Rossouw, T; (2013) Self-harm in young people: a randomised control trial comparing mentalization based treatment against treatment as usual. Doctoral thesis , UCL (University College London).

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Abstract

Objective This thesis aims to explore self-harm in young people in terms of its epidemiology, longitudinal outcome and treatment. Due to close associations between self-harm and personality disorder (PD) and depression, the thesis also aim to better understand the stability of PD from adolescence into adulthood as well as the links between depression and PD into adulthood. Further this thesis aims to examine the differences between self-harmers and non-self-harmers. The final aim to examine whether mentalization-based treatment for adolescents (MBT-A) will be more effective than treatment as usual (TAU) for adolescents who harm themselves. Method Four systematic literature reviews were done to explore the longitudinal outcome of self-harm, the treatment of adolescent self-harm, the stability of adolescent personality disorder into adulthood and the longitudinal outcome and interplay between depression and personality disorder. A cross-section analysis was conducted to compare a self-harming group against two non-self-harming control groups. Finally a randomised control trial (RCT) was conducted, comparing MBT-A against TAU for self-Harming adolescents in terms of reduction in self-harm and depression. Results The outcome of literature reviews are discussed in the thesis. The cross-sectional analysis found that the self-harm group demonstrated significantly more borderline personality disorder traits, more avoidant attachment and worse scores in terms of mentalization. The self-harm group demonstrated more personality pathology in general on most of the personality domains as well as more history of childhood abuse. MBT-A was more effective than TAU in reducing self-harm and depression. This superiority was explained by improved mentalization and reduced attachment avoidance and reflected improvement in emergent borderline personality disorder symptoms and traits.

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