Emotion Regulation and Self-Harm Among Forensic Psychiatric Patients

Emotion regulation has been specifically linked to both non-suicidal self-injury (NSSI) and attempted suicide. It is also known that self-harm is disproportionally higher (30–68.4%) in forensic samples than in the general population, yet knowledge about the association between emotion regulation and self-harm in forensic settings is scarce. The purpose of this study was to describe emotion regulation in a sample of forensic psychiatric patients, to explore dimensions and levels of emotion regulation between forensic psychiatric patients with and without self-harm, and to explore associations between forensic psychiatric patients’ self-reported emotion regulation and self-reported functions of NSSI. A cohort of forensic psychiatric inpatients (N=98) was consecutively recruited during 2016–2020 from a high-security forensic psychiatric clinic in Sweden. Data were collected through the self-report measures Difficulties in Emotion Regulation Scale (DERS) and Inventory of Statements About Self-injury (ISAS). In relation to the first aim, median total and subscales scores for DERS were reported. Results showed a statistically significant difference in emotion regulation between participants with and without self-harm (p=0.004), with a medium effect size (Cohen’s d=0.65) for the DERS total scale. The DERS subscales returned large differences for Impulse (p=0.001, d=0.86), Goals (p=0.014, d=0.58), and Strategies (p=0.012, d=0.54) between participants with and without self-harm. Finally, DERS scores were correlated with both the interpersonal (rs=0.531, p<0.001, n=43) and intrapersonal factors (rs=0.503, p<0.001, n=43) of NSSI as reported on the ISAS. Participants with self-harm (NSSI and/or suicide attempts) demonstrated significantly more difficulties with emotion regulation than those without self-harm. Emotion dysregulation was associated with both interpersonal and intrapersonal functions of NSSI in the participants. We suggest further studies on forensic psychiatric patients’ maladaptive behaviors that focus on substance abuse, self-harm, and aggressive behaviors in relation to the regulation and expression of emotion.

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Clinical Characteristics and Self-Harm in Forensic Psychiatric Patients

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.698372 ◽

2021 ◽

Vol 12 ◽

Author(s):

Natalie Laporte ◽

Andrejs Ozolins ◽

Sofie Westling ◽

Åsa Westrin ◽

Märta Wallinius

Keyword(s):

Affect Regulation ◽

Suicide Attempts ◽

Psychiatric Patients ◽

Conduct Disorders ◽

Structured Interviews ◽

Self Injury ◽

Forensic Psychiatric Patients ◽

Increased Risk ◽

Self Harm ◽

Forensic Psychiatric

Self-harm, comprising non-suicidal self-injury, and suicide attempts, is a serious and potentially life-threatening behavior that has been associated with poor life quality and an increased risk of suicide. In forensic populations, increased rates of self-harm have been reported, and suicide is one of the leading causes of death. Aside from associations between self-harm and mental disorders, knowledge on self-harm in forensic psychiatric populations is limited. The purpose of this study was to characterize the clinical needs of a cohort of forensic psychiatric patients, including self-harm and possible risk factors thereof. Participants (N = 98) were consecutively recruited from a cohort of forensic psychiatric patients in Sweden from 2016 to 2020. Data were collected through file information, self-reports, and complemented with semi-structured interviews. Results showed that self-harm was common among the participants, more than half (68.4%) of whom had at some point engaged in self-harm. The most common methods of non-suicidal self-injury were banging one's head or fist against a wall or other solid surface and cutting, and the most common method of suicide attempt was hanging. The most prominent functions of non-suicidal self-injury among the participants were intrapersonal functions such as affect regulation, self-punishment, and marking distress. Self-harm in general was associated to neurodevelopmental disorders (p = 0.014, CI = 1.23–8.02, OR = 3.14) and disruptive impulse-control and conduct disorders (p = 0.012, CI = 1.19–74.6, OR = 9.41), with reservation to very wide confidence intervals. Conclusions drawn from this study are that self-harm was highly prevalent in this sample and seems to have similar function in this group of individuals as in other studied clinical and non-clinical groups.

