depression in adolescents where is it comng from modern samples of self injurious behavior

1. MILEN S. RAMOS MA MSc PhD
Clinical Psychology Neuroscience
Criminology
Psychserv. Ph

3. One has to differentiate ordinary depression with
clinical depression. Clinical depression, more often
than not is associated with suicide or nihilism as
psychologist call it when one showed obsession to
stop breathing biologically or end one s life. But
clinical depression per se is not just one disorder.
From a clinician s point of view they scrutinize all
gamut’s of affective problem. Dysthymia is not often
heard. On the other hand, there s a type of bipolar
disorder associated with suicide... Borderline
personality disorder with psychotic dip can also end
one s life. Narcissistic rage in narcissistic personality
disorder is also a problem to watch out for.
Anhedonia, the inability to experience pleasure is
also worth comprehending

7. Clinical depression is characterized by the
presence of 5 or more of these depressive symptoms:
Depressed mood most of the day, nearly every day, as indicated by either
subjective report (e.g., feeling sad, blue, “down in the dumps,” or empty) or
observations made by others (e.g., appears tearful or about to cry). (In
children and adolescents, this may present as an irritable or cranky, rather
than sad, mood.)
Markedly diminished interest or pleasure in all, or almost all, activities
every day, such as no interest in hobbies, sports, or other things the
person used to enjoy doing
Significant weight loss when not dieting or weight gain (e.g., a change of
more than 5 percent of body weight in a month), or decrease or increase in
appetite nearly every day

8. Insomnia (inability to get to sleep or difficulty staying asleep) or hypersomnia
(sleeping too much) nearly every day
Psychomotor agitation (e.g., restlessness, inability to sit still, pacing, pulling at
clothes) or retardation (e.g., slowed speech, movements, quiet talking) nearly
every day
Fatigue, tiredness, or loss of energy nearly every day (e.g., even the smallest
tasks, like dressing or washing, seem difficult to do and take longer than usual.)
Feelings of worthlessness or excessive or inappropriate guilt nearly every day
(e.g., ruminating over minor past failings)
Diminished ability to think or concentrate, or indecisiveness, nearly every day
(e.g., appears easily distracted, complains of memory difficulties)
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideas
without a specific plan, or a suicide attempt or a specific plan for committing
suicide

13. Persistent Depressive Disorder (PDD) or Dysthymic disorder,
or dysthymia, is a type of depression that lasts for at least 2
years.
Some people suffer from dysthymia for many years.
Their depression is usually mild or moderate, rather than
severe. Most people who have dysthymia can't tell for sure
when they first became depressed.

14. The PDD symptoms listed in the DSM-5 include:
a depressed mood
almost every day for most of the day.
having a poor appetite or overeating.
difficulty falling asleep or staying asleep.
low energy or fatigue.
low self-esteem.
poor concentration or difficulty making decisions.
feelings of hopelessness.

16. Bipolar disorder is a serious brain illness. It is
also called manic-depressive illness or manic
depression. People with bipolar disorder go
through unusual mood changes. Sometimes
they feel very happy and “up,” and are much
more energetic and active than usual. This is
called a manic episode. Sometimes people
with bipolar disorder feel very sad and “down,”
have low energy, and are much less active.
This is called depression or a depressive
episode

17. TYPES OF BIPOLAR DISORDER
Bipolar I disorder involves periods
of severe mood episodes from
mania to depression.
Bipolar II disorder is a milder form
of mood elevation, involving milder
episodes of hypomania that
alternate with periods of severe
depression.

18. In clinical samples, about 50% of
persons with bipolar disorder (BD) were
found to have a history of a suicide
attempt. In the largest epidemiological
study on the topic to date, the suicide
attempt rate in persons with BD was
twice that of individuals with unipolar
depression.

19. Patients' risk for committing bipolar suicide may be elevated
if they display any of the following behaviors:
Talking about how they feel suicidal or want to die, or think the world
would be a better place without them in it.
Feeling hopeless, that nothing will ever change or get better
Feeling helpless, that nothing one does makes any difference
Feeling like a burden on family and friends.
Abusing alcohol or drugs (this is a risk because drugs increase the
likelihood that impulsive actions will take place)
Putting affairs in order (e.g., organizing finances or giving away
possessions to prepare for their death)
Writing a suicide note
Putting themselves into harm's way when this is not necessary, or
into situations where there is a danger that they will be killed or

21. Borderline personality disorder (BPD) is a
condition characterized by difficulties in
regulating emotion. This difficulty leads to
severe, unstable mood swings, impulsivity and
instability, poor self-image and stormy personal
relationships. People may make repeated
attempts to avoid real or imagined situations of
abandonment. The combined result of living
with BPD can manifest into destructive
behavior, such as self-harm (cutting) or suicide
attempts.

22. Manipulative, “just threats,”
or suicide gestures are terms often have
heard or used to label suicidal thoughts and
behavior in individuals with borderline
personality disorder (BPD). ... A
prospective study showed a 3.8%
completed suicide rate in a sample
of borderline patients at 6-year follow-up.

25. narcissistic rage

26. Narcissistic personality disorder is a mental disorder in
which people have an inflated sense of their own
importance, a deep need for admiration and a lack of
empathy for others. But behind this mask of ultraconfidence
lies a fragile self-esteem that's vulnerable to the slightest
criticism.
A narcissistic personality disorder causes problems in many
areas of life, such as relationships, work, school or financial
affairs. You may be generally unhappy and disappointed
when you're not given the special favors or admiration you
believe you deserve. Others may not enjoy being around
you, and you may find your relationships unfulfilling.

27. The relationship of Narcissistic Personality Disorder (NPD) to suicidal behavior is
understudied. The modest body of existing research suggests that NPD is
protective against non-fatal suicide attempts, but is associated with high
lethality attempts. Mood-disordered patients (N = 657) received structured
interviews including Axis I and II diagnosis and standardized clinical measures.
Following chi-square and t-tests, a logistical regression model was constructed to
identify predictors of suicide attempt. While there was no bivariate relationship of
NPD on suicide attempt, in the logistic regression patients with NPD were 2.4 times
less likely to make a suicide attempt (OR = 0.41; 95% CI = 0.19 - 0.88; p < 0.05),
compared with non-NPD patients and controlling for possible confounding variables.
NPD was not associated with attempt lethality. NPD patients were more likely to be
male, to have a substance use disorder, and to have high aggression and hostility
scores. Limitations include that the sample consists of only mood-disordered
patients, a modest sample size of NPD, and the data are cross-sectional. The
multivariate protective effect of NPD on suicide attempt is consistent with most
previous research. The lower impulsivity of NPD patients and less severe personality
pathology relative to other personality disorders may contribute to this effect. No
relationship of NPD to attempt lethality was found, contradicting other research, but
perhaps reflecting differences between study samples. Future studies should
oversample NPD patients and include suicide death as an outcome. Clinical
implications include discussion of individualized suicide risk assessment with NPD
patients.

29. Anhedonia is the inability to experience pleasure from
activities usually found enjoyable, e.g. exercise, hobbies,
singing, sexual activities or social interactions.
Anhedonia is one of the main symptoms of major depressive
disorder (MDD). It is the loss of interest in previously
rewarding or enjoyable activities. People suffering from
clinical depression lose interest in hobbies, friends, work--
even food and sex. It's as if the brain's pleasure circuits shut
down or short out--but do they? Some experts define
hedonic function as the total amount of pleasure that it's
possible to gain from a single activity.

30. Anhedonia predicts suicidal ideation in a large psychiatric inpatient sample.
Winer ES1
, Nadorff MR2
, Ellis TE3
, Allen JG3
, Herrera S3
, Salem T2
.
Author information
Abstract
This study examined the relationship among symptoms of anhedonia and
suicidal ideation at baseline, at termination, and over time in 1529 adult
psychiatric inpatients. Anhedonia was associated with suicidality cross-
sectionally at baseline and at termination. In addition, change in
anhedonia from baseline to termination predicted change in suicidality
from baseline to termination, as well as level of suicidality at termination;
moreover, anhedonia remained a robust predictor of suicidal ideation
independent of cognitive/affective symptoms of depression.
Symptom-level analyses also revealed that, even after accounting for the
physical aspect of anhedonia (e.g., loss of energy), loss of interest and
loss of pleasure were independently associated with higher levels of
suicidal ideation at baseline, over time, and at discharge. Loss of interest
was most highly predictive of suicidal ideation, providing support for
recent differential conceptualizations of anhedonia. Taken together, these
findings indicate that the manner in which anhedonia is conceptualized is
important in predicting suicidal ideation, and that anhedonia symptoms
warrant particular clinical attention in the treatment of suicidal patients.

31. Male Female Total
(%) (%) (%)
Most of the time or always 9.5 11.2 10.5
felt lonely in the past 12
months
Most of the time or always 12.8 16.1 14.6
felt so worried about
something that they could
not sleep at night during the
past 12 months
During the past 12 months, 39.0 44.3 42.0
felt so sad or hopeless
almost every day for two
weeks or more consecutively
that they stopped doing their
usual activities
Seriously considered 18.4 16.2 17.1
attempting suicide during the
past 12 months
Made a plan about how they 16.6 16.8 16.7
would attempt suicide during
the past 12 months
Table 8: Mental health
issues among
students, the
Philippines, 2003–
2004
Source: Global School-
Based Student Health Survey, 2003–
2004.

32. • Check if there is a need for a
psychiatric intervention
• Make academic endeavor less
punishing

33. Common Ways of Self-injury
Cutting
Hair-pulling (trichotillomania)
Other Forms
Branding – burning self with a hot object
Friction burn – rubbing a pencil eraser on your skin
Picking at skin or re-opening wounds
(dermatillomania) – an impulse control disorder
characterized by the repeated urge to pick at one’s
own skin, often to the extent that damage is caused
which relieves stress or is gratifying

34. Many compulsive skin picking causes are
emotional or mental. Emotional trauma can lead
to feelings of helplessness and insecurity. When
a child is being traumatized and bullied, he or she
loses the feeling of being in control of their
environment.
Hitting (with hammer or other object)
Bone breaking
Punching
Head-banging (more often seen with autism or
severe mental retardation)
Multiple piercing or tattooing – may also be a
type of self-injury, especially if pain or stress relief
is a factor
Drinking harmful chemicals

38. Hikikomori has entered the Oxford English
Dictionary as "In Japan: abnormal avoidance of social contact“
In Japan, hikikomori (Japanese: ひきこもり or 引き籠
り , lit. "pulling inward, being confined", i.e., "acute social
withdrawal") are reclusive adolescents or adults who withdraw
from social life, often seeking extreme degrees of isolation and
confinement. Hikikomori refers to both the phenomenon in
general and the recluses themselves. Hikikomori have been
described as loners or "modern-day hermits"

40. More recently, researchers have developed more specific criteria
to more accurately identify hikikomori.
During a diagnostic interview, trained clinicians evaluate for:
spending most of the day and nearly every day confined to
home,
marked and persistent avoidance of social situations,
social withdrawal symptoms causing significant functional
impairment
duration of at least six months, and
no apparent physical etiology to account for the social
withdrawal symptoms.

42. • Create group which enhance and
tap creativity
• Create relational gathering
which enhances communication

43. Alexithymia / e l ksə θa miə/ is a personality constructˌ ɪ ɛ ˈ ɪ
characterized by the subclinical inability to identify and
describe emotions in the self. The core characteristics of
alexithymia are marked dysfunction
in emotional awareness, social attachment, and
interpersonal relating

44. The relationship between self-harm and alexithymia
Hilary Norman,
Jo Borrill
Abstract
This paper presents a systematic review of the literature
concerning the relationship between alexithymia and self-
harm. Fifteen studies were selected following a systematic
search of relevant databases. Results indicate significantly
higher levels of alexithymia in women who self-harm compared
with women who do not self-harm. Studies of men were less
conclusive and require further investigation. A subsample of
the studies found that childhood abuse and bullying were more
likely to be associated with self-harm if alexithymia was
present as a mediator. Other studies found that depression
mediated between alexithymia and self-harm. The results
indicate that the poor emotional cognition and expression
associated with alexithymia may increase vulnerability to self-
harm, particularly in women.

45. Alexithymia and Personality Disorders in the Adolescent Non-
suicidal Self Injury: Preliminary Results
RitaCerutti MoniaCalabrese CarmelaValastro
Abstract
The aim of the present study was to describe the
characteristics of repetitive self-injurious behaviour and
related personality functioning as well as to explore the
relationship between NSSI and alexithymia in a sample of
NSSI adolescents (mean age= 16.1 yrs) within therapeutic
communities. The results showed a representation of Cluster
B personality features and personality disorders (e.g.,
borderline, narcissistic, antisocial). A significant association
between NSSI behaviours and alexithymia was found.
Additionally, the data supported the use of SWAP-200-A as
an instrument for assessing personality functioning and
personality pathology in adolescents who self-injure. Future
research will be necessary to confirm these results.

46. SALAMAT
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