1. CP 510: Professional Ethics and Law Chatzistavraki Vania Giannikakis Dimitris Gkioka Maria 14/10/2013

2. What is Deliberate Self Harm (DSH)? DSH an intentional act of self poisoning or selfinjury regardless of the type of motivation or degree of suicidal attempt (Whitlock et al., 2006). It is considered to be an indication that something is wrong and a primary disorder. Whatever the type of DSH is used, it is an unhealthy and dangerous act, and can leave deep scars. Both physically and emotionally. 3. Types-Expression of DSH Cutting the skin o Sharp objects: Razors Knives Needles/pins Sharp stones Broken glass Deep Scratching Burning Hitting or brushing Biting Head banging Pulling hair Overdose/neglect ofmedication-drugs Alcohol abuse Self mutilation Hanging Asphyxiation Royal College of Psychiatrists (2010) 4. Adolescents Ross & Heath (2002) the 13 % of the generaladolescent population 13%-25% of adolescents and young adults (Rodham & Hawton, 2009) Often is repetitive Age 14-16 onset Begin in childhood continue adulthood All marks are hidden even in the summer periods (e.g. long sleeves) 5. Adolescents (Demographics) Prevalent among adolescent girls. Population in middle school is in higher riskbecause this is the rate they initiate in self-injury (Gollust, et al., 2008). No socioeconomic status give significant differences (Jacobson & Gould, 2007). High risk appear to be in bisexual individuals compared to heterosexual or homosexual teenagers. 6. Adolescents Intentionally Harm themselves and usually are documented tohave the following characteristics-disorders: Depression Schizophrenic Abused Childhood trauma Poor family communication Low family warmth Cope with painful emotions Feel good of chemical release Influence by peers (Ross & Heath, 2002) 7. Adolescents Intentionally Adolescents are not able to handle their emotions(negative or sensitive) and experience an intense shame or they cannot control their selves (Chapman et al., 2006) During the self-injury the brain releases chemicals, the endorphins. They produce a high feeling that causes an addiction to the teenagers (Sher & Stanley, 2009). 8. Adults There is a stereotype that only teenagers andyoung girls commit self-harm. However, it is also common during the adulthood for both genders. The rate of self-harm is higher in females, but fatal self-harm which concluded into suicide is more prevalent among men (Royal College of Psychiatrics, 1994). Adults are more prevalent into suicide in comparison to adolescents (Hepple & Quinton, 1997). 9. Adults Adults from all social and cultural backgrounds commit self-harm, but some individuals are more vulnerable because of: Life experiences Personal or social circumstances Socioeconomic deprivation (Mitchell & Dennis, 2006) Physical factors or a combination of the above 10. Reasons for self-harm in adults Bipolar disorder Mood disorders Alcohol abuse Drugs abuse Traumatic events Coping mechanism (for some individuals self-harm can be a coping mechanism) Illness (Royal College of Psychiatrist, 1994) 11. Further Research in self-harm in adults Self harm is one of the commonest reasons foremergency hospital attendance in England and Wales with an estimated 140-150,000 hospital presentations every year (Gunnell et al., 2004). 4026 (99.8%) episodes o 3198 (79,4%) Overdose o 457 (11,4%) Self-laceration o 193(4,8%) combination of laceration and overdose o 178(4,4%) Other methods o Bleach/ weed killer (n=30), o Self strangulation/Hanging (n=27) o Jumping (n=22) o Carbon monoxide poisoning (n=19) 12. Mitchell & Dennis (2006) review tableThis figure illustrates the difference between the above age groups concerning the two genders in Deliberate self harm attendances (DSH). 13. Older people who self harm are in high risk for committing suicide. It is more likely to beMEN over 75 years old. Evidence suggest that fatal and non-fatal self harm are more closely related in elderly than in younger adults. Elderly who self harm are more likely to live alone or to be single (Murphy, 2011) Elderlywho self-harm present 67 times greater risk to committee suicide than elderly who dont. There is 3 times greater risk of suicide than younger adults who self harm (Murphy, 2011). Approximately 90% of older people who are both depressed and self-harmed, committee suicide (Merrill & Owens, 1990). 14. How they self harm 34% are Paracetamoloverdose 30% Benzodiazepine overdose 12% Antidepressant overdose 11% Psychotropic overdose 9% Aspirin overdoseFrom those who self harm: 40% were sorry they self harmed. 40% were ambivalent and 20% regretted the fact they were alive. (Dennis, Wakefield, Molloy , Andrews, & 15. What are their motives 1. 2. 3.4. 5. 6.61% to gain relief from an intolerable state of mind. 53% to escape from an intolerable situation. 22% to make other people understand how desperate the person was feeling. 18% to influence others. 18% to seek help. 12% to make other people feel sorry (Hawton, Cole, OGrady, & Osborn, 1982). percentages 1,3,5 higher were noticed in depressed elderly. 2,4,6 higher percentages were noticed in non- 16. Diseases elderly suffer when selfharm: Most common:(43%) Depression, (24%)Recurrent Depression, (1%)Bipolar affective disorder (currently depressed) Less Common: Alcohol abusers, Alzheimer sufferers. 19% has no psychiatric disorder (Dennis, et. al, 2006). 17. Why they self harm? 79% face difficulties with their own health. 19% face relationship difficulties. 17% are affected by others health problem. 6% face financial difficulties.(Dennis, et. al, 2006) 18. Possible treatments of DSH Antidepressants Problem solving therapy Individual therapy Group therapy Family therapy In-patient hospitalization Stress reduction and management skills Attention to possible indicators after the therapy forrepeated episodes of DSH (Mitchell & Dennis, 2005) 19. Ethical Codes for DSH AMHCA (2010), in Confidentiality section, thecounselor has to break off the confidentiality in cases of self harm, suicidality or other extreme occasion (abuse, murder, neglect) that threat the client or others. BPS (2009), in Confidentiality section 4.3 thepsychologist disclosures when there is adequate indication about the safety of the client. Has to inform appropriate third parties without prior consent. 20. Ethical Codes for DSH Counselors also have responsibilities to parentsand the school (ASCA, 2004). In Standard D.1b, p. 2 ( ASCA) informs the appropriate officials in accordance with school policy and the parents.. ACA (2005) B.1.b, Respect for Confidentiality, thetherapist do not share confidential information only in a few serious situations, harm to him/herself or others. All of the Codes of Ethics state that all of the above occurespecially in minority groups (children, teenagers and elder). Especially, when the individuals are not able to decide for themselves (e.g. mental illness). 21. Additional guidance for self harm According to National Institute for Health and Care Excellence (2004): Self harmed individuals deserve equal treatment, respect and confidentiality, as any other patient. Health care professionals should also take under consideration the possible distress and the emotional damage these people have experienced, and they should provide them emotional support and supervision. Furthermore, they should sympathize with the clients and encourage them to express their feelings about their self harm experience. Psychologists should have a risk assessment for all age groups in order to avoid suicidal attempts. A psychiatric diagnosis is also recommended for individuals with DSH. 22. References American Counseling Association (1995).Code of ethics and standards of practice. Alexandria, VA: Author. American Mental Health Counselors Association (2010). Code of Ethics. Alexandria, VA: Author American School Counselor Association (2004). ASCA ethical standards. Alexandria, VA: Author British Psychological Society (2009). Code of Ethics and Conduct. Ethics Committee of the British Psychological Society. Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behavior Research and Therapy, 44(3), 371-394. Dennis, M., S., Wakefield, P., Molloy, C., Andrews, H. & Friedman, T. (2006). A study of self-harm in older people: Mental disorder, social factors and motives. Aging & Mental Health. 23. References Gollust, S. E., Eisenberg, D., & Golberstein, E. (2008). Prevalence and correlates of self-injury among university students. Journal of American College Health, 56, 491498. Gunnell, D., Bennewith, O., Peters, J., House, A., Hawton, K. (2004). The epidemiology and management of self-harm amongst adults in England. Journal of public health. Vol 27, no 1, 67-73. Hawton, K., Cole, D., OGrady, J., & Osborn, M. (1982). Motivational aspects of Deliberate self- poisoning in adolescents. British Journal of Psychiatry, 141, 286-291. Hepple, J., & Quinton, C. (1997). One hundred cases of attempted suicide in the elderly. British Journal of Psychiatry, 171: 42-46 Jacobson, C. M., & Gould, M. (2007). The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: A critical review of the literature. Archives of Suicide Research, 11(2), 129-147. 24. References Mitchell, A., & Dennis, M. (2006). Self harm and attempted suicide in adults: 10 practical questions and answers for emergency department stuff. Emergency Medicine Journal. Murphy, E., (2011). Risk factors for repetition and suicide following self-harm in older adults: multicentre cohort study. National Institute for Health and Care Excellence (2004). Self-harm: The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. Retrieved from http://publications.nice.org.uk/self-harm-cg16/guidance Rodham, K., & Hawton, K. (2009). Epidemiology and phenomenology of nonsuicidal self-injury. In M. K. Nock (Ed.), Understanding nonsuicidal self-injury: 25. References Ross, S. and Heath, N. (2002). A study of the frequency of self-mutilation in a community sample of adolescents. Journal of Youth and Adolescents, 31 (1): 67-78 Royal College of Psychiatrists (2010). Selfharm, suicide and risk: helping people who self-harm. College Report CR158, Royal College of Psychiatrists. Sher, L., & Stanley, B. (2009). Biological models of nonsuicidal self-injury. In M. K. Nock (Ed.), Understanding nonsuicidal self-injury: Origins, assessment, and treatment (pp. 99-116). Washington, DC: American Psychological Association. Whitlock, J., Eckenrode, J., & Silverman, D. (2006). Self-injurious behaviors in a college population. Pediatrics, 117, 1939-1948.