kelly watt mcmahon - spectrum

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Safe and Secure Hospitals


  • 1. Understanding & managing anger & aggression from people who self-harmKelly Watt-McMahon Consulting Clinical PsychologistSafe & Secure Hospitals Conference Sydney, October 21st 2014
  • 2. 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 doesnt? General management strategies for frequent flyers
  • 3. 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
  • 4. 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
  • 5. 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
  • 6. BPD PrognosisHopeful With treatment, better prognosis than schizophrenia Treatment of choice is medium to long term psychotherapy Specialist treatment
  • 7. StigmaSelf-harming patients are stigmatised Clinicians can experience strong negative emotions The community finds it hard to understand Stigma negatively impacts the patients ability to recover
  • 8. 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
  • 9. 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
  • 10. What helps? Monitoring our own emotional reactions & how we respond Authentically showing an interest & care Listening & trying to understand even if you dont non-controlling management - talk to them Asking the patient what they think would help right now Usually, custodial interventions & involuntary status is unhelpful
  • 11. What helps? contWhen 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 theres no management plan: Be mindful of your reactions Be authentically interested & show care Take a collaborative approach, even with anger & potential aggression
  • 12. Thank you Questions please