Download - Kelly Watt McMahon - Spectrum
Understanding &
managing anger &
aggression from
people who self-harm
Kelly Watt-McMahon Consulting Clinical
Psychologist
Safe & Secure Hospitals Conference
Sydney, October 21st 2014
OutlineSelf-harm : a diagnostic indicator of borderline personality
disorder (BPD)
The features of BPD & prognosis
Stigma
Why do they self-harm?
Why do they get angry?
What helps & what doesn’t?
General management strategies for frequent flyers
Self-harm : a feature of borderline
personality disorder (BPD)
BPD is a severe mental disorder
that makes up 1-2% of the
general population & 20% of
psychiatric treatment
populations, mostly females
Chronic self-harm & suicidal
actions are a significant feature
Diagnostic features of BPD Marked by a pattern of behaviours that usually begin in
early adolescence. At least 5 of the following:
frantic efforts to avoid
abandonment
identity disturbance
chronic feelings of
emptiness & boredom
impulsive acts
recurrent suicidal
behaviours and/or self-
harm
Emotional dysregulation
Inappropriate & intense
anger
Dissociation / transient
psychosis
Unstable relationships
marked by over-valuing &
de-valuing the other
Attachment problems in BPD: BPD a disorder of attachment:
Some diagnostic criteria are a function of the person having a
disrupted attachment to caregivers early in life
This means they did not receive attuned caregiving - for
example:
mother did not form an attachment
unresponsive, neglectful, or critical parenting
trauma or abuse
Child does not internalise the ability to manage their emotions,
and has a poorly formed sense of self
BPD Prognosis
Hopeful
With treatment, better prognosis
than schizophrenia
Treatment of choice is medium
to long term psychotherapy
Specialist treatment
Stigma
Self-harming patients are stigmatised
Clinicians can experience strong negative emotions
The community finds it hard to understand
Stigma negatively impacts the patient’s ability to
recover
Why do they self-harm?
The functions of self-harm are often UNCONSICOUS
Self-harm functions to
regulate emotions
self-punish
turn emotional pain into physical pain
ground the person out of a dissociated state - make
them feel ‘real’
communicate how bad things are
Why do they get angry?
History of trauma & abuse
Extreme sensitivity to rejection
Heightened state of arousal
Expecting to be controlled / punished / abused
Can sometimes unconsciously set up situation so
this will occur
What helps?
Monitoring our own emotional reactions & how we
respond
Authentically showing an interest & care
Listening & trying to understand even if you don’t
non-controlling management - talk to them
Asking the patient what they think would help right now
Usually, custodial interventions & involuntary status
is unhelpful
What helps?cont
When there are other services involved, get to know the perspective
of other clinicians:
Know who else is involved - community supports & treating
professionals
Is there a service-wide management plan?
Does the management plan cover aggression, and if not, who
can we ask about it?
If there’s no management plan:
Be mindful of your reactions
Be authentically interested & show care
Take a collaborative approach, even with anger & potential
aggression
Thank you …
Questions please