Self-Mutilation, Risk factors and Appropriate Interventions

Self- Mutilation Concept Analysis Outline

            Self-mutilation is ranked among some of the most pressing public health concerns confronting the United States today. This has is chiefly been due to its apparent association with severe underlying mental health concerns requiring specialized care to improve patient outcomes. According to Taylor (2017), self-mutilation has majorly been associated with personality disorders where the patient acts out to as part of a maladaptive coping mechanism. Exploring this concept was, therefore necessary in order to implement it within a clinical environment to promote early detection within different populations. Furthermore, this paper will thus provide an in-depth evaluation of self-mutilation within a care setting as it relates to nursing and associated implications.

            Moreover, self-mutilation is clustered in self-injury and normally manifests in direct injury to skin tissue without suicidal intention It is, therefore, defined as non-suicidal but still remaining aware of the possibility of a fatal outcome. Sensation-seeking behaviors and self-punishment are among major motivating factors which influence the emergence of this behavior and now even associated with maintaining it (Winkler, 2017). Ultimately, patients experience a high frequency of suicidal ideations and are more likely to commit suicide compared to the general population.

            The rationale informing my decision to explore concept of self-mutilation was highly influenced by my familiarity with the subject a direct consequence of my role as a nurse within a mental/behavioral health facility. A comprehensive evaluation of the concept is, therefore, fundamental when aspiring to improve one’s own comprehension of the framework informing its manifestations and how to identify them properly within a care environment. In my clinical experience, I identified the presence of a history of cutting as a major sign of an underlying psychological disorder, especially when accompanied by anxious and depressive symptoms.

            The application of findings from the evaluation of the concept of self-mutilation is, therefore, necessary when aspiring to develop feasible interventions. Additionally, its application to nursing research and nursing education is bound to contribute to the ongoing discourse on the attitudes of nurses towards self-harm and future implications for mental health care on a global scale. This paper is, therefore, bound to promote the implementation of practicable alternatives likely to be supported by the fostering of strong nurse-patient relationships.

Self-mutilation Definition

The definition of self-mutilation according to Merriam-Webster online dictionary (2020) is:

  • Self: Noun – (I) an individual’s typical character or behavior (2) The union of elements (such as body, emotions, thoughts and sensations) that constitute the individuality and identity of a person (3) Personal interest or advantage (4) the entire person of an individual.
  • The word ‘mutilate’ means the infliction of pain or a violent act of disfiguring   deforming by slitting, removing or boring of a body part. Hence, self- mutilation refers to an injury that is widely executed by the individual in question (Merriam-Webster, 2020).

Literature Review

The evaluation of the most recent and applicable studies for this study followed the narrative approach which reviewed journal articles published between 2014 and 2020. Searches were conducted in English by focusing primarily on perspectives discussed under the title of self-mutilation. Each journal study utilized, therefore, represents an inimitable presentation on self-mutilation and its impact on patients with the condition. The Critical Appraisal Skills Program (CASP) was also crucial in informing the decision to choose the most suitable journal articles for this paper.

Literature review is an invaluable tool that often proves crucial in identifying relevant scholarly resources associated with a specific topic. The theme of search for this particular paper was, therefore, expanded by the use of keywords to identify relevant peer-reviewed scholarly resources exploring self-mutilation. Pursuant to this objective, “self-mutilation” and “nursing” were utilized as the most apposite keywords for use in this study. It was also crucial to ensure that the research material identified for use was directly linked to the research question. Leading electric databases such as the Regis College library, Sage, Medline, and EBSCOhost, and the internet search engine were useful when conducting the search protocol. The identification of eligible peer-review articles was then followed by transferring the material to the EndNote® X5 library. Apart from journal articles, cross sectional studies were also evaluated since they provide useful information regarding the implementation ever-based practice to address this particular challenge.

Hawton & Salisbury (2015) probed self-mutilation through the angle of self-harm among children and adolescents, in addition to proposing practical interventions. The preliminary evaluation of the subject matter had previously revealed that self-harm was increasingly becoming common among children and adolescent, hence the need for early intervention. This, the primary objective was to identify recommended interventions based solely on randomized control trials, compared to other forms of treatment alternatives or placebos. A meta-analysis of the 11 randomized control trials identified after applying the Cochrane Depression, Anxiety and Neurosis Group (CCDAN) trial search option identified metallization, therapeutic assessment, and dialectic behavior change as some of the most promising interventions in cases of self-harm in children. However, the authors still pointy out the need for additional large-scale trials to improve the quality of the evidence evaluated based exclusively on the GRADE criteria.

