suicide attempt. A teenager tries to commit suicide. It may or may not be complete, in which case the teenager may continue to try to change direction.
Post-suicide.

The main causes of suicidal behavior include:

protest,
call,
avoidance,
self-punishment
giving up life.

“Call” and “protest” are the most popular among teenagers.

Andrei Lichko, a well-known and respected Soviet psychiatrist and professor, names the following most common causes of suicide among adolescents:

loss of a loved one,
chronic fatigue and fatigue,
damage self-esteem
use of psychoactive substances.

Self-harming behavior among adolescents

Adolescence is one of the difficult stages in a person’s life, and not everyone can go through it safely. In modern society, there has been a rather unfavorable trend of suicidal activity, as well as self-harmful behavior among adolescents. Often, preventive work is ineffective without the participation of parents and other specialists from medical institutions. What is self-harmful behavior? Otherwise known as self-harm, it is a pathology in which a person deliberately harms his health without pursuing the goal of suicide. According to the medical classification, selfharm is not an independent disease, but is a symptom of various mental disorders. Often the debut occurs in early adolescence. It should be noted that self-harm is based on endorphin addiction - a mechanism close to drug addiction, so a visit to a psychiatrist is mandatory! A teenager inflicts various injuries on himself, trying to numb his mental pain. Most often these are cuts on the arms, thighs, and burns. Less commonly used are types such as: - poisoning with medications;

- pulling out hair, eyelashes, eyebrows;

- deliberate actions to worsen the condition during the period of illness and prolong the recovery period;

- absolute starvation and dehydration of the body.

You should pay attention to the fact that teenagers carefully hide traces of damage and the damage themselves. What are the reasons and what pushes teenagers to such actions?

External factors:

it may be depression and other pathological mental disorders;
crisis events in life (death of loved ones, acts of violence, parental divorce, difficulties at school);
childhood traumas.

Internal reasons:

with the help of real pain they try to drown out mental pain;
trying to punish themselves for something;
trying to express some complex hidden emotions and feelings in this way;
draw attention to themselves or communicate that they need help.

It should be remembered that self-harm always grows!
If parents or loved ones notice cases of self-harmful behavior, they should contact a specialist. The teenager does not pursue the goal of suicide, but it can still happen. What actions should parents take if they notice self-harmful behavior?

1. Focus on yourself - think about how you feel, how you explain to yourself what is happening with your son or daughter. Fear, disappointment, anger - these experiences can be quite difficult. And if you need help, make an appointment with a psychologist. Without a child, try to figure out your own attitude towards what is happening in the family. Only when your moral state is sufficiently stable can you be a reliable support for your own child. Try to restrain your aggression due to self-harming behavior, try to understand the reasons for the teenager’s actions.

2. It is important to understand that self-harm will not go away immediately, it takes time. If we hide all self-harm items, this will not solve the problem.

3. Be there, try to hear your child. Learn to show care and attention. Discuss some family issues as equals, ask for help. Do not attack or reproach, do not check personal belongings in search of objects with which they can harm themselves.

4. Make an appointment for your teenager to see a specialist. Teenagers want their parents to get information about their problem. Initially, you can contact a psychologist, but a visit to a psychiatrist is required! Only as a team can this problem be overcome.

Actions that can harm and even worsen the condition:

Help by force;
Total control over a teenager;
Ignore or focus too much on damage;
Treats self-harm only as a case of attracting attention.

Say these phrases to your children to help support your teenager:

You are not alone;
I am close to you;
You mean a lot to me;
I worry about you;
If you want, I am always ready to listen to you.

List of sources:

1. https://www.pravmir.ru/ 2. https://www.b17.ru/ 3. Andronnikova O.O. Main characteristics of adolescents with self-harming victim behavior (Text) O.O. Andronnikova // Bulletin of Tomsk University. – 2010.- No. 332.- P.145-155.

Parshakova Elena Petrovna, educational psychologist,
State Budgetary Educational Institution "TsPPMSP" Orda branch

Symptoms of pathomimia

The clinical picture of this pathological manifestation is varied. Scratches, blisters, pustules, hemorrhages, and ulcers are found on the patient's skin. There is also a disturbance in the structure of hair and nails. During the initial examination, an inexperienced specialist may mistake manifestations of pathomymia for dermatosis. Therefore, you should pay attention to the features of the lesion:

uniformity;
predominance of minor elements;
correct linear localization;
damage in places accessible to the patient.

