nonsuicidal self injury, self harming, borderline personality disorder, psychopathology, schizophrenia, bipolar

1. IS SELF HARMING
BEHAVIOR A FORM OF
NIHILISM OR SUICIDE
Milen Santiago Ramos
MA MSc PhD

2. CASE STUDY
This is a case of a walk in patient who travelled all the way from
BGC to my office in Quezon City. His call for session is a cause of
concern as he seems to be very much distraught and anxious.
According to him his symptoms emanated from recent break up with
a girlfriend who broken up with him because of disparity in choice of
political figure as presidential candidate
But one has to consider that this is the fourth time that he has broken
off with partner. The first one is the longest one (i.e. 4 years) and
involves a female. The second and third one are males. And the
more recent one is a female

3. When asked about his formative years he said that as a child he
did performed well in school. But according to him his maternal
figure tend to be punitive to achieve the end result of being on top
of his class. But he is really endowed with intelligence He was
also able to finish college even while he was away from home and
land on a job despite emotional . He is from Cotabato and decided
to go MetroManila as he tend to go after the person he is in
relationship with which happened to be in the city.
While being assessed he got so symptomatic. He is having
hallucinations ….. auditory halludination mostly persecutory. It
turned out that he was also on fasting because of the Ramadan.

4. He was with his mother who came all the way from Cotabato and
decided that she would like to take care of him even for a week
to his discomfort. Maternal figure came due to his ex girlfirends
communication with his sister and told the family that he is sick.
It is so bothersome to him that he would be seen as a failure
and have not succeed.
Breathing technique was employed at the time that he got
symptomatic during assessment. He uttered the classic
statement “ Don’t leave me” or rather you will not leave me
which is associated with those with borderline personality
disorders

5. CERTIFICATE FOR
DISABILITY
MANAGEMENT
Subject was referred to a psychiatrist
for psychopharmacological
management , Dr XXX and will
undergo psychotherapeutic
intervention for behavioural
management
DIAGNOSTIC RESULTS
Subject is noted to be suffering from
BRIEF REACTIVE PSYCHOSIS
(which explains the presence of
auditory hallucination. There is also a
concomitant BORDERLINE
PERSONALITY DISORDER (for self
harming behaviour)
He did underwent psychological assessment using the
gold standard diagnostic test for psychological
assessment of Wechsler Social Intelligence Test,
Minnesota Multiphasic Personality Inventory, MIllon s
Test, Hand test, Rorschach test (Exner s Comprehensive
System) Sacks Sentence Completion test

6. HIGHLIGHTS OF THE CASE FROM THE SYMPTOMS
symptoms emanated from recent break up with a girlfriend who broken up with him
because of disparity in choice of political figure as presidential candidate
this is the fourth time that he has broken off with partner.
his maternal figure tend to be punitive to achieve the end result of being on top of
his class. But he is really endowed with intelligence He was also able to finish
college even while he was away from home and land on a job despite emotional
He is from Cotabato and decided to go MetroManila as he tend to go after the
person he is in relationship with which happened to be in the city.
Breathing technique was employed at the time that he got symptomatic during
assessment. He uttered the classic statement “ Don’t leave me

7. In the clinic nowadays
there s a lot of referral for
SELF HARMING BEHAVIOR

8. NONSUICIDAL SELF INJURY
(NSSI)
Nonsuicidal self-injury (NSSI) can be defined
as “directly and intentionally inflicting damage
to one’s own body tissue without intention of
suicide and not consistent with cultural
expectations or norms.”

9. NSSI manifests in a variety of different forms,
including cutting, skin carving, burning, severe
abrading or scratching, punching or hitting,
bone breaking, biting, pinching, interfering with
wound healing, and (rarely) auto-amputation
and ocular enucleation

10. WRIST CUTTING

11. WRIST CUTTING

12. recent form of self mutilation called skin
stitching (China)

13. SELF INJURIOUS BEHAVIOR

14. BRACE YOURSELF YOU WILL SEE MORE

18. recent reviews of community samples
have found mean and pooled rates as
high as 17% to18% of the population
NSSI is “distinct in intent, function and
epidemiology” from suicidality and a
separate entity.

19. “NSSI is not, in and of itself, a suicide attempt,” On
the contrary, it is often “used as a coping strategy to
avoid suicide.”
What distinguishes it from nonfatal suicide
attempts, since it is associated with decreased
negative emotion and increased positive affect. In
contrast, suicide attempts can lead to more
depressive symptoms and suicidal behavior due to
distress that the attempt did not actually result in
death

20. more likely to be repeated and become chronic, with
roughly one-quarter of individuals who self-injure
reporting 11 to 50 separate episodes of self-injury
The average age of onset is 13 to 14, and a second
age of onset is late adolescence —Those are key
developmental transition periods. During the first,
individuals are transitioning from junior high school
to high school, or when they are transitioning from
high school to college

21. there are gender differences in the method of self-
injury chosen, with cutting being more common in
females and burning and self-battery more common in
males. females are more likely to be identified and/or
seek help than males.
The most common reason is emotional regulation not
attention getting according to myth, when people
are trying to cope with overwhelming distress or self-
punishment, which has its origins in self-hatred.”

