Download PDF
Nervenheilkunde 2013; 32(01/02): 30-36
DOI: 10.1055/s-0038-1628476
Selbstverletzendes Verhalten
Schattauer GmbH

Psychotherapie von nicht suizidalem selbstverletzendem Verhalten

Psychotherapeutic interventions for non-suicidal self-injury
R. C. Groschwitz
1   Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Ulm
,
P. L. Plener
1   Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Ulm
› Author Affiliations
Further Information

Publication History

eingegangen am: 31 May 2012

angenommen am: 16 August 2012

Publication Date:
22 January 2018 (online)

    Permissions and Reprints

Zusammenfassung

Nicht suizidales selbstverletzendes Verhalten (NSSV) stellt ein heterogenes Verhaltensmuster dar, das häufig komorbid zu weiteren psychiatrischen Symptomen auftritt. Aktuelle internationale Vergleiche ergeben eine Lebenszeitprävalenz hinsichtlich NSSV von 19% im Jugendalter und 5,6% in der Gesamtbevölkerung. Diese Zahlen verdeutlichen die Notwendigkeit effektiver Therapieverfahren, die speziell auf die Behandlung von NSSV ausgerichtet sind. Bislang existieren nur wenige Studien, die sich auf die Reduktion von NSSV im Rahmen einer therapeutischen Intervention beziehen. In dieser systematischen Übersichtsarbeit werden Ergebnisse bezüglich der Inanspruchnahme von Hilfeangeboten und der Effektivität kognitiv-behavioraler und psychodynamischer Therapieverfahren bei NSSV in Bezug auf Erwachsene und Jugendliche dargestellt. Erste vielversprechende Effekte zeigen sich vor allem im Bereich kognitiv-behavioraler Interventionen. Diese müssten jedoch anhand größerer, repräsentativer Stichproben und mithilfe einheitlich definierter Zielvariablen validiert werden.

Summary

Non-suicidal self-injury (NSSI) comprises a heterogenic behavioural pattern, which is associated with a number of psychiatric symptoms. Current international comparisons illustrate a 19% life-time prevalence of NSSI in youth and 5.6% in the general population. These numbers point to the necessity of effective therapeutic interventions which focus on the treatment of NSSI. To date few studies evaluating the reduction of NSSI through psychotherapeutic treatment exist. In this systematic review, we discuss results concerning the utilisation of therapeutic help and the effectiveness of cognitive-behavioral and psychodynamic interventions on NSSI with regards to adults and adolescents. First encouraging results, especially regarding cognitive-behavioral methods, can be reported. However, these results would have to be validated using larger, more representative samples and defining NSSI as outcome-variable.

Schlüsselwörter

Nicht suizidales selbstverletzendes Verhalten (NSSV) - Psychotherapie - Behandlung - Review