When a doctor recommends the use of local and general dermatological treatments, the effectiveness is low. The person's behavior disorder persists and this leads to new skin lesions. If, in the presence of a patient, a specialist expresses a hypothesis about the psychogenic origin of the pathology, he often receives a clearly negative reaction in response.

If treatment of pathomymia is carried out incorrectly, then in this case various complications are often observed:

formation of purulent foci;
formation of scar tissue;
irreversible nail deformation;
persistent alopecia (baldness).

Self-injury will not be able to transmit itself, it will intensify. The person begins to try to inflict even more severe physical pain on himself, and this ends in self-harm and even suicide attempts. Often self-torture goes hand in hand with paranoia, when a person insists on being cured of a problem, but at the same time categorically denies his participation in it.

What is the reason for this behavior?

Researchers have suggested (Thomas and Chess 1977, 1986) that a key source is a disabling childhood environment. This is an environment in which the feelings of a little person are not recognized, ignored or perceived sharply negatively by loved ones, often followed by punishment. Then the child perceives all his emotions and behavior as “wrong.”

At the same time, there are two significant features that form auto-aggression: the child is made to understand that he is mistaken in the description, reasons and analysis of his own experiences (“No, you’re angry, you just don’t want to admit it,” “You really should be ashamed of that.” , that you are offended by your mother (brother, sister)." Secondly, all violent emotional reactions of the child are regarded as “bad” behavior. Parents in such families do not know how to console, support, or reassure the child. This position resembles a situation when a drowning man must pull himself out by the hair, all he has to do is try, and he can do everything. If he couldn’t, it means he didn’t try. At the same time, individual skill and personal achievements are highly valued. Failure to meet these expectations leads to reproach, criticism and attempts to change the “inadequate” child's behavior.

The consequences of a child’s development in a disabling environment are manifested in the following :

Without recognizing and ignoring the child’s feelings, the environment does not teach one to treat one’s experiences as a natural process characteristic of all people. Because the problems of an emotionally vulnerable child are not acknowledged, adults make no attempt to help him cope with them;
By downplaying life's problems, adults do not teach them to endure difficulties and set realistic goals and expectations;
In a family, extreme emotional experiences and manifestations are often necessary in order to evoke the desired reaction. The child constantly fluctuates on the verge of restraining emotions and displaying extremely vivid emotional states in order to attract attention.
The child is not taught to trust his feelings; he is always looking for guidelines that will tell him how to think, feel and act.

In order to help a person with parasuicidal behavior, several areas need to be developed simultaneously. First of all, help you acquire the skill of getting in touch with your feelings, as well as develop the ability to manage them. There is an active focus on developing interpersonal effectiveness, self-control, and distress tolerance skills.

Types of pathomymia

This symptom is characterized by several variants of its manifestation. The most common forms:

trichotillomania (pulling, curling of body hair);
onychotillomania (damage to the nail plate using improvised means);
onychophagia (nail biting);
cheilophagia (constant lip biting);
acne excoriation (damage due to skin inflammation);
dermatolasia (provocation of skin irritation);
dermatozoal delirium (scraping, frequent washing, treatment with products to eliminate an imaginary disease of the dermis).

How to help yourself overcome pathomimia

How can I help myself now?

When you have a strong desire to harm yourself, it's hard to imagine doing anything else right now.

But there are several ways to change or delay self-harm:

understand patterns and patterns of self-harm,
distract yourself from the desire to harm yourself,
put off self-harm.

This section will help you learn how the desire to harm yourself arises, and learn to notice when this desire first begins to appear. Although you may not be able to resist self-harm this time, it is helpful to think about what happened. Next time you will understand your experience better.

Try dividing your experiences into the following categories:

Learn to recognize triggers. Triggers are what make you want to harm yourself. A trigger can be people, situations, feelings, certain thoughts and emotions.
Try writing what happened just before the Self Harma episode: what thoughts did you have? Do your surroundings, people or objects bring up unpleasant or difficult memories?
Be aware of the desire to harm yourself. It can manifest itself through physical sensations:

Rapid heartbeat or feeling of heaviness
Strong emotions such as sadness or anger
Feeling out of touch and numb
Repetitive thoughts, such as "I want to cut"
Unhealthy decisions, such as throwing yourself into work so you don't feel anything.

If you think these signs are a trigger for you, track them down and write them down - this will help you overcome self-harm when it comes up again.

Taking your mind off the urge to self-harm is a good way to give yourself more space and choice and reduce the urge to self-harm.

You can be distracted both when the desire to harm yourself has just appeared, and when you are already in the process.

“I learned to distract myself. My favorite way is a positive book, it’s a scrapbooking album in which I wrote down everything that makes me happier.”

To understand patterns of self-harm, it is helpful to keep a diary and write down what happened before, during and after each episode of self-harm. To notice patterns, you will need to keep such records for some time, on average about a month.

But journaling can be frustrating. If you feel ready to try this technique yourself, be sure to do something nice and relaxing after recording.

If this method is causing you pain, try asking someone you trust for support.

Distract yourself from self-harm. This is a basic self-help technique for self-harm. Different people experience distractions differently, and each method may not work every time. For example, distracting from anger is not the same as distracting from fear, so it is better to use different strategies to be able to choose the right one in the moment.

Another way to counteract self-harm is to procrastinate: wait 5 minutes. It's not always easy, so if the urge to harm yourself persists, allow it to happen. If possible, increase respite time and gradually create breaks between each act of self-harm, such as cutting.

Some may find it too easy to get distracted and put off self-harm in order to solve a complex and serious problem. In this case, the section “How can I help myself in the future?” this may be more useful for you.

How can I help myself in the future?

Ultimately, you can help yourself by exploring the causes of self-harm. This will help you find other behaviors to replace the self-harming behavior.

Accept your emotions. If you've been ashamed of your feelings or have learned to suppress them for other reasons, getting in touch with them again will take courage. Difficult experiences can be very frightening, so it is important to take it very slowly and gradually. It may be worth using techniques such as mindfulness or journaling to support yourself and reduce the likelihood of emotional overwhelm.

Try smartphone apps, online tools, books and workbooks to resolve your emotions
Try working with a psychologist or psychotherapist you trust. You will have a positive experience of accepting and respecting your experiences.
Try mindfulness techniques: Notice your feelings and name them as soon as you feel them.

Work with self-respect. Self-acceptance and a positive view of yourself can make a big difference in your life.

Speak and think more kindly about yourself, as if you were talking about your loved one.
Replace the urge to hurt yourself that pops up in your head with words that will empower you. For example: “Even if I want to cut myself, I will find another way to express how sad I am.”
Regularly write down three things you value about yourself. It doesn't matter how small or insignificant they seem to you.
Learn to calmly and confidently talk about your limits, to say “no” to what you think is inappropriate for you.
Take control of your decisions. Remind yourself that you are responsible for your choices and choose something that aligns with how you feel about support and self-care.

Take care of your well-being and overall health.

Keeping an eye on your health in all aspects will help you feel better.
Regular exercise can improve your mood and reduce stress.
A regular diet rich in fresh fruits and vegetables also affects our well-being
Making sure you get enough sleep will not only improve your well-being, but also make you more resilient to stress
Creativity helps you express your feelings: write songs, write stories, blog, draw, etc.
Once a week, do something you enjoy: meet friends or go for a walk. Try to find time for yourself, even if your life is busy.

Try to understand your behavior more accurately. Recovering from self-harm can be difficult and time-consuming. It may be helpful to gain a deeper understanding of your relationship with him to prepare you for the big step. The more you understand why you self-harm, the better prepared you will be to make changes, find good alternatives, and learn what can support you in the process.

These questions will help you understand the origins of self-harm:

How do you feel before and after your injury?
How and why did you do this for the first time?
What are the benefits of self-harm now?
In what situations does self-harm occur?
What's scary about a future without self-harm?
What effects might you have missed?
What else can help us understand self-harm?

Ask for help. Asking for help can be very difficult, especially if you fear that others will judge or refuse to help. Remind yourself that everyone needs support sometimes, and it's okay to ask for help.

When you're ready, choose someone you trust and tell them how you feel. This could be a friend, family member, psychologist, or doctor (see What help and treatment you can get). Remember that only you decide what to say, and you don't have to say anything you're not yet ready to share.

It can be helpful to make a list of people, organizations, and websites that can help you find help in difficult situations. This will remind you that you are not alone and that help is available. (see section “Useful contacts”)

Unfortunately, there is no magic or quick way to stop self-harm, and change takes time and also involves setbacks. It is normal for the old behavior to temporarily take over after moving forward and making progress. If this happens to you, remind yourself that this is not a failure, but part of the process of getting rid of self-harm.

What help can I get?