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Privacy of Patients in the Forensic Department of a Psychiatric Clinic: a phenomenological Study

Nursing Ethics ◽

10.1191/0969733002ne520oa ◽

2002 ◽

Vol 9 (4) ◽

pp. 347-360 ◽

Cited By ~ 4

Author(s):

K Koller ◽

V Hantikainen

Keyword(s):

Phenomenological Study ◽

Qualitative Content Analysis ◽

Psychiatric Patients ◽

Phenomenological Approach ◽

Psychiatric Clinic ◽

Human Right ◽

Ethical Implications ◽

Forensic Psychiatric Patients ◽

Recommendations For Practice ◽

Forensic Psychiatric

This study, based on the phenomenological approach, was aimed at exploring the meaning of privacy for forensic psychiatric patients. The narratives of two such patients, diagnosed with schizophrenia and hospitalized on a forensic unit because of a killing offence, were analysed by means of qualitative content analysis. The study was conducted in a Swiss psychiatric clinic with forensic units. The results demonstrated that ‘privacy’ is not a question of luxury but a very basic human right. The ethical implications for nurses acting as key workers in such situations are highlighted. Recommendations for practice are detailed.

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Theta/SMR Neurofeedback Training Works Well for Some Forensic Psychiatric Patients, But Not for Others: A Sham-Controlled Clinical Case Series

International Journal of Offender Therapy and Comparative Criminology ◽

10.1177/0306624x19849562 ◽

2019 ◽

Vol 63 (14) ◽

pp. 2422-2439

Author(s):

S. Fielenbach ◽

F. C. L. Donkers ◽

M. Spreen ◽

A. Smit ◽

S. Bogaerts

Keyword(s):

Clinical Case ◽

Psychiatric Patients ◽

Case Series ◽

Cortical Activity ◽

Self Report ◽

Close Monitoring ◽

Neurofeedback Training ◽

Forensic Psychiatric Patients ◽

Patient Reported ◽

Forensic Psychiatric

Electroencephalographic (EEG) neurofeedback could be a promising treatment for forensic psychiatric patients. Increasing evidence shows some patients are unable to regulate cortical activity. Before neurofeedback can be applied successfully, research is needed to investigate the interpersonal mechanisms responsible for patients’ ability to respond to neurofeedback. A single-case experimental design allows for close monitoring of individual patients, providing valuable information about patients’ response to the intervention and the time frame in which changes in clinical symptoms can be observed. Four patients with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) substance use disorder and various comorbidities participated in a sham-controlled clinical case study. Self-report level of impulsivity and craving were assessed. Results indicate that one patient showed more improvements on behavioral measures after the neurofeedback training than did the others. This patient reported less impulsivity and reduced levels of self-reported craving. However, these findings could not be attributed to the neurofeedback intervention. The findings suggest that there is insufficient evidence for the beneficial effects of a theta/sensorimotor rhythm (SMR) neurofeedback intervention on measures of impulsivity and craving, and that there may be great interindividual differences in patients’ ability to regulate cortical activity.

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Self-harm among in-school and street-connected adolescents in Ghana: a cross-sectional survey in the Greater Accra region

BMJ Open ◽

10.1136/bmjopen-2020-041609 ◽

2021 ◽

Vol 11 (1) ◽

pp. e041609

Author(s):

Emmanuel Nii-Boye Quarshie ◽

Farag Shuweihdi ◽

Mitch Waterman ◽

Allan House

Keyword(s):

Public Health Problem ◽

Self Report ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Self Injury ◽

Significant Public Health Problem ◽

Significant Public Health ◽

Treatment Measures ◽

Self Harm ◽

Greater Accra Region

ObjectivesTo identify the prevalence, methods, associations and reported reasons for self-harm among in-school and street-connected adolescents in Ghana.DesignA cross-sectional survey. We applied multi-level regression models and model-based cluster analysis to the data.SettingThree contexts in the Greater Accra region were used: second cycle schools, facilities of charity organisations and street census enumeration areas (sleeping places of street-connected adolescents, street corners, quiet spots of restaurants, markets, train and bus stations, and lorry and car parks).ParticipantsA regionally representative sample of 2107 (1723 in-school and 384 street-connected) adolescents aged 13–21 years.Outcome measuresParticipants responded to a structured self-report anonymous questionnaire describing their experience of self-harm and eliciting demographic information and social and personal adversities.ResultsThe lifetime prevalence of self-harm was 20.2% (95% CI 19.0% to 22.0%), 12-month prevalence was 16.6% (95% CI 15.0% to 18.0%) and 1-month prevalence was 3.1% (95% CI 2.0% to 4.0%). Self-injury alone accounted for 54.5% episodes and self-poisoning alone for 16.2% episodes, with more than one method used in 26% of episodes. Self-cutting (38.7%) was the most common form of self-injury, whereas alcohol (39.2%) and medications (27.7%) were the most commonly reported means of self-poisoning. The factors associated with self-harm were interpersonal: conflict with parents (adjusted OR (aOR)=1.87, 95% CI 1.24 to 2.81), physical abuse victimisation (aOR=1.69, 95% CI 1.16 to 2.47), difficulty in making and keeping friends (aOR=1.24, 95% CI 0.85 to 1.80), sexual abuse victimisation (aOR=1.21, 95% CI 0.78 to 1.87) and conflict between parents (aOR=1.07, 95% CI 0.73 to 1.56).ConclusionsSelf-harm is a significant public health problem among in-school and street-connected adolescents in the Greater Accra region of Ghana. Its origins are very largely in social and familial adversity, and therefore prevention and treatment measures need to be focused in these areas.

