Patients with Overt or Covert Self-Harm: Differences in Optimism and Self-Efficacy

Abstract

Background: Self-harming behavior seems to aim at reducing states of tension and/or reestablishing a sense of self-control. Following this assumption, it is hypothesized that self-destructive patients, especially those with overt self-harm of the skin, have reduced levels of optimism and self-efficacy. Patients and Methods: 854 general hospital patients referred to a psychosomatic-psychotherapeutic liaison-consultation service or to the outpatient department participated in the study. Using an expert rating assessment, 63 patients exhibiting selfharm (overt or covert) could be identified. For comparison, 63 patients without self-destructive behavior and 63 healthy controls were matched for age and sex. Generalized expectancies were assessed by a validated self-rating questionnaire measuring optimism and self-efficacy. Results: No differences were found between patients with or without self-destructive behavior. Yet, patients with overt self-harm had significantly lower values of optimism and self-efficacy than those who concealed their behavior. We discuss whether the self-efficacy of covertly self-destructive patients might be enhanced by perceived long-term positive effects of their behavior.

Three assessment tools for deliberate self-harm and suicide behavior: evaluation and psychopathological correlates

“…We expected to replicate those findings in our sample. Moreover, given the evidence of reduced levels of optimism and self-efficacy among patients with overt self-harm (compared to those who concealed their self-harm [27]), we expected to find lower optimism and self-efficacy in patients with self-harm compared to those without. Finally, given that self-harm is considered to be a coping mechanism that functions to alleviate distress, we expected to find heightened levels of perceived stress among self-harming patients.…”

“…Direct self-harm was the most common type (exhibited by 61.2% of all self-harming patients). There are some evidence for the criterion validity of this instrument [21,27].…”

Risk factors and correlates of deliberate self-harm behavior: A systematic review

“…In several studies, deliberate self-harm was associated with low self-esteem and low problem-solving abilities. Self-harmers showed a lower belief in self-efficacy [80] and had a higher tendency towards a self-blaming coping style [73] and to selfderogation [26,88] than non-self-harmers.…”

When Emotional Problems Explode

“…Often self-therapy creates psychological areas of resistance that are best left intact by the psychotherapist. Fliege et al [2004] demonstrate that it is possible to make a scientific research study with selfharming patients and point to the differences of overt or covert self-harm. Over the last years, we have also benefited from the experiences of psychotherapy with post-traumatic or borderline personality disorders as well from the psychodynamic [Clarkin et al, 1993] or behavioral points of view [Linehan, 1993].…”