Self-harming behaviors and emotional regulation in a case of Intellectual Disability and Borderline Personality Disorder, Behavioral and Cognitive Team Intervention in a residential context

Author/s Mirko Dai Prà, Riccardo Claudi, Svitlana Ihnatova
Publishing Year 2022 Issue 2022/2
Language Italian Pages 23 P. 149-171 File size 247 KB
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Aim. This work aims to describe a therapeutic intervention with a person suffering from Borderline Personality disorder and Intellectual Disability of medium severity and to evaluate the results in terms of self-injurious behavior (SIB), ap-propriate requests for help and self-monitoring skills. Method. A Behavioral and Cognitive integrated intervention was conducted by the rehabilitation team. This was performed according to a functional assessment of the case with the ABC Behavioral Model (Antecedent, Behavior, Consequences) with a 19-year-old patient with Borderline personality disorder and moderate Intellectual Disability. The intervention was designed with operative conditioning models and behavioral principles were followed which make use of reinforcing the learning of new skills. Cognitive interventions aimed at achieving greater awareness of person’s limits and learn mastery intervention strategies. The entire rehabilitation team of a residential structure RSD V.M. was present within 24 hours, the intervention lasted for 1 year. Results. During the intervention self-damaging behaviors and uncontrolled emotional manifestations such as screaming and crying extinguished, and requests for adequate help have increased. From April 2021, given the good level of compensation achieved, it was decided to reduce drug therapy. Conclusions. The intervention proved to be effective in terms of decreas-ing problematic behaviors and learning self-regulation skills, and the results ob-tained led to an initial decrease in the drug therapy. The work offers food for thought relating to the effectiveness of the intervention with people with Intellec-tual Disabilities and Borderline Personality disease in a residential setting.

Keywords: Self injury, Borderline, Intellectual Disability, Behavior Cognitive, équipe.