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Self-injurious behaviour in forensic mental health care: a study into the prevalence and characteristics of incidents of self-injury

Journal of Forensic Practice ◽

10.1108/jfp-12-2020-0053 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Vivienne de Vogel ◽

Nienke Verstegen

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Suicide Attempts ◽

Psychiatric Patients ◽

Forensic Mental Health ◽

Content Type ◽

Self Injury ◽

Forensic Psychiatric ◽

The Impact

Purpose Incidents of self-injury by forensic psychiatric patients often have a deleterious impact on all those involved. Moreover, self-injurious behaviour is an important predictor for violence towards others during treatment. The aim of this study is to analyse methods and severity of incidents of self-injury of patients admitted to forensic psychiatry, as well as the diagnoses of self-injuring patients. Design/methodology/approach All incidents of self-injury during treatment in a forensic psychiatric centre recorded between 2008 and 2019 were analysed and the severity was coded with the modified observed aggression scale+ (MOAS+). Findings In this period, 299 incidents of self-injury were recorded, displayed by 106 patients. Most of these incidents (87.6%) were classified as non-suicidal. Methods most often used were skin cutting with glass, broken plates, a razor or knife and swallowing dangerous objects or liquids. Ten patients died by suicide, almost all by suffocation with a rope or belt. The majority of the incidents was coded as severe or extreme with the MOAS+. Female patients were overrepresented and they caused on average three times more incidents than male patients. Practical implications More attention is warranted for self-injurious behaviour during forensic treatment considering the distressing consequences for both patients themselves, supervisors and witnesses. Adequate screening for risk of self-injurious behaviour could help to prevent this behaviour. Further research is needed in different forensic settings into predictors of self-injurious behaviour, more specifically, if there are distinct predictors for aggression to others versus to the self. Originality/value Incidents of self-injury occur with some regularity in forensic mental health care and are usually classified as severe. The impact of suicide (attempts) and incidents of self-injurious behaviour on all those involved can be enormous. More research is needed into the impact on all those involved, motivations, precipitants and functions of self-injurious behaviour and effective treatment of it.

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The role of psychosocial treatment in decreasing of future violence behavior risk in forensicly treated psychiatric patients

European Psychiatry ◽

10.1016/s0924-9338(11)72488-9 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 783-783

Author(s):

S. Jonovska ◽

V.Š. Jengić ◽

L. Safner ◽

G. Bošković ◽

S. Zudenigo

Keyword(s):

Psychiatric Patients ◽

Violent Behavior ◽

Psychosocial Treatment ◽

Violence Risk ◽

Forensic Psychiatric Patients ◽

Forensic Treatment ◽

Aggression Questionnaire ◽

Schizophrenic Group ◽

Forensic Psychiatric ◽

In The Beginning

The main aim of this study was to establish to what extent psychosocial treatment as a part of complex, multicomponent forensic treatment has an influence on decreasing of the future violence behavior risk in population of forensic psychiatric patients. We examinated 13 patients treated on Department of Forensic Psychiatry of Psychiatric Hospital Rab in Rab, Croatia. 9 of them were males and 4 of them females, 25–60 years of age, all of them were compulsory hospitalized because of committed criminal act connected with violent behavior. All of them have diagnosis of schizophrenic group of diseases with different duration of forensic treatment (from few months to few years). During 2010. all of them participated in psychosocial programe workshops once a week, for 6 months.MethodsViolence Risk Screening-10 (V-RISK-10), subjective measure of the programme chairmen performed in the beginning and in the end of the programme. The Aggression Questionnaire and Daily Spiritual Experience Scale as self-assesment scales were performed in the end of the programme. Results point on decreasing of V-RISK-10 results in the end of the programe in all participants. Interested observation was that mentioned results and those on self-assesment scales were not always been correlated positively. We also proved negative correlation between aggressivity and spirituality. As a conclusion, we have indications to believe that is real to expect that comining psychosocial treatment with targeted psuchopharmacological interventions could leed to decreasing the risk of future violent bihevior in forensicly treated psuchiatric patients.

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