Keywords

Non-suicidal self injury (NSSI) - psychotherapy - treatment - review
 

  • Literatur

  • 1 Lloyd-Richardson EE. et al. Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychological Medicine 2007; 37: 1183-92.
    CrossrefPubMedGoogle Scholar
  • 2 Linehan MM. Cognitive behavioral treatment of borderline personality disorder. New York: Guilford Press; 1993
    Google Scholar
  • 3 Madge N. et al. Deliberate self-harm within an international community sample of young people: Comparative findings from the Child & Adolescent Self-Harm in Europe (CASE) study. Journal of Child Psychology and Psychiatry 2008; 49: 667-77.
    CrossrefPubMedGoogle Scholar
  • 4 American Psychiatric Association. DSM-5 development. Non-suicidal self injury. 2012 www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=443
    PubMed
  • 5 Plener PL. et al. Non-suicidal self-injury: state of the art perspective of a proposed new syndrome for DSM V. Child and Adolescent Psychiatry and Mental Health 2012; 06: 9.
    CrossrefPubMedGoogle Scholar
  • 6 Andover MS. et al. The co-occurrence of non-suicidal self injury and attempted suicide among adolescents: Distinguishing risk factors and psychosocial correlates. Child and Adolescent Psychiatry and Mental Health 2012; 06: 11.
    CrossrefPubMedGoogle Scholar
  • 7 Petermann F. et al. Selbstverletzendes Verhalten-Diagnostik und psychotherapeutische Ansätze. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie 2007; 55: 123-33.
    CrossrefGoogle Scholar
  • 8 Muehlenkamp JJ. et al. International prevalence of non-suicidal self-injury and deliberate self-harm in adolescents. Child and Adolescent Psychiatry and Mental Health 2012; 06: 10.
    CrossrefPubMedGoogle Scholar
  • 9 Moran P. et al. The natural history of self-harm from adolescence to young adulthood: A population based cohort study. The Lancet 2012; 379: 236-43.
    CrossrefPubMedGoogle Scholar
  • 10 Brunner R. et al. Prevalence and psychological correlates of occasional and repetitive deliberate selfharm in adolescents. Archives of Pediatrics and Adolescent Health 2007; 161: 641-9.
    Google Scholar
  • 11 Washburn JJ. et al. Psychotherapeutic Approaches to non-suicidal self-injury in adolescents. Child and Adolescent Psychiatry and Mental Health 2012; 06: 14.
    CrossrefPubMedGoogle Scholar
  • 12 Muehlenkamp JJ. Empirically supported treatments and general therapy guidelines for non-suicidal self-injury. Journal of Mental Health Counseling 2006; 28: 166-85.
    CrossrefGoogle Scholar
  • 13 Plener PL. et al. Selbstverletzendes Verhalten im Jugendalter. Z Kinder Jugendpsych Psychoth 2010; 38: 77-89.
    Google Scholar
  • 14 Walsh BW. Treating self-injury. New York: Guilford Press; 2006
    Google Scholar
  • 15 Nock MK. Understanding non-suicidal self-injury. Washington D.C: American Psychological Association; 2008
    Google Scholar
  • 16 Nixon MK. et al. Self-injury in youth. The essential guide to assessment and intervention. New York: Routledge; 2009
    Google Scholar
  • 17 Hawton KE. et al. Psychosocial and pharmacological treatments for deliberate self harm. The Cochrane Collaboration. 2009
    PubMedGoogle Scholar
  • 18 Fortune S. et al. Adolescents’ views on preventing self-harm. Soc Psychiatry Psychiatr Epidemiol 2007; 43: 96-104.
    PubMedGoogle Scholar
  • 19 Fortune S. et al. Help-seeking before and after episodes of self-harm: a descriptive study in school pupils in England. BMC Public Health 2008; 08: 369.
    CrossrefPubMedGoogle Scholar
  • 20 Laukkanen E. et al. A brief intervention is sufficient for many adolescents seeking help from low threshold adolescent psychiatric services. BMC Health Services Research 2010; 10: 261.
    CrossrefPubMedGoogle Scholar
  • 21 Ougrin D. et al. Specific psychological treatment versus treatment as usual in adolescents with selfharm. Crisis. 2010 31. doi: 10.1027/0227- 5910/a000060..
    PubMedGoogle Scholar
  • 22 Ougrin D. et al. Self-harm in young people. A therapeutic assessment manual. London: Hodder Arnold; 2010
    Google Scholar
  • 23 Ougrin D. et al. Therapeutic assessment based on cognitive-analytic therapy for young people presenting with self-harm: Pilot study. Psychiatric Bulletin 2008; 32: 423-6.
    CrossrefGoogle Scholar
  • 24 Ougrin D. et al. Trial of Therapeutic Assessment in London: Randomised controlled trial of therapeutic assessment versus standard psychosocial assessment in adolescents presenting with self-harm. Arch Dis Child 2011; 96: 148-53.
    CrossrefPubMedGoogle Scholar
  • 25 Newman CF. et al. Cognitive therapy for non-suicidal self-injury. In: Nock MK. Understanding non-suicidal self-injury: Origins, assessment, and treatment. Washington DC: American Psychological Association; 2009: 201-19.
    Google Scholar
  • 26 Slee N. et al. Cognitive-behavioural intervention for self-harm: randomised controlled trial. The British Journal of Psychiatry 2008; 192: 202-11.
    CrossrefPubMedGoogle Scholar
  • 27 Hayes SC. et al. Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford Press; 1999
    Google Scholar
  • 28 Gratz KL. et al. Preliminary data on an acceptancebased emotion regulation group intervention for deliberate self-harm among women with borderline personality disorder. Behavior Therapy 2006; 37: 25-35.
    CrossrefPubMedGoogle Scholar
  • 29 Winter DA. Personal construct psychology in clinical practice: Theory, research and applications. London: Routledge; 1992
    Google Scholar
  • 30 Kelly GA. The psychology of personal constructs. New York: Routledge; 1991
    Google Scholar
  • 31 D’Zurilla TJ. et al. Problem solving and behaviour modification. J Abnorm Psychol 1971; 78: 107-26.
    CrossrefPubMedGoogle Scholar
  • 32 Hawton K. et al. Deliberate self-harm: A systematic review of the efficacy of psychosocial and pharmacological treatments in preventing repetition. British Medical Journal 1998; 317: 441-7.
    CrossrefPubMedGoogle Scholar
  • 33 Townsend E. et al. The efficacy of problem-solving treatments after deliberate self-harm: Meta-analysis of randomized controlled trials with respect to depression, hopelessness and improvement in problems. Psychological Medicine 2001; 31: 979-88.
    PubMedGoogle Scholar
  • 34 Evans K. et al. Manual-assisted cognitive-behaviour therapy (MACT): A randomized controlled trial of a brief intervention with bibliotherapy in the treatment of recurrent deliberate self-harm. Psychological Medicine 1999; 29: 19-25.
    CrossrefPubMedGoogle Scholar
  • 35 Tyrer P. et al. Randomized controlled trial of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: the POPMACT study. Psychological Medicine 2003; 33: 969-76.
    CrossrefPubMedGoogle Scholar
  • 36 Byford S. et al. Cost-effectiveness of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: A decision-making approach. Psychological Medicine 2003; 33: 977-86.
    CrossrefPubMedGoogle Scholar
  • 37 Crowe M. et al. Repeated self-injury and its management. International Review of Psychiatry 2000; 12: 48-53.
    CrossrefGoogle Scholar
  • 38 Lynch RT. et al. Behavior therapy for non-suicidal self-injury. In Nock MK. Understanding nonsuicidal self-injury. Washington, DC: American Psychological Association; 2009: 221-50.
    Google Scholar
  • 39 Bohus M. et al. Psychopathologie und Therapie der Borderline Persönlichkeitsstörung. Nervenarzt 2007; 78: 1069-81.
    CrossrefPubMedGoogle Scholar
  • 40 Barley WD. et al. Development of an inpatient cognitive-behavioral treatment program for borderline personality disorder. Journal of Personality Disorders 1993; 07: 232-40.
    CrossrefGoogle Scholar
  • 41 Bohus M. et al. Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: A controlled trial. Behaviour Research and Therapy 2006; 42: 487-99.
    Google Scholar
  • 42 Linehan MM. et al. Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry 1991; 48: 1060-4.
    CrossrefPubMedGoogle Scholar
  • 43 Stanley B. et al. Brief dialectical behavior therapy (DBT-B) for suicidal behavior and non-suicidal self injury. Archives of Suicide Research 2007; 11: 337-41.
    CrossrefPubMedGoogle Scholar
  • 44 Bateman A. et al. Effectiveness of partial hospitalization in the treatment of borderline personality disorder a randomized controlled trial. Am J Psychiatry 1999; 156: 1563-9.
    CrossrefPubMedGoogle Scholar
  • 45 Bateman A. et al. Mentalization based treatment for borderline personality disorder. World Psychiatry 2010; 09: 11-5.
    CrossrefPubMedGoogle Scholar
  • 46 Bateman A. et al. Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder. Am J Psychiatry 2009; 166: 1355-64.
    CrossrefPubMedGoogle Scholar
  • 47 Bateman A. et al. 8-year follow-up of patients treated for borderline personality disorder: Mentalization-based treatment versus treatment as usual. Am J Psychiatry 2008; 165: 631-8.
    CrossrefPubMedGoogle Scholar
  • 48 Kernberg OF. et al. Transference focused psychotherapy: Overview and update. Int J Psychoanal 2008; 89: 601-20.
    CrossrefPubMedGoogle Scholar
  • 49 Clarkin JF. et al. Psychotherapy for borderline personality: Focusing on object relations. Washington, DC: American Psychiatric; 2006
    Google Scholar
  • 50 Clarkin JF. et al. Evaluating three treatments for borderline personality disorder: A multiwave study. Am J Psychiatry 2007; 164: 922-8.
    CrossrefPubMedGoogle Scholar
  • 51 Doering S. et al. Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: Randomised controlled trial. BJP 2010; 196: 389-95.
    CrossrefPubMedGoogle Scholar
  • 52 Giesen-Bloo J. et al. Outpatient psychotherapy for borderline personality disorder. Archives of General Psychiatry 2006; 63: 649-58.
    CrossrefPubMedGoogle Scholar
  • 53 Hobson RF. Forms of Feeling. The Heart of Psychotherapy. Tavistock: London: 1985
    Google Scholar
  • 54 Meares R. The conversational model: An outline. American Journal of Psychotherapy 2004; 01: 51-6.
    Google Scholar
  • 55 Shapiro D. et al. Raters manual for the Sheffield Psychotherapy Rating Scale. Sheffield: MRC/ESRC Social & Applied Psychology Unit, University of Sheffield, Memo 1154. 1990
    PubMedGoogle Scholar
  • 56 Meares R. et al. Psychotherapy with borderline patients: 1. A comparison between treated and untreated cohorts. Australia and New Zealand Journal of Psychiatry 1999; 33: 467-72.
    CrossrefPubMedGoogle Scholar
  • 57 Korner A. et al. Borderline personality disorder treated with the conversational model: a replication study. Comprehensive Psychiatry 2006; 47: 406-11.
    CrossrefPubMedGoogle Scholar
  • 58 Stevenson J. et al. Five-year outcome of outpatient psychotherapy with borderline patients. Psychological Medicine 2005; 35: 79-87.
    CrossrefPubMedGoogle Scholar
  • 59 Burns J. et al. Clinical management of deliberate self-harm in young people: The need for evidencebased approaches to reduce repetition. Aust NZ J Psychiatry 2005; 39: 121-8.
    CrossrefPubMedGoogle Scholar
  • 60 Wood A. et al. Randomized trial of group therapy for repeated deliberate self-harm in adolescents. J Am Acad Child Adolesc Psychiatry 2001; 40: 1246-53.
    CrossrefPubMedGoogle Scholar
  • 61 Green JM. et al. Group therapy for adolescents with repeated self harm: randomised controlled trial with economic evaluation. BMJ 2011; 342: d682.
    CrossrefPubMedGoogle Scholar
  • 62 Hazell PL. et al. Group therapy for repeated selfharm in adolescents: Failure of replication of a randomized trial. J Am Acad Child Adolesc Psychiatry 2009; 48: 662-70.
    PubMedGoogle Scholar
  • 63 Miller AL. et al Dialectical behavior therapy adapted for suicidal adolescents. Journal of Practice Psychiatry and Behavior Health 1997; 03: 78-86.
    Google Scholar
  • 64 Fleischhaker C. et al. Dialektisch-Behaviorale Therapie für Adoleszente (DBT-A) - Eine Pilotstudie zur Therapie von Suizidalität, Parasuizidalität und selbstverletzenden Verhaltensweisen bei Patienten mit Symptomen einer Borderlinestörung. Zeitschrift für Kinder und Jugendpsychiatrie und Psychotherapie 2006; 34: 15-27.
    PubMedGoogle Scholar
  • 65 Böhme R. et al. Dialektisch-Behaviorale Therapie für Jugendliche (DBT-A) - Therapiemanual. Abt. für Psychiatrie und Psychotherapie im Kindesund Jugendalter, Universität Freiburg. 2002
    PubMedGoogle Scholar
  • 66 Fleischhaker C. et al. Dialectical behavioral therapy for adolescents (DBT-A): A clinical trial for patients with suicidal and self-injurious behavior and borderline symptoms with a one-year follow-up. Child and Adolescent Psychiatry and Mental Health 2011; 05: 3.
    CrossrefPubMedGoogle Scholar
  • 67 Miller AL. et al. Dialectical behaviour therapy with suicidal adolescents. New York: Guilford Press; 2007
    Google Scholar
  • 68 Quinn CR. Efficacy of dialectical behavior therapy for adolescents. Australian Journal of Psychology 2009; 61: 156-66.
    CrossrefGoogle Scholar
  • 69 Plener PL. et al. “Stop cutting-rock!”: A pilot study of a music therapeutic program for self-injuring adolescents. Music and Medicine 2010; 02: 59-65.
    CrossrefGoogle Scholar
  • 70 Taylor LMW. et al. Development and pilot evaluation of a manualized cognitive-behavioural treatment package for adolescent self-harm. Behavioural and Cognitive Psychotherapy 2011; 39: 619-25.
    CrossrefPubMedGoogle Scholar
  • 71 Ryle A. Cognitive analytic therapy and borderline personality disorder: The model and the method. Chichester: Wiley; 1997
    Google Scholar
  • 72 Chanen AM. et al. Early intervention for adolescents with borderline personality disorder using cognitive analytic therapy: A randomised controlled trial. Br J Psychiatry 2008; 193: 477-84.
    CrossrefPubMedGoogle Scholar
  • 73 Chanen AM. et al. Early intervention for adolescents with borderline personality disorder: quasiexperimental comparison with treatment as usual. Australian and New Zealand Journal of Psychiatry 2009; 43: 397-408.
    CrossrefPubMedGoogle Scholar
  • 74 Brent D. et al. Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: The TORDIA randomized controlled trial. JAMA 2008; 299: 901-13.
    CrossrefPubMedGoogle Scholar
  • 75 Selekman MD. Living on the Razor’s Edge. New York: W.W. Norton & Company; 2002
    Google Scholar
  • 76 Klonsky The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review 2007; 27: 226-39.
    CrossrefPubMedGoogle Scholar