The EMDR DeTUR protocol for the treatment of self-injury in a patient with severe personality disorder: a case report

Publication Date28 Feb 2019
AuthorPhyllis Annesley,Adedayo Alabi,Laura Longdon
SubjectHealth & social care
The EMDR DeTUR protocol for the
treatment of self-injury in a patient with
severe personality disorder: a case report
Phyllis Annesley, Adedayo Alabi and Laura Longdon
Purpose The purpose of this paper is to describe the Eye movement desensitisation and reprocessing
(EMDR) treatment of an adult female patient detained within a high secure hospital with complex
mental health difficulties, including complex trauma, factitious disorder, self-injury and a history of offending.
The EMDR treatment addressed the patients urges to engage in severe and sometimes life-threatening
self-injury, a primary motive of which was to access physical healthcare interventions within a general
hospital. The paper describes the wide-ranging benefits of the treatment and incorporates feedback from the
patient and clinicians within her multi-disciplinary team (MDT).
Design/methodology/approach Four triggers for self-injury were processed during the therapy using the
DeTUR Protocol (Popky, 2005, 2009) and the Constant Installation of Present Orientation and Safety (CIPOS,
Knipe, 2009a) method. In total, 18 one hour therapy sessions were delivered plus three follow-up sessions to
continue to offer support and complete the post-treatment evaluation.
Findings The level of urge for each trigger was reduced to 0 which the patient defined as no urge to
self-injure. Benefits went well beyond self-injury with reported positive impacts on mood, thinking, sleep,
concentration, memory and experience of flashbacks.
Practical implications This case report demonstrates that the EMDR DeTUR Protocol together with the
CIPOS method can be extremely valuable in the treatment of patients who self-injure.
Originality/value The case report offers an important contribution to an area that requires much
further research.
Keywords Treatment, Self-harm, Constant installation of present orientation and safety (CIPOS),
DeTUR protocol, Eye movement desensitisation and reprocessing, Self-injury
Paper type Case study
Literature review
Diminished self-control, the presence of urges or craving, tolerance symptoms, withdrawal
symptoms, compulsivity and impulsivity are core features of behavioural addictions. Some
argue that self-injury (also called self-harm) is best viewed within an addictions framework
(Victor et al., 2012). This is debated within the literature as there is evidence for both important
similarities (e.g. Nixon et al., 2002) and differences (e.g. Klonsky, 2007) between non-suicidal
self-injury and addictive behaviours. Further, in patients with complex symptomatology adhering
to strict definitions of non-suicidal self-injury becomes problematic. For example, in self-injury a
patient might be ambivalent as to whether they die or not. This said self-injury is defined within the
literature as intentional physical self-injury without an intent to die, which includes various
methods such as cutting, burning, scratching, beating oneself, biting, interfering with wound
healing, reckless sex and eating to be sick (Mosquera and Ross, 2016). Self-injury is a complex
behaviour commonly experienced in secure environments (Sandy, 2013). Common motives
for self-harm include to feel relief, to stop psychological pain, to show suffering, to request help,
to obtain self-punishment, to cleanse oneself and to feel re-connected with ones body
(Mosquera and Ross, 2016). Self-harming behaviours only provide temporary relief and
Received 2 November 2018
Revised 28 November 2018
Accepted 16 December 2018
The authors would like to express
their deep gratitude to Emily for
her active involvement with the
evaluation and for giving her
consent for the case report to be
written up for publication. They
would also like to thank their
colleagues for their generous
contributions to the case report.
Phyllis Annesley is based at the
Department of Clinical and
Forensic Psychology, National
Womens Service and National
High Secure Learning Disability
Service, Rampton Hospital,
Retford, UK.
Adedayo Alabi is based at
North Bay Regional Health
Centre, North Bay, Canada.
Laura Longdon is based at the
Department of Clinical and
Forensic Psychology, National
Womens Service, Rampton
Hospital, Retford, UK.
DOI 10.1108/JCRPP-11-2018-0034 VOL. 5 NO. 1 2019, pp.27-38, © Emerald Publishing Limited, ISSN 2056-3841
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