Cutters

sbic56, BSN, RN · Apr 22, 2005

You'll see people who cut on the psych ward, but treatment is best delivered on an outpatient basis, so any admission will probably be a very short one or should be. These people usually carry a borderline personality disorder diagnosis. The environment on a psych unit can be such that it actually exacerbates the behaviors of the disorder. DBT is a behavioral therapy often used to help these patients in reforming reactions to life's stressors. DBT link:

http://www.palace.net/~llama/psych/dbt.html

Best of luck in your psych nursing endeavors!!

wannabepsychnurse · Apr 22, 2005

thanks so much! I would just LOVE to work with teenage cutters. And like to how involved should you get with your patients? Because I'm a pretty compassionate person and my parents think that I would get too upset in psych because I would care so much about them, but I think that the patients who are in the psych ward need some one too care about them and want them to get better dont you think??? Any input you have I would love to hear about. And like for any one else reading what kind of person does it take to work in psych. Id love to hear from anyone! thanks so much

kate (wannabepsychnurse) :balloons:

psychpt · Apr 24, 2005

the notion that cutters usually carry a dx of bpd is actually outdated. self harm is only one possible symptom out of five that needs to be satisfied to be given the dx of bpd and it is sad to see that there are still psych nurses of all people who are working and believe that cutters are necessarily suffering bpd. if you took the time to get to know your patients you would find out that many of them are suffering other complex problems, such at ptsd. it is easy to label someone bpd, even though the credibility of such a 'label' is being questioned entirely and may be scrapped.

if you want to work on an adolescent psych ward, you are going to be seeing self harm of all sorts (not just cutting) on a daily basis. don't go into this area because you want to help people stop cutting. go into this area because you are willing to stick with your patients as they work through the underlying issues that have led them to self harm. you can't save people from themeselves. psych requires dedication and commitment to developing therapeutic relationships with patients so that they can eventually adopt healthier coping strategies.

sbic56, BSN, RN · Apr 24, 2005

Good advice to wannabepsychnurse regarding caring for teenagers who cut, psychpt. Yes, I know BPD is a controversial diagnosis and agree labels can be harmful. The point I was more getting at was that we no longer try to treat people for long periods of time on psych units who cut, as it is not the best place to do it. Remembering how poorly those who use self abusive behavior to cope did 10-15 years ago when kept on a psych unit for long periods of time was what triggered my response. It was not a good situation and made matters worse. I see you are in Australia. Is DBT used there?

sbic56, BSN, RN · Apr 24, 2005

thanks so much! I would just LOVE to work with teenage cutters. And like to how involved should you get with your patients? Because I'm a pretty compassionate person and my parents think that I would get too upset in psych because I would care so much about them, but I think that the patients who are in the psych ward need some one too care about them and want them to get better dont you think??? Any input you have I would love to hear about. And like for any one else reading what kind of person does it take to work in psych. Id love to hear from anyone! thanks so much
kate (wannabepsychnurse) :balloons:

I thought this was a nice informative site about teenage cutting.

http://kidshealth.org/teen/your_mind/mental_health/cutting.html

Healthy boundaries are very important when it comes to working with patients. Certainly you need to be caring and want to sincerely be of help, but your job is to help the person to learn how to help themselves to cope in a postive manner.

barefootlady, ADN, RN · Apr 24, 2005

What a great post psychpt! Thanks. :flowersfo :yelclap:

psychpt · Apr 24, 2005

DBT is starting to become more readily available in Australia, but it is still considered very new and it is difficult to get into courses. Personally, I have never done it. I'm a patient in the private system and the hospital where I'm an inpatient only started offering it at the start of the year (was meant to start, but they wouldn't let me because I was inpatient at time). From what I've heard from the patients going, it is helful.

On the other hand though, I used to self harm everyday and lengthy hospitalisations have helped me a lot. I've been in 7 weeks (coming home tomorrow!) this time, but last year I spent nearly 4 months in. I only self harm every couple of weeks, if that, now.

I've often complained that self harm isn't enough to get you landed in hospital, but once you get there it is reason enough to keep you there. I think that a lot of it depends on whether or not you are in the private or public system. I've been lucky to mostly be treated in a private psych hospital but honestly, the best and most helpful things have been developing good relationships with my dr's and nurses.

sbic56, BSN, RN · Apr 24, 2005

DBT is starting to become more readily available in Australia, but it is still considered very new and it is difficult to get into courses. Personally, I have never done it. I'm a patient in the private system and the hospital where I'm an inpatient only started offering it at the start of the year (was meant to start, but they wouldn't let me because I was inpatient at time). From what I've heard from the patients going, it is helful.
On the other hand though, I used to self harm everyday and lengthy hospitalisations have helped me a lot. I've been in 7 weeks (coming home tomorrow!) this time, but last year I spent nearly 4 months in. I only self harm every couple of weeks, if that, now.
I've often complained that self harm isn't enough to get you landed in hospital, but once you get there it is reason enough to keep you there. I think that a lot of it depends on whether or not you are in the private or public system. I've been lucky to mostly be treated in a private psych hospital but honestly, the best and most helpful things have been developing good relationships with my dr's and nurses.

I appreciate your thoughtful and encouraging reply. I agree that you have probably received better treatment in a private hospital. Your story is an inspiring one for those who are trying to overcome cutting. The experiences I had with patients being treated in the public institution where I once worked was that those who cut did not get better, as often the case was that they were among up to as many as 60 patients, plus often were admitted involuntarily. Additionally, many there had true personality disorders as well. This was obviously a bad situation for everyone and this practice, thankfully, has since been revisited!

Again, I did not mean to imply that all who cut have a personality disorder and I am gald you set that point straight.

Having only been exposed to DBT in a philosophical sense, personally I have not been involved with it's use, but have met those whom it has been used sucessfully when done with a therapist who is knowlegable in it.

It sounds as if your treatment team is awesome and has done very good things for you in an inpatient setting. Thank you much for sharing your experience and wisdom.

Marie50 · Apr 24, 2005

Hi i had a question for all you psych nurses out there! How often do you guys have cutters come into the psych ward? Is it often? or do you hardly ever see them? Thanks!!
wannabespsychnurse!!!!!! :balloons:

self inflicted harm is unfortunately seen frequently in longer term settings - DBT is one modality..there are many reasons people self abuse; don't work just to help cutters - this is very challenging and very rewarding nursing - be open, learn daily, listen.

Psychaprn · Apr 28, 2005

Dear Nurse Wannabe-if You're Serious About Doing This Kind Of Work I Would Suggest Two Things-that You Be Sure To Have Regular Clinical Supervision-usually By A Clinical Nurswe Specialist In The Hospital, And/or Go Into Individual Therapy Yourself. You Cannot Really Help People If You Aren't Clear On Your Own Issues And Motivation. This Work Is Very Stressful And You Need Support To Understand Your Own Feelings And Reactions To Patients. Good Luck!

mattsmom81 · Apr 29, 2005

I have often wondered if cutting was a frustrated anxiety driven compulsion, or a prelude to suicide attempt? (I am not a psych nurse but am interested in what drives human beings)

How does cutting compare to those who picks their skin, pulls out their hair and eyelashes in compulsive anxiety/agitation? Can a person who does these things progress to cutting? any opinions on what drives these behaviors?

Psych nursing has expanded so since I went to nursing school(back in the stone age...LOL)