Response on Non-Suicidal Self-Injury (NSSI)

Please respond to discussion post. Please all reference should be 5 years or less. Thank you
1. Define NSSI behavior. Non-suicidal self-injury (NSSI) is defined as the deliberate destruction of one's body tissue without suicidal intent and for purposes not socially sanctioned. NSSI is associated with many psychiatric problems, including borderline personality disorder (BPD), suicidality, anxiety, and depression (Calati & Courtet, 2019). This can include self-inflicted destruction of body tissue without suicidal intent such as cutting, burning, biting, and scratching skin.
2. Discuss how the psychiatric mental health nurse practitioner (PMHNP) differentiates between NSSI and suicide attempts. Nonsuicidal self-injury (NSSI) is direct destruction of body tissue without suicidal intent or act to end one’s life. Suicide attempts refer to the engagement in potentially self-injurious behavior with some intent to die from the behavior (Calati & Courtet, 2019).
3. Discuss evidence-based therapy for BPD. Borderline personality disorder (BPD) is now effectively treated by a growing number of evidence based psychotherapeutic treatments. Suicidal personality disordered patients who did not improve with standard cognitive behavioral therapy intervention. Dialectal behavioral therapy (DBT) showed more improvement, this is completed by incorporating the concept of dialectics and the strategy of validation into a treatment focused on skills acquisition and behavioral shaping (Prada, Perroud, Rufenacht, & Nicastro, 2018). DBT proposes that individuals with BPD can become more effective in managing their sensitivities and interactions with others through acquisition of skills that enhance mindfulness and enable them to better tolerate distress, regulate their emotions, and manage relationships (Prada, Perroud, Rufenacht, & Nicastro, 2018). Mentalization is another therapy used for BPD and refers to the complex capacity human beings develop to imagine the thoughts and feelings in one’s own and other’s minds to understand interpersonal interactions (Prada, Perroud, Rufenacht, & Nicastro, 2018). MBT aims to stabilize the problems of BPD by strengthening the patient’s capacity to mentalize under the stress of attachment activation. MBT therapists adopt a stance of curiosity in order to encourage patients to assess their emotional and interpersonal situation through a more grounded, flexible, and compassionate view.
How does therapy interrupt the patterns of NSSI and suicidality? Core strategies to interrupt the patterns include change-oriented interventions like contingency management or cognitive restructuring including the practice of mindfulness (Calati & Courtet, 2019). These skills are implemented in an effort to strike a dialectical balance between accepting the reality as it is and changing behaviors that need to be changed. The four treatment modes of standard DBT includes: individual therapy, group skills training, telephone coaching, and the therapist consultation team. This type of DBT improves dysfunctional patterns of emotion regulation, impulse control, identity and improves interpersonal relationships to construct a life worth living and therefore reducing suicidal ideations and urge to self-harm. Emotionally dysregulated patients are encouraged to change their maladaptive problem-solving strategies by learning skills to tolerate distress with more effective and adaptive means (Prada, Perroud, Rufenacht, & Nicastro, 2018). Four skills modules are proposed during therapy including: mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation.
4. What specific ethical and clinical challenges might the clinician face when treating clients with BPD who are suicidal? Those who attempt suicide tend to have more symptoms of depression and display more anger and aggression. Individuals who engage primarily in NSSI tend to present with more emotional instability and volatility. Suicidal ideation is predictive of later suicide attempts (Prada, Perroud, Rufenacht, & Nicastro, 2018). It is important for the clinician to affectively diagnose, monitor, and treat these individuals to prevent death or harm. Clinicians should consider discussing with their patients what they would do if a suicide attempt occurred and even consider signing a non-suicide contract. It is important to be available for the patient however how much is too available? Challenges that must be discussed early on in treatment should include informed consent, confidentiality, conflict of interest, therapy misconceptions and operational challenges (Prada, Perroud, Rufenacht, & Nicastro, 2018). This will need to be discussed between the clinician and patient and boundaries must be set.
References
Calati, R., & Courtet, P. (2019). Is psychotherapy effective for reducing suicide attempt and non-suicidal self-injury rates? Meta-analysis and meta-regression of literature data. J. Psychiatr. Res. 79, 8–20.
Prada, P., Perroud, N., Rufenacht, E., & Nicastro, R. (2018). Strategies to Deal With Suicide and Non-suicidal Self-Injury in Borderline Personality Disorder, the Case of DBT. Front Psychol. 17(9), 2595.
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