| Abstract | Uvod: Ciljevi istraživanja bili su istražiti pojavnost nekih unutranjih (psihičke karakteristike i poteškoće, mehanizmi obrane, aleksitimija) i vanjskih čimbenika (nepovoljna razvojna, obiteljska iskustva, funkcioniranje u školi i grupi vršnjaka, kršenje pravila) u adolescenata sa samoozljeđujućim ponašanjem koja ih razlikuju u odnosu na adolescente koji ne pokazuju samoozljeđujuće ponašanje.
Ispitanici: U istraživanju je sudjelovalo 150 adolescenta u dobi od 14 do 18 godina. Nakon inicijalnog razgovora sa dječjim i adolescentnim psihijatrom i ispunjavanja samoocjenskih upitnika podijeljeni su skupinu sa (24 ispitanika i 55 ispitanica) i bez samoozljeđujućeg ponašanja (45 ispitanika i 26 ispitanica). Korišteni su mjerni instrumenti: Semistrukturirani klinički intervju za djecu i adolescente, Opći upitnik, Torontska skala aleksitimije, Upitnik povezanosti s roditeljima, Upitnik o obrambenim stilovima, Prilagođena skala funkcionalne procjene samomutilacije, Izvješće za mlade od 11 do 18 godina
Rezultati: Kod ispitanica samoozljeđujuće ponašanje je povezano sa smanjenom roditeljskog brigom, pogotovo oca, intenzivnom depresivnošću u komorbiditetu s eksternalizirajućim tegobama, značajno lošijim funkcioniranjem u grupi vršnjaka, korištenjem više nezrelih i manje zrelih mehanizama obrane, latentnom aleksitimijom. Kod ispitanika samoozljeđujuće ponašanje povezano je s kroničnom bolešću i prezastičnički roditeljskim stilom majke, s korištenjem nezrelijih mehanizama obrane, aleksitimičnim smetanjama, komorbiditetom visoke razine eksternalizirajućih i subsindromalnih internalizirajućih smetnji, teškoćama u vršnjačkim grupama
(interpersonalna i identitetna funkcija samoozljeđivanja). Rezultati sindromskih skala su svih ispitanika imali kliničku razinu.
Zaključak: Postoje psihopatološke i okolinske specifičnosti kod adolescenata sa samoozljeđivanjem. Njihovo poznavanje nužno je za planiranje, razvijanje i provođenje prilagođenih preventivnih i kurativnih programa koji za sada ne postoje u Republici Hrvatskoj. |
| Abstract (english) | Introduction:
Self-harming behavior is prevalent both in community and in clinical population of adolescents. Potential negative outcomes of such behavior range from low quality of life, academic failure, development of mental health problems in later life to risk of suicide attempts and completition. Broadening and deepening of understanding of psychopathological and enviromental background and function of self-harming behavior is needed. Main goal of this study was identification of psychopathological features in referred adolescents with self-harming behavior which differentiate them from referred adolescents who do not engage self-harming behavior. Data provided with this study could be used in planning, preparing and conducting optimized treatment programs for adolescents and their caregivers, on primary and secondary prevention and treatment levels.
Materials and methods:
During their initial interview with an child and adolescent psychiatrist adolescents filled out self-rated questionnaires. General questionnaire (with detailed family history), Youth Self Report, (ASEBA, 2001.), Functional Assessment of Self Mutilation (Lloyd E.,1997) - Adapted and modified, Parental bonding instrument (Parker, 1979.), Toronto Alexithymia Scale 20 (Taylor, 1992.) and Defense Style Questionnaire (Bond, 1983.). One hundred and fifty adolescents, 54% female, 46 % male (14–18 years old, median age 17 years) participated in the study. Exclusion criteria were psychotic disorders, cognitive impairment, pervasive spectrum, psychiatric emergency. They were assigned to two
groups according to self-harming status. In the self-harming group there were 24 males i 55 females, and in the non self-harming group there were 45 males and 26 females.
Results: Self-harming behavior among females, compared to non self-harming group, corelates with low parental, especially paternal, care, commorbidity of depressive and externalising problems (clinical level on all YSR problem scales, except aggression), poor peer relationships, usage of immature defense mechanisms, and latent alexithymia. Self-harming behavior had negative interpersonal function. Self-harming behavior among males was correlated with maternal chronic illnes, maternal overprotection, commorbidity of externalising and latent internalising problems, usage of immature defense mechanisms, significant alexithymic difficulties, poor peer functioning. Self-harming behavior had positive interpersonal and identity and identification seeking function. Predominant parental style in both groups with self-harming behavior was affectionless control. Clinical levels of YSRs’ Total problems scale were found in both gender.
Conclusion
Self-harming behavior is prevalent among adolescents. Affected adolescents carry heavy psychopathological burden, with a risk for numerous negative events and outcomes including fatality. It has diverse, individually specific manifestations and functions which complicates research, understanding and clinical work. Hence, there are no specific, standardized preventive measures and treatment strategies developed yet. Interventions dealing with self-harming behavior should encompass multidisciplinary and multilevel approach, significant others need to be actively included in the process. Close follow-up and availability of help is needed because of the suicidal risk. |