Sometimes external support is required. You may need to try a few times to find what works for you and combine self-help techniques and professional support:

therapist/psychotherapist,
pharmacological treatment,
support groups,
online support community,
scar treatment.

It takes courage and courage to ask for help. You may feel that you will not be understood or that you will be asked to make quick changes even if you are not ready for them. Such doubts are normal. But you have the right to support that will give you strength.

Any medical professional, your therapist or psychiatrist, psychotherapist, psychologist is obliged to discuss with you all possible treatment methods, your opinion and wishes must be taken into account.

How can friends and family help?

There is a lot you can do for someone suffering from self-harm. Your attitude is one of the main things that will help a person feel supported.

Here's what to remember:

Try not to judge.
Let him know that you are close.
Remember that a person is more than his problem.
Try to show empathy and understanding of the reasons for these actions.
Allow the person to make their own decisions.
Offer help and support.
Remind the person of their strengths and what they are good at.
Try to speak up and take responsibility for your fears.

What does not work?

Sometimes when we want to do our best, but it turns out just the opposite.

Here are some dangers to avoid:

An attempt to help by force.
Speak or act as if you are trying to control.
Ignoring or focusing too much on damage.
Definition of self-harm as "attention seeking."

While self-harm is not the case in most cases, sometimes it can be a way to get attention. If so, remember that it's completely normal to want attention, and that extreme stress can affect a person's ability to communicate directly what they need.

Project of Belarusian parents for everyone who is close to the problem of autism

Original: https://www.autism.org.uk/living-with-autism/understanding-behaviour/challenging-behaviour/self-injurious-behaviour.aspx Translator/editor: Marina Lelyukhina

Self-harming behavior is one of the most challenging issues facing people with autism spectrum disorder and their loved ones. Most often, such behavior, which poses a direct threat to human health and well-being, is caused by a whole range of different reasons. Conventional behavioral strategies in such a situation are often not effective enough and specialist intervention is required.

What is self-harmful behavior?

Self-injurious behavior (sometimes called self-injury or auto-aggression) is any action as a result of which a person causes physical harm to himself: • hitting his head (on the floor, walls or other hard surfaces) • biting his hands • pulling out his hair • pressing on his eyeballs • hits himself in the head or face • pinches or scratches himself • shakes his head violently

People with autism spectrum disorder, given their perceptual and intellectual disabilities, are more likely than others to engage in self-injurious behavior (Howlin, 1998). This problem can occur at any age. If the behavior has already occurred, then a person can return to it at any time in a situation when he experiences stress, physical discomfort, or experiences serious changes.

The reasons why self-harmful behavior may occur are very diverse. As a rule, this is a whole complex of different circumstances that influence each other in one way or another. Head banging, caused by a desire for additional sensory stimulation, can transform into a way of avoiding demands. Ear blows caused by acute otitis media can then be used to get what you want from others. Below we will look at some more reasons that can cause self-harmful behavior.

Toothache and other medical problems

When you encounter self-harming behavior, the first and most important thing to do is to rule out possible health problems and toothache. People with autism spectrum disorders often find it very difficult to let them know that something is hurting them. Specific self-injurious behaviors, such as hitting the head or ears, may be their way of coping with physical discomfort without being able to seek help.

Self-injurious behavior can be caused by the following problems: • Infectious diseases (for example, colds, flu, ear infections, upset stomach) • Physical pain (tooth, ear, menstrual pain) • Seizure activity (in various forms of epilepsy) • A general feeling of discomfort (in disorders digestion, skin diseases) • Researchers are also considering a possible connection between self-harmful behavior and various tics and compulsions. High levels of stress are thought to increase their frequency (Clements and Zarkowska, 2000).

Neurochemical theories Researchers have also suggested a possible connection between self-injurious behavior and features of the brain's neurochemical systems:

Endogenous opioid system Research shows that some people with autism spectrum disorders have elevated levels of beta-endorphins in their bodies, causing their pain threshold to be greatly elevated, which in turn may be associated with self-injurious behavior. It has also been suggested that self-harm may be caused by the body's release of opiates, which produce a euphoric feeling that reinforces self-harm behavior.

Serotonin Researchers have suggested that elevated blood levels of sertonin, which occur in some people with autism, may cause a variety of behavioral problems, including self-harm (Gillberg and Cole, 1992).

