sebepožkozování2
Sebepoškozování (self-harm, self-injury, self-wounding)je termín, který je nejčastěji spojován s vědomým, záměrným, často opakovaným sebepoškozováním (sebezraňováním) bez vědomé suicidální motivace, v němž dochází k narušení tělesné integrity, bez závažného letálního dosahu. Nejčastěji jde o řezná poranění kůže, zápěstí, předloktí, hřbetů rukou, škrábance, vyřezávání znaků do kůže. K sebepoškození bývají používány ostré předměty, např. žiletka, sklo. Další formou sebepoškození je popálení, např. cigaretou nebo zapalovačem. Uváděné motivy pro sebepoškození jsou rozličné, nejčastěji uváděným motivem bývá pocit vzteku na sebe samého, úleva od napětí, někdy též přání zemřít. Sebepoškozování je považováno za jeden ze znaků narušené osobnosti, nejčastěji hraničního charakteru. Někteří autoři ovšem sebepoškozující chování koncipují spíše jako návykovou poruchu (addiction) než jako znak specifické poruchy osobnosti. Do okruhu sebepoškozování bývá zahrnováno i předávkování léky, které je opakováno a není u něj patrný přímý suicidální motiv. I když v sebepoškozujícím chování můžeme nalézt apel na okolí, nebývá snaha o získání pozornosti okolí jediným motivačním mechanismem.
Syndrom záměrného sebepoškozování (deliberate self-harm)představuje
širší pojetí sebepoškozujícího chování, které je vydělené z kategorie
suicidálních pokusů a zahrnuje sebepoškozování jako specifický
patologický projev u poruch osobnosti (hraniční, histrionské,
disociální, mnohočetné poruchy osobnosti), nebo u pacientů s poruchami
příjmu potravy (zejména mentální bulimie) a pacientů závislých na
návykových látkách.
Syndrom pořezávaného zápěstí (wrist-cutting, slashing)má
charakter sebepoškozování, v němž dominuje pořezávání, typicky na
zápěstí a předloktí, které nemá vědomý suicidální motiv. Popisuje se,
že afektivní projevy, které provázejí sebepořezávání, mají specifickou
dynamiku a průběh. Pacienti prožívají tenzi a dysforii. Sebepořezání
vede k úlevě a k opakování tohoto jednání. Osoby, které se pořezávají,
mají snahu proti tomuto jednání bojovat, ale při snaze ovládnout se
prožívají napětí, dysforii a vztek