Peixoto, Toscano, & Santos (2018) conducted an in-depth review of self-mutilation by evaluating signs indicative of the disorder when making a nursing diagnosis. The primary intention of the researchers was to present new perspectives on Concept Analysis Diagnostic Self-mutilation and its implications for the nursing profession. Additionally, the study also sought to classify identifying factors and major characteristics commonly associated with early onset of the condition. The study identified alcohol and tobacco use, dependence on controlled substances, violence, and the presence of negative feelings as major factors which predispose at-risk populations to engaging in self-mutilation. Such efforts represent contributions that are currently being made mental health, accompanied by an accurate definition to distinguish it from practices such as scarification. This would ultimately go a long way in contributing to the specificity required when probing self-inflicted cuts while, simultaneously aspiring to improve the nursing practice.

NANDA-International plays a defining role in reviewing, researching, and standardizing nursing diagnosis.  Adherence to this framework is particularly significant in the case of self-mutilation since it relies on peer-reviewed process during diagnoses to guarantee accuracy. NANDA-I standards for self-mutilation, therefore, focus on definitions, defining principles and etiological factors. It also focuses on problem-focused diagnoses, risk analysis, health promotion, and syndrome. Proper definition of the concept was, therefore, meant to improve the situational awareness of clinical staff and further improve their ability to identify persons with the condition by relying on the Systematization of Nursing Assistance (SAE) manual. Future implications of its widespread use are an enhancement of clinical judgment in response to a serious public health concern.

Shaw & Sandy (2016) also evaluated self-mutilation by focusing primarily on the attitudes of mental health nurses. The study is crucial since it considers the increasing incidences of self-harm and accompanying implications for clinical staff. A qualitative approach was harnessed to detail the perspectives and attitudes of mental health nurses within a typical care setting with the ultimate aim of informing curriculum development for patients exhibiting symptoms signaling the presence of serious psychological disorder responsible for self-mutilation. The data obtained for the study was gathered using focus groups and routine interviews to conduct a phenomenological review following a strict phenomenological approach. The inference made from the review was that nurse attitudes towards self-harm were mostly negative and a direct consequence of limited skill and awareness. However, the conclusion made was the FASH model represents a practicable option for the development of new curriculum in the future.

Vander (2016) conducted a study of the prevalence of self-harming behavior among a population of university students in South Africa. The survey utilized for self-reporting in this study was used with the main aim of determining the actual frequency of self-harm behavior among respondents. 19.4 % of the respondents reported deliberate self-harm attempts during their stint at several institutions of higher learning situated in South Africa Vander (2016). Furthermore, a clear association was also drawn between engaging in risky behavior, substance abuse, and self-harming. These results were also instrumental in painting a complete picture of the impact of self-harming behaviors on young adults and accompanying consequences in cases where appropriate action is not implemented.

Zatterqvist (2015) introduces a new perspective to the ongoing debate on self-mutilation by exploring the diagnosis of non-suicidal self-injury disorder as defined in DSM-5. The study’s main focus is on empirical literature focusing mainly on the actual operationalization of the term, identifying current prevalence rates and clinical correlates. An ideal community and clinical sample population was also identified for this same purpose in order to provide an independent evaluation of the manifestation of self-injury behavior today.  The results obtained from the study endorsed distinctive NSSID diagnosis, hence the need for further study to evaluate this phenomenon and its inferences.

Edmondson, Brennan, & House (2016) conducted a systematic review focusing self-reported accounts of some of the major motivations behind non-suicidal self-harm behavior. The primary aim of conducting this study was to highlight self-harm as a major public health issues with the ultimate aim of removing barriers to care. First-hand accounts from participants were evaluated based on the initial systematic review of literature for non-suicidal motivations behind self-harm behaviors. A thorough thematic evaluation of relevant literature identified distress as a major non-suicidal reason behind self-harm behavior. Social effects associated with self-validation and distress was also identified from the first-hand accounts provided as noteworthy areas of concern for individuals with the condition.

Tsirigotis & Lukczak (2016) conducted a study on emotional intelligence and indirect destructiveness to investigate its association with self-harm. The main focus of the study was on the actual relationship that exists between emotional intelligence and self-destructiveness       using INTE and the Chronic Self-Destructiveness. A lower level of emotional intelligence was ultimately associated with poor social functioning and one of the first signs of underlying psychosocial deficiencies. The study also recommends a combination of therapeutic and prophylactic approaches to address symptoms of inherent self-destructiveness which may manifest in the form of self-harm behavior.

In summary, the resources reviewed above were crucial identifying in identifying self-harm and its impact on affected persons. The preliminary evaluation revealed that self-harm was increasingly becoming common among children and adolescent, hence the need for early intervention. Furthermore researchers new perspectives on Concept Analysis Diagnostic Self-mutilation were evaluated and their impact on the nursing profession. Additionally, it was also crucial to classify identifying factors and major characteristics commonly associated with early onset of self-mutilation. Alcohol and tobacco use, dependence on controlled substances, violence, and the presence of negative feelings were also identified as major factors which predispose at-risk populations to engaging in self-mutilation. The focus was also on problem-focused diagnoses, risk analysis, health promotion, and syndrome diagnosis. Proper definition of the concept was, therefore, meant to improve the situational awareness of clinical staff and further improve their ability to identify persons with the condition by relying on the Systematization of Nursing Assistance (SAE) manual.  The data obtained was crucial when focusing on groups and routine interviews to conduct a phenomenological review following a strict phenomenological approach. Another crucial inference was that nurse attitudes towards self-harm were mostly negative and a direct consequence of limited skill and awareness Furthermore, a clear association was also drawn between engaging in risky behavior, substance abuse, and self-harming An ideal community and clinical sample population was also identified for this same purpose in order to provide an independent evaluation of the manifestation of self-injury behavior today.  . A thorough thematic evaluation of relevant literature identified distress as a major non-suicidal reason behind self-harm behavior. A lower level of emotional intelligence was ultimately associated with poor social functioning.

Self-mutilation Defining Attributes

            Defining attributes of a particular concept normally appear repeatedly in published literature and are, therefore, crucial in clarifying its meaning. The following are major defining attributes associated with self-mutilation.

Self-injury

            The act of causing deliberate harm to one’s own body: with non-suicidal intentions in an attempt to cope with emotional angst and intense frustration (Merriam-Webster, 2020). Although self-injury may result in momentary relief, it is soon accompanied by a return of painful emotions requiring appropriate treatment in the long run to improve patient outcomes.

Self- mutilation

            Disfiguring or inflicting injury to oneself as a symptom of major emotional disturbance. Self-mutilation commonly involves the cutting or burning of skin tissue and majorly linked to personality disorders such as Borderline Personality Disorder (BPD).

  Emotions

            Represent the subjective state of an individual’s mind within a specified environment (Merriam-Webster, 2020). Emotions also emerge as a direct consequence of exposure to stimuli which predisposes to an alteration of their state of mind at any given moment.

Behavior

            The manner in which an individual acts and associated mannerisms. Behavior is also known to change an individual’s relationship to the environment.   

Self-mutilation Model Case

            J.P. is a 17-year old Caucasian female who presents to the care facility accompanied by her father who first noticed signs which seemed consistent with evidence of self-harm. The patient had clear signs of cutting on both forearms which seemed to have persisted for a considerable period. Initially, the patient appeared unreceptive but later decided to cooperate in order to receive the most suitable care to address their current challenge. J.P. admits suffering in silence and being under pressure; especially considering the fact that she experienced challenges at home and at school. She reveals that she first started experimenting with cutting 8 months ago after a protracted struggle with protracted anxiety. The patient is quick to point out that her decision was not informed by the presence of suicidal ideations but only cut her arms as a coping strategy. Cutting seemed to provide temporary relief to the worry and anxiety; ultimately becoming a major motivation behind its persistence. J.P. had successfully managed to hide evidence of cutting at home and at school by covering up and did not want to reveal this dark secret to anyone. The idea of opening up to a family member or a stranger about her struggles seemed alien and further hindered early intervention. However, she is now aware of the fact that mental health challenges confront a considerable section of society which makes it imperative to   seek professional help. A combination of mood stabilizers and psychotherapy was recommended as an appropriate intervention to address the challenges faced by patient. This case study meets the criteria for self-mutilation in adolescents. The patient is in a great deal of stress and intense frustration which then forces her to act out with the intention of finding relief in the act.

   Antecedents of Self-Mutilation

Self-mutilation is a serious public health challenge with far-reaching consequences for patients, their families, and the healthcare sector in general. Perhaps the most worrying party of engaging in self-mutilation is tissue destruction. This negative coping strategy is likely to result in the development of impaired coping strategies and an unsustainable response to stressful situations. Major risk factors for engaging in self-mutilation include gender, race, and a history of sexual abuse as a child (Winkler, 2017). . A negative consequence of self-mutilation is the fact that it gives patients the illusion of gaining control over their emotions while cementing a maladaptive coping strategy.

Empirical Referents

            The application of empirical referents is primarily meant to gauge the occurrence of a concept such as self-mutilation today.  It is crucial to make this consideration from patient’s perspectives with the aim of improving care outcomes in the long haul. This empowers patients to take control over their maladaptive coping cycle by autonomously seeking care and controlling intervention. Zattergvist (2015) utilizes the independent non-suicidal self-injury disorder (NSSID) criteria as an import intervention tool. The DSM-5 NSSID tool was also crucial in making an accurate comparison of the impact of self-mutilation among varying populations within the general population.

 Conclusion

     Self-mutilation is increasingly becoming a serious public health concern today. This has prompted concerted efforts to properly categories this phenomenon with the aim of stemming its permeation within the general population. An in-depth understanding of self-harm was, therefore, warranted to foster collaborative relationships likely to promote improved care outcomes in the future. Additionally, addressing this particular challenge is also crucial in advancing clinical competence to a level where care practitioners are now fully capable of promoting patient welfare.

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