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The Reduction of Self-Mutilation in Borderline Personality Patients using Sensory Integration Therapy. Aron Lipman Department of Applied Psychology New York University. Acknowledgements. Specialized Programs in Occupational Therapy Services (SPOTS) Prudence Heisler, OT/L

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The Reduction of Self-Mutilation in Borderline Personality Patients using Sensory Integration Therapy

Aron Lipman

Department of Applied Psychology

New York University

acknowledgements
Acknowledgements
  • Specialized Programs in Occupational Therapy Services (SPOTS)
  • Prudence Heisler, OT/L
  • Michelle Kafko, OTR/L
  • Lindsey Britchkow, OTR/L
  • Peer Reviewers
self mutilation
Definition

A way to cope, release tension, lessen anger, gain control and security, self-regulate, and create a feeling of euphoria.

Self-mutilation can also have an immediate orienting effect, acting as intense, calming, or alerting stimuli enabling the individual to feel alive.

Self-Mutilation

Types

  • Culturally Sanctioned
  • Deviant
    • Major
    • Stereotypic
    • Superficial
      • Compulsive
      • Episodic
      • Repetitive
pathways to self mutilation
Pathways to Self-Mutilation

Excessive Stress

Feeling overwhelmed, unable to cope

Self-mutilation

Feeling relieved, in control, and calm

pathways to self mutilation5
Pathways to Self-Mutilation

Dissociation

Feeling numb, overwhelmed, unreal

Self-mutilation

Feeling real, alive, able to function better

borderline personality disorder
BPD is a “pervasive pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by…recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.”

BPD is the only mental illness under personality disorders in the DSM-IV-TR that has self-mutilation as one of its main diagnostic criteria.

Borderline Personality Disorder

DSM-IV-TR, 2002

self mutilation among bpd patients
Self-Mutilation among BPD Patients
  • 6-10 million Americans are diagnosed with BPD.
  • 75% of BPD patients engage in self-injurious behavior.
  • The rate of unintentional suicides, as a result of self-injurious behavior in BPD patients, is rising.
  • There is a major gap in the research in terms of effective forms of treatment that properly address the growing number self-injurious BPD patients.

Moro, 2007

occupational therapy
Occupational Therapy
  • The use of purposeful activity or interventions designed to achieve functional outcomes.
  • Occupational therapists help people who are injured or ill regain their maximum level of functioning.
  • Therapists address three crucial aspects of a person’s life:
    • Activities of daily living
    • Work/productive activities
    • Play/leisure activities
sensory integration
Sensory Integration
  • Sensory-based therapy addresses:
    • An understanding of the sensory dimensions of human behavior.
    • The brain’s interpretation and organization of stimuli from an individual’s environment.
    • Adaptive responses for appropriate engagement in occupation.
    • The use of controlled sensorimotor experiences that help individuals function better in their environment.

Baranek, 1998; Bright, Bittick, & Fleeman, 1981; Moro, 2007

types of sensory integration
Types of Sensory Integration
  • Wilbarger Protocol
    • Deep Pressure Brushing
    • Joint Compressions
    • Sensory Diet

Champagne & Stromberg, 2004

types of sensory integration11
Types of Sensory Integration
  • Weighted Pressure Vest
    • A woman with a history of self-mutilation described her weighted pressure vest as a “bullet proof vest…in which nobody can hurt me.”
    • She now asks for her vest when she has the urge to self-mutilate because the pressure across her back and chest helps her “stay in control.”

Champagne & Stromberg, 2004

types of sensory integration12
Types of Sensory Integration
  • The Sensory-Modulation Room offers a combination of sensorimotor activities with calming and alerting options for all sensory areas.

Champagne & Stromberg, 2004

related studies
Related Studies
  • There have only been two studies looking at the use of sensory-based techniques and sensory-modulation rooms as treatment for self-injurious behavior.
    • In one study (N=47), 89% of the participants reported positive effects from the use of a sensory-modulation room.
    • In the second study (N=3), 2 out of the 3 women reported that after receiving sensory based treatment they no longer felt the urge to engage in self-injurious behavior.

Champagne & Sayer, 2003; Moore & Henry, 2002

research question hypothesis
Research Question & Hypothesis

Is Sensory Integration, as provided by an occupational therapist, an effective form of treatment for people diagnosed with borderline personality disorder who self-mutilate?

The use of sensory integration therapy, specifically the Wilbarger Protocol and sensory-modulation rooms, will significantly reduce the desire and incidence of self-mutilation on patients diagnosed with BPD.

participants
Participants
  • 150 females all diagnosed with BPD and with known self-injurious behavior.
  • Must be 20 years of age or older at the beginning of study.
  • SES, race, and ethnicity will not be taken into account.
  • Participants must be willing to commit to a two-year longitudinal study.
procedure
Procedure
  • Participants will be interviewed by a psychologist using the Revised Diagnostic Interview for Borderlines (DIB-R) at baseline.
  • Participants will receive 4 months of inpatient treatment, followed by 8 months of outpatient treatment.
  • Participants will be required to record daily their desire to self-mutilate, their feelings, and if applicable, their response to the desire to self-mutilate.
  • At the end of the first year, a standard discharge plan will be suggested to each participant.
  • A follow-up interview will be conducted at the end of the second year.
expected results and benefits
Expected Results and Benefits
  • The results of this study will show that sensory integration therapy and the use of a sensory-modulation room as components of a larger treatment plan will reduce the use of self-injurious behavior in patients diagnosed with BPD.
  • Current trends indicate that the numbers of people self-mutilating are increasing, and as a result unintentional suicides are also increasing.
  • Additionally, the results of the study will benefit all people who use self-mutilation as a coping mechanism or a way to self-regulate.