22. What diagnostic criteria is strongly associated
with self harm
Borderline personality disorder (BPD) or known
as emotionally unstable personality
disorder (EUPD

23. BORDERLINE
PERSONALITY
DISORDER

24. The 9 symptoms of BPD
Fear of abandonment. People with BPD are often
terrified of being abandoned or left alone. ...
Unstable relationships. ...
Unclear or shifting self-image. ...
Impulsive, self-destructive behaviors. ...
Self-harm. ...
Extreme emotional swings. ...
Chronic feelings of emptiness. ...
Explosive anger.

28. INTERVENTION

29. COGNITIVE BEHAVIORAL
THERAPY

30. Cognitive-behavioral treatments are the
cornerstone of therapy for people with borderline
personality disorder.
It is particularly helpful in the treatment of BPD when
combined with focus on understanding of thought
distortions related to self and others. Borderline
personality disorder includes symptoms that change
thought patterns, and CBT can reframe these thoughts
to manage those symptoms

31. CBT is based on several core principles, including:
1.Psychological problems are based, in part, on faulty or
unhelpful ways of thinking.
2.Psychological problems are based, in part, on learned
patterns of unhelpful behavior.
3.People suffering from psychological problems can
learn better ways of coping with them, thereby relieving
their symptoms and becoming more effective in their
lives.

32. CBT treatment usually involves efforts to change
thinking patterns. These strategies might include:
•Learning to recognize one’s distortions in thinking
that are creating problems, and then to reevaluate
them in light of reality.
•Gaining a better understanding of the behavior and
motivation of others.
•Using problem-solving skills to cope with difficult
situations.
•Learning to develop a greater sense of confidence
in one’s own abilities.

33. CBT treatment also usually involves efforts to
change behavioral patterns.
These strategies might include:
•Facing one’s fears instead of avoiding them.
•Using role playing to prepare for potentially
problematic interactions with others.
•Learning to calm one’s mind and relax one’s body.

34. DIALECTIC BEHAVIORAL
THERAPY

35. Dialectical behaviour therapy (DBT)
is a type of talking therapy. It's
based on cognitive behavioural
therapy (CBT), but it's specially
adapted for people who feel emotions
very intensely. The aim of DBT is to
help you: Understand and accept your
difficult feelings. Learn skills to
manage them.

36. Dialectical behaviour therapy (DBT) is a type of
talking therapy. It's based on cognitive
behavioural therapy (CBT), but it's specially
adapted for people who feel emotions very
intensely. The aim of DBT is to help : Understand
and accept difficult feelings. Learn skills to
manage them

37. There are four components of comprehensive
DBT: skills training group, individual treatment,
DBT phone coaching, and consultation team. DBT
skills training group is focused on enhancing clients'
capabilities by teaching them behavioral skills
Dialectical behavior therapy (DBT) must follow five
basic functions to be comprehensive in nature. These
five functions include motivating clients, teaching
skills, generalizing skills to natural environments,
motivating and improving the skills of therapists,
and structuring the treatment environment.

38. SCHEMA THERAPY

39. Schema therapy (ST) is an integrative approach
that brings together elements from cognitive
behavioral therapy, attachment and object
relations theories, and Gestalt and experiential
therapies. It was introduced by Jeff Young in 1990
and has been developed and refined since then.

40. Schema therapy shows promise as a treatment for
many mental health concerns, including eating
disorders and depression. Most of the existing
research has looked at the role of schema therapy in
treating borderline personality disorder and other
personality disorders.

41. Cognitive techniques used within
schema therapy include: data
collection, reframing/​reattribution,
schema flashcards and diaries, and
schema dialogues. Emotion-focused
techniques used with schema
therapy include: role-play / chair
work, and guided imagery.

42. RELATIONSHIP BETWEEN CBT
AND DBT
CBT DBT
CBT mainly helps clients identify and change problematic ways of
thinking and behaving, while DBT also helps clients regulate extreme
emotions to improve relationships through validation and behavior
change

43. RELATIONSHIP BETWEEN CBT AND
SCHEMA
CBT SCHEMA
Schema therapy is a psychological approach that was developed by Jeffry
Young as a modification of cognitive behavioral therapy (CBT) for patients
for whom a standard CBT was not effective

44. RELATIONSHIP BETWEEN SCHEMA
AND CBT
DBT focuses on the dialectic underlying both acceptance and change
of the patient concurrently, while schema therapy focuses on
uncovering the early maladaptive schemas that lead to dysfunctional
relationships and behavior
DBT SCHEMA

45. To answer the question
NNSI is not a form of
nihilism in fact it is to
prevent suicide BUT
accidents to happen

46. THANK YOU VERY MUCH FOR
INVITING ME