Download The Reduction of Self-Mutilation in Borderline Personality Patients

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

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.
Types


Culturally Sanctioned
Deviant
 Major
 Stereotypic
 Superficial
 Compulsive
 Episodic
 Repetitive
Pathways to Self-Mutilation
Excessive Stress
Feeling overwhelmed, unable to cope
Self-mutilation
Feeling relieved, in control, and calm
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 selfmutilating 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.
DSM-IV-TR, 2002
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

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-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

Wilbarger Protocol



Deep Pressure Brushing
Joint Compressions
Sensory Diet
Champagne & Stromberg, 2004
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 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

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 sensorymodulation 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

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 sensorymodulation rooms, will significantly reduce the
desire and incidence of self-mutilation on
patients diagnosed with BPD.
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 twoyear longitudinal study.
Treatment Procedure
Control
Group
(n=75)
Experimental
Group
(n=75)
Daily group and
individual psychotherapy
sessions
X
X
Medication
X
X
Individualized sensory
diets
X
3x weekly individual
sensory integration
therapy sessions
X
Use of sensorymodulation room
X
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

The results of this study will show that sensory
integration therapy and the use of a sensorymodulation 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.