Assessing the functions of self-harm behaviours in a high secure hospital setting for patients deemed dangerous and severely personality disordered

Abstract

Objectives: The present research aims to investigate what purpose[s] self-harm serves for male patients in a dangerous and severe personality disorder unit in Rampton high secure hospital. It is proposed that existing functional models of self-harm should be modified to suit this group due to environmental constraints and features of their diagnoses. Methods: A model of self-harm was devised from interviews with patients, literature reviews and a pilot review of daily nursing notes, therapy notes and incident reports. The ten proposed functions for self-harm in this population were affect regulation, interpersonal influence, control, sensation seeking, psychosis, feeling generation, self-punishment, anti-suicide, revenge and the expression of aggressive intent. This was applied to data collected from incident reports and daily nursing notes on all incidents (n=386) of self-harm for all current patients (n=53) in the unit in December 2008, in order to establish the nature and context of the incidents, i.e. the location, time and method of self-harm, as well as the function of the behaviour. Results: The nature and context of self-harm was similar to that in other inpatient and secure settings, except the number of incidents, which did not vary according to time of day. The functions of self-harm were diverse, and there was evidence for those unique to this population. Conclusions: Future research intends to develop a behavioural classification system for the assessment of motivations for self-harm that can be administered to staff and patients. The clinical impact of this work is discussed.