Dopamine Studies of Lesch-Nyhan syndrome (an inherited condition associated with self-injurious behavior such as lip and finger biting) have shown an imbalance in the brain's dopaminergic systems, which researchers have suggested may play a role in the development of self-injurious behavior.

Sensory stimulation (increasing or decreasing the stimulus)

By analogy with the opioid theories discussed above, self-injurious behavior may be an attempt to achieve sensory stimulation (especially if the person has a high pain threshold due to increased levels of beta-endorphins) or, conversely, to cope with sensory overload (i.e., for example, hitting the head may be a way to block out an unpleasant or disturbing auditory stimulus such as a barking dog or the whirring of a lawn mower).

Stages of development Some types of self-injurious behavior may be a residual manifestation of motor stereotypies characteristic of an earlier age (for example, hand flapping that may remain from early childhood).

Communication and Learned Behavior Many self-injurious behaviors occur when people have no other way to communicate their needs, wants, and feelings. A person who bangs his head against a wall is more likely to get what he wants, be it attention, a desired object or activity, or a reduction in demands. For another person, head waving may be a way to communicate that they are upset; for others, hand biting may be a way of dealing with frustration or agitation. For some people, pinching the skin or pressing on the eyeballs may be a reaction to lack of sensory stimulation or boredom.

By analyzing the reactions of others, a person will most likely quickly understand that self-harm is an excellent way to control the environment.

Thus, self-injurious behavior (such as hitting the head), which was originally a reaction to physical pain or discomfort, gradually becomes a way to avoid an unpleasant situation (for example, getting others to turn off the TV).

Repetitive behavior

People with autism spectrum disorder tend to engage in ritualistic and repetitive behavior. Some self-injurious behaviors may be triggered by this tendency.

Mental health Some self-injurious behaviors may signal underlying mental health problems such as depression or anxiety, especially in people with high-functioning autism or Asperger's syndrome.

Strategies Below you will find some basic ideas to help you prevent and respond to self-harmful behavior. If self-harm becomes serious and frightening, it is necessary to consult a specialist.

Proactive measures

What can be done in everyday settings to prevent self-injurious behavior.

Rule out dental problems and possible diseases

Discuss the problem with your doctor and arrange consultations with other specialists (if necessary). Bring with you notes about when, at what time of day and in what situation the self-injurious behavior occurs and how long it usually lasts. The notes will help the doctor determine if there is physical discomfort or pain. You will also likely want to keep a record of episodes of self-harmful behavior for some time before your visit. Take these notes with you as well.

Define Behavior Function

Try to understand the function of self-injurious behavior. The behavior may occur as a way to obtain sensory stimulation, cope with sensory overload, or as a response to physical discomfort. Often self-harmful behavior is caused by a complex of different reasons; to understand this, you should contact a specialist.

Poschpopopovyvvaaa

Develop communication skills

If the person cannot speak, teach him alternative, more acceptable ways to communicate his wants and needs, or the discomfort he is experiencing. Various visual aids will help you a lot.

Structure your environment and maintain a daily routine

To make daily events more predictable and your client to suffer less from anxiety, structure the environment and maintain a daily routine. Try to evenly distribute the activities of your ward so that he does not have the opportunity to get bored and start harming himself. For Dl vrlalvrao

For those moments when your client is having a particularly difficult time, prepare a step-by-step schedule. Perhaps for such events, additional supervision from a specialist should be organized and other methods of support should be considered.

Enrich your sensory environment

If the cause of self-harm is a search for sensory stimulation, try to find alternative activities that will help your person get a similar sensory experience. Jumping on a trampoline or riding a merry-go-round can be a great alternative to swinging and hitting your head because... also affect the vestibular apparatus. For someone who bites their hands and fingers, you can pick up a whole bag of edible or simply safe objects that can be chewed, for example, gum, carrots, dry pasta, nougat.

Physical training

Researchers suggest that regular aerobic exercise not only improves a person's physical and emotional well-being, but may also reduce the incidence of self-injurious and aggressive behavior (Rosenthal-Malek & Mitchell, 1997). Aerobic exercise includes running, swimming, cycling, trampolining, dancing and aerobics, ideally at least three times a week. Analyze your mentee's tendencies and try to choose activities that can be built into his weekly schedule. Sometimes, before prescribing training, you should consult with a professional instructor or doctor.

Reinforce Desired Behaviors Make it a habit to reward desired behaviors and times when your person in your care is not engaging in self-injurious behavior. This will help him understand that alternative behavior leads to pleasant consequences, and thus help him increase the frequency of occurrence of this behavior, and reduce self-harm. Rewards may include verbal praise and attention, desired activities, toys, tokens, or a small amount of a favorite treat. Make sure that you are clear about what the child is receiving the reward for (“You're doing well”), and make sure that the reward is given immediately after the behavior you want to reinforce (“Now we can play on the computer for 10 minutes”). It should be noted that not all people with autism enjoy social attention. In these circumstances, verbal praise can cause anxiety and reduce the likelihood that the person will engage in the desired behavior in the future.

Medications There is evidence to suggest that certain medications may help reduce the incidence of self-harming behavior in some cases. Like physical restraint, medications are used as a last resort and, of course, strictly under the supervision of a specialist.

Reactive Strategies

What to do when the behavior occurs

If self-harmful behavior does occur, it is very important to respond to it correctly and develop an intervention program in a timely manner. Even if the function of the behavior is to seek attention, serious cases of self-harm cannot be ignored. The response depends on the behavior you encounter, but there are a number of common features in each strategy. It is important to remember that regardless of the chosen course of action, your coachee needs to be given the opportunity to learn to communicate their needs in a more acceptable way, as well as to independently regulate their stress and anxiety levels.

Try to calmly react to cases of self-harm, if possible, do not comment or show unnecessary emotions in facial expressions, because this may unwittingly reinforce the behavior. Try to speak calmly and clearly, in an even and firm voice.

Reduce the requirements, so you will get rid of the “trigger” for self-harming behavior in a situation where the task turned out to be too difficult for your ward, or he does not have time to cope with it in the allotted time. In such a situation, it would be correct to lower the bar, or stop completing the task altogether. You will return to him later, when your ward has calmed down.

Try to get your coachee's attention by calling him by name and give him simple instructions that will help him distract himself from self-harmful behavior. Example: “David, put your hands on your knees.”

Remove or reduce exposure to an unpleasant sensory stimulus (sound, smell, light). Help cope with physical discomfort (for example, give pain medication).

Use visual aids, such as pictograms to provide instructions. Immediately redirect attention to another task that does not provide an opportunity for self-harm (for example, requires action with both hands) and be sure to praise and reward the first manifestation of the desired behavior (“David, you are so good at playing with the train”).

Physical restraint in a very light form may be acceptable if the person himself has difficulty stopping the unwanted behavior, for example, he cannot stop hitting himself on the head. But try to use force as little as possible. Immediately try to redirect your person to another activity, and be prepared to restrict his movements again if he tries to harm himself again. This approach must be used very carefully, because... in this way you can unwittingly strengthen behavior or redirect aggression towards others

Place a barrier between the person and the object that causes harm. For example: You can place a pillow between your head or hand and a hard surface that the person can hit. You can choose special mats, wall coverings, or “safe furniture.” To avoid biting your hands, offer another object for biting.

Call for help In case of emergency, contact the rescue service

Physical restraint

In some cases, self-harm becomes so severe that the person risks causing serious injury to himself. In this situation, the use of restraints such as belts, helmets, etc. is acceptable. Clements and Zarkowska (2001) suggested that the use of physical restraint reduces unwanted behavior more quickly than physical restraint by another person, and is thus considered more acceptable. However, belts and ropes are still recommended to be used only as a last resort, and of course the procedure should be supervised each time by a specialist who will help make sure that these means are used carefully and no one gets hurt as a result.

Esd

Ethics and safety aside, when used incorrectly, physical restraints can significantly increase self-injurious behavior (Howlin, 1998). It should also be taken into account that physical restraint essentially does nothing about the cause of the behavior, so it is unacceptable to use it without parallel work on the formation of alternative behavior and learning new skills.

Summary

Check to see if self-injurious behavior is caused by toothache or other health problems.
Determine the function of the behavior.
Help your client learn to communicate their needs in a more acceptable way.
Provide structure and routine to your daily activities, and make sure your person has plenty of opportunities throughout the day to get the sensory stimulation they need.
Reward your client often for engaging in desired behavior and when he is not self-harming.
In cases where self-injurious behavior does occur, respond calmly and consistently, stop the behavior (gently restrain or put a barrier) and redirect the person to another activity.
In case of emergency, contact the rescue service.
If self-harmful behavior is difficult to correct, your ward is at risk of seriously harming himself, and you don’t know what to do - be sure to consult a specialist.

What to consider when contacting a specialist

Seek help from your healthcare provider and ask to arrange a consultation with a specialist who understands not only the characteristics of autism spectrum disorder, but also behavior (a clinical psychologist, psychiatrist or behavior analyst, if you have such an opportunity). You may want to ask your doctor to dedicate a separate meeting to discuss your client's behavioral problems. Any notes collected from observing self-injurious behavior should be brought to this meeting. It is important to properly communicate your concerns about self-harmful behavior in your client to ensure that you are going in the right direction.

Source: specialtranslations.ru

Our guarantees

You can sign up for a consultation by calling the number listed in the header of the site.

When you turn to our specialists for help, you can be sure that this is:

Anonymous: When registering, it is not necessary to indicate your real name, passport details or other personal information about yourself. All you have to do is provide a name under which the industry will contact you in the future.
Confidential: Any information you provide to your consultant or other industry staff will remain within our practice. We do not share patient information with third parties. By contacting us, you can be sure of the complete security of the data you provide about yourself.
Voluntary - While we understand the need to provide care to every patient we receive, we nevertheless reserve the right to stop working for you. You can always cancel your appointment or reschedule it for another day or time.

Professional treatment of pathomymia

Treatment of pathomymia is carried out comprehensively, for this purpose only conservative measures are used. This will require symptomatic therapy aimed at stopping the secondary infection. But the basis for providing assistance with such a deviation is the elimination of the cause of the disease, namely the mental deviation that leads to auto-aggression.

Usually in this case they use:

psychotherapy;
taking medications;
local drugs;
physiotherapy.

In the presence of self-destruction due to depression, neurosis or psychosis, outpatient treatment can be used. Severe disorders associated with schizophrenia or paranoid delusions require an initial hospital stay. This allows you to constantly monitor the patient’s condition and his reaction to the drugs used.

Psychotherapy for pathomymia

Since aggression towards oneself manifests itself due to a psychogenic disorder, the first place in providing assistance is given to the work of a psychologist. In this case, its goal is to restore a person’s inner balance and restore love for himself and his body. The following methods of psychotherapy are considered the most effective for this:

analytical;
cognitive-behavioural.

By analyzing the problem, a person is able to identify moments of self-harm when he does not consciously register them. The doctor helps to identify and eliminate the root causes of internal conflict and replace actions that are dangerous to health with safe ones. At the same time, the patient acquires self-control and relaxation skills.

If his incision is accompanied by increased tension, and the obsessive action allows him to calm down for a while, then in this case it is better to use cognitive behavioral therapy. An explanatory conversation is held with the patient about the origin of his illness, the destructiveness of such behavior, and he is taught a normal reaction to irritating factors and events.

Use of medications and ointments

In severe forms of mental disorders, it is recommended to select drug therapy after the patient is hospitalized. In case of insanity or inability to care for oneself, therapy can be prescribed without his consent, but only after consultation with a doctor. To alleviate conditions that cause autoaggression, it is recommended to use the following groups of drugs:

anxiolytics;
sedatives;
neuroleptics;
tranquilizers;
antidepressants.

The prescription of each drug and the duration of its use is controlled by a doctor. At the same time, topical agents are used to promote tissue healing and prevent infection. First of all, this problem is solved:

aniline dyes;
solutions with antiseptic properties;
antibacterial ointments and creams;
medicines to speed up repairs;
During scar formation, emollient emulsions and retinoids are used.

Other techniques

Physiotherapy works well for this pathology. Dermatitis of this origin quickly disappears as a result of exposure to:

paraffin therapy;
laser;
electrophoresis;
Ultrasound;
ultraviolet radiation.

Medications and physical therapy speed up the healing process and prevent the formation of scar tissue and hyperpigmentation. The procedures help not only locally, but also have a beneficial effect on the human psyche and the entire body as a whole.

Laser treatment of pathomymia helps reduce the inflammatory reaction in the affected area, stimulate metabolic and regenerative processes, increase local immunity and prevent secondary infections. The use of paraffin helps with superficial violations of the integrity of the skin, when there are no deep wounds or inflammations. The skin becomes less dry, its water balance is restored, and the healing process proceeds many times faster.

Ultrasound helps relieve redness, swelling and other signs of an inflammatory reaction in the affected area. Electrophoresis relieves pain, calms, and activates local metabolism in tissues. Ultraviolet radiation in the form of radiation allows you to cope with all kinds of injuries, but in the absence of deep damage, local immunity increases.