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

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

Self-Mutilation 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. Types  Culturally Sanctioned  Deviant Major Stereotypic Superficial  Compulsive  Episodic  Repetitive

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

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

Borderline Personality Disorder  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. DSM-IV-TR, 2002

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

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

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

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

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

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

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

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.

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.

Treatment Procedure Control Group (n=75) Experimental Group (n=75) Daily group and individual psychotherapy sessions XX Medication XX Individualized sensory diets X 3x weekly individual sensory integration therapy sessions X Use of sensory- modulation room X

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.

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.