EVRİM AKTEPE

Ergenlerde kendine zarar verme davranışı

Kendine zarar verme erken ergenlikte başlayan ve gizli kalması nedeniyle saptanması oldukça zor olan bir davranış tipidir. En sık saptanan yöntemler kendini kesme ve kendine vurmadır. Cinsel istismara maruz kalma ve olumsuz yaşam olaylarının kendine zarar verme davranışı açısından risk faktörleri olduğu bildirilmektedir. Ergenlerde yüksek anksiyete, depresyon ve hostilite düzeyleri, benlik saygısında azalma, intihar girişim ve düşünceleriyle birliktelik göstermekte olup emosyonel regulasyona aracılık ettiği düşünülmektedir. Kendine zarar verme davranış fonksiyonlarını açıklamada otomatik ve sosyal destek teorileri ile sosyal öğrenme teorisi öne sürülmektedir. Ergenlerde intiharla kendine zarar verici davranışlar arasındaki ilişkiler karmaşıktır. Kendine zarar verici davranışın tamamlanmış intihar riskini arttıran bir faktör olup olmadığı ile ilgili henüz yeterli bilgi bulunmamaktadır. Ergenlerde kendine zarar verme sık görülen bir davranış şekli olmasına rağmen bu davranışa yönelik spesifik tedaviyi araştıran randomize kontrollü çalışmalar kısıtlıdır. Erişkinlerde bu davranışla ilgili olarak en çok etkinliği gösterilen tedavi şekli diyalektik davranışsal terapidir. Kendine zarar verici davranışlara yönelik tedavide davranışı bitirmeye yönelik ihtiyaçları tespit etmek, duygusal algıları ve dürtüleri düzenlemek ve ihtiyaç duyulan daha sağlıklı yöntemleri ergene öğretmek gerekmektedir. Tedavi; intihar riski ve komorbid psikiyatrik durumları saptamaya yönelik psikiyatrik değerlendirmeye de dayalıdır. Kendine zarar verici davranışa yönelik olarak uygulanan ilaç tedavisi ise altta yatan psikiyatrik hastalığa yönelik olmalıdır.

Self injurious behavior in adolescents

Self injury is a kind of behavior which begins in early adolescence and difficult to determine because remains suppressed. Most often forms are to cut and hit own. To be exposed to sexual abuse and stressfully life events are known as risk factors for self injurious behavior. High anxiety, depression and hostility levels, decrease of self esteem, suicidal attempts and thoughts are usually together with self injurious behavior and it may be mediating to emotional regulation. To explain the functions of self injurious behavior automatic and social support theories and social learning theories have suggested. The relation between suicidality and self injurious behavior is complex for adolescents. There is no enough knowledge if self injurious behavior aggravates the risk of completed suicide. Although it’s a frequent behavior there are limited randomized controlled studies which examine specific treatment approaches. Dialectic behavior treatment is the type of treatment which shown as most effective for adults. To determine the needs to stop the behavior, to manage emotional senses and urges and to learn more healthy ways for needs to youth are necessary in treatment of self injurious behavior. Treatment also includes determining suicidal risk and comorbid psychiatric disorders. In self injurious behavior medical treatment is useful for comorbid psychiatric disorders.

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