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

1. The Reduction of Self-Mutilation in Borderline Personality Patients using Sensory Integration Therapy Aron Lipman Department of Applied Psychology New York University

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

3. 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

4. Pathways to Self-Mutilation Excessive Stress Feeling overwhelmed, unable to cope Self-mutilation Feeling relieved, in control, and calm

5. Pathways to Self-Mutilation Dissociation Feeling numb, overwhelmed, unreal Self-mutilation Feeling real, alive, able to function better

6. 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

7. 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

8. 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

9. 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

10. Types of Sensory Integration • Wilbarger Protocol • Deep Pressure Brushing • Joint Compressions • Sensory Diet Champagne & Stromberg, 2004

11. 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

12. 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

13. 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

14. 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.

15. 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.

16. Treatment Procedure

17. 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.

18. 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.