  1. American Psychiatric Association (APA). DSM-5. Manuale diagnostico e statistico dei disturbi mentali, tr. it. Raffaello Cortina Editore, Milano, 2014. Muehlenkamp JJ. Self-injurious behavior as a separate clinical syn-drome. American Journal of Orthopsychiatry 2005; 75, 324-333.9432.75.2.324. DOI: 10.1037/0002
  2. Stoffers JM, Völlm B A, Rücker G, Timmer A, Huband N, Lieb K. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev 2012; 8. DOI: 10.1002/14651858
  3. Dusi N, Bracco L, Bressi C, Delvecchio G, Brambilla P. Imaging associations of self-injurious behaviours amongst patients with Borderline Personality Disorder: A mini-review. J Affect Disord 2021; 295: 781-787.
  4. International Society for the Study of Self-Injury. Definition of nonsuicidal self-injury [Internet]. Bronx (NY): Fordham University c2007, cited 2014 Apr 5. -- Available from:
  5. Jacobson CM, Muehlenkamp JJ, Miller AL, Turner JB. Psychiatric impairment among adolescents engaging in different types of deliberate self-harm. J Clin Child Adolesc Psychol 2008; 37(2): 363-75. DOI: 10.1080/15374410801955771.PMID:18470773
  6. Washburn JJ, Richardt SL, Styer DM, Gebhardt M, Juzwin KR, Yourek A et al. Psychotherapeutic approaches to non-suicidal self-injury in adoles-cents. Child Adolesc Psychiatry Ment Health 2012; 6(1): 14. DOI: 10.1186/1753-2000-6-14.PMID:22463499
  7. Klonsky ED, May AM. Differentiating suicide attempters from suicide ideators: a critical frontier for suicidology research. Suicide Life Threat Behav 2014; 44(1): 1-5.
  8. Dulit RA, Fyer MR, Leon AC, Brodsky BS, Frances AJ. Clinical correlates of self-mutilation in borderline personality disorder. Am J Psychiatry 1994; 151(9): 1305-11.
  9. Favazza AR, Conterio K. Female habitual self-mutilators. Acta Psychiatr Scand 1989; 79(3): 283-9. 2711856.
  10. Klonsky ED. The functions of deliberate self-injury: a review of the evidence. Clin Psychol Rev 2007; 27(2): 226-39.
  11. 2006 Oct 2. PMID: 17014942.
  12. Gratz KL. Risk factors for and functions of deliberate self-harm: An empiri-cal and conceptual review. Clinical Psychology: Science and Practice 2003; 10, 192-205.
  13. Allen C. Helping with deliberate self-harm: Some practical guidelines. Journal of Mental Health 1995; 4, 243-250.
  14. Linehan MM. Cognitive-behavioral treatment for borderline personality disorder. New York: Guildford Press; 1993
  15. Shannon T. Self-injury in patients with intellectual disability. Nursing 2016; 46(5): 61.
  16. Minshawi NF, Hurwitz S, Fodstad JC, Biebl S, Morriss DH, McDougle CJ. The association between self-injurious behaviors and autism spectrum disorders. Psychol Res Behav Manag 2014; 7: 125-36. PMID: 24748827. DOI: 10.2147/PRBM.S44635
  17. Aliakbari F, Parvin N, Heidari M, Haghani F. Learning theories application in nursing education. J Educ Health Promot 2015; 4:2. DOI: 10.4103/2277-9531.151867.PMID:25767813
  18. Cooper JO, Heron TE, Heward WL. Applied Behavior Analysis Third Edition. Upper Saddle River, New Jeresey Columbus, Ohio: Pearson Merrill Prentice Hall; 2018.
  19. Cartella Socio-Sanitaria. -- cartella/.
  20. Carradori G, Sangiorgi A. L’analisi funzionale del comportamento. Principi, metodi e tecniche. Trento: Erickson; 2017.
  21. Shireen LR. L’analisi delle catene comportamentali nella DBT. Milano: Raffaello Cortina Editore; 2020.
  22. Turner BJ, Austin SB, Chapman AL. Treating nonsuicidal self-injury: a systematic review of psychological and pharmacological interventions. Can J Psychiatry 2014; 59(11): 576-85. DOI: 10.1177/070674371405901103
  23. Giannotta F, Rydell AM. The Prospective Links Between Hyperactive/ Impulsive, Inattentive, and Oppositional-Defiant Behaviors in Childhood and Antisocial Behavior in Adolescence: The Moderating Influence of Gender and the Parent-Child Relationship Quality. Child Psychiatry Hum Dev 2016; 47(6): 857-870.
  24. Engel GL. The need for a new medical model: a challenge for biomedicine. Science 1977; 196, 4286: 129-36.
  25. Cipolla C, Agnoletti V. Medicine(a) a fondamento scientifico e medicine(a) basate(a) su altri principi metodologici. Salute e società. Fascicolo 2, 2006. DOI: 10.1400/68117
  26. Bowers L. Manipulation: Description, identification and ambiguity. Journal of Psychiatric Nursing and Mental Health Nursing 2003; 10, 323-328.
  27. Potter NN. What is manipulative behavior, anyway? Journal of Personality Disorders 2006; 20(2), 139-156.
  28. Linehan MM. Trattamento cognitivo – comportamentale del disturbo borderline. Milano: Raffaello Cortina Editore; 2011.
  29. Flavell, J.H. Metacognition and cognitive monitoring: a new area of cognitive- development inquiry. Am. Psychol 1979;34:906-911. DOI: 10.1037/0003-066X.34.10.906
  30. D’Abate L, Delvecchio G, Ciappolino V, Ferro A, Brambilla P. Borderline personality disorder, metacognition and psychotherapy. J Affect Disord 2020; 276: 1095-1101.
  31. Martin G, Pear J. Strategie e tecniche per il cambiamento. La via Comportamentale. (Tr It. Moderato P & Rovetto F.). New York: McGraw – Hill; 2000. (Opera originale pubblicata nel 1999).
  32. Haraldstad K, Wahl A, Andenæs R, Andersen JR, Andersen MH, Beisland E et al. LIVSFORSK network. A systematic review of quality of life re-search in medicine and health sciences. Qual Life Res 2019; 28(10): 2641-2650.
  33. Dai Prà M. Uno studio di caso di paziente con Disabilità Intellettiva e disturbo Bipolare in contesto residenziale: comportamenti aggressivi, furto, Qualità della Vita e terapia farmacologica. Un intervento Comportamentale e Cognitivo. Rivista Sperimentale di Freniatria 2020; 2: 115-140. DOI: 10.3280/RSF2020-002007
  34. Shawler LA, Russo SR, Hilton JL, Kahng S, Davis CJ, Dorsey MF. Be-
  35. havioral Treatment of Self-Injury: 2001 to 2016. Am J Intellect Dev Disabil 2019; 124(5): 450-469. DOI: 10.1352/1944-7558-124.5.450.PMID:31512946
  36. Apolone G, Mosconi P. The Italian SF-36 Health Survey: translation, vali- dation and norming. J Clin Epidemiol 1998; 51(11): 1025-36.

Mirko Dai Prà, Riccardo Claudi, Svitlana Ihnatova, Comportamenti autolesivi e regolazione emotiva in un caso di Disabilità Intellettiva e Disturbo di Personalità Borderline: intervento omportamentale e Cognitivo di équipe in contesto residenziale in "RIVISTA SPERIMENTALE DI FRENIATRIA" 2/2022, pp 149-171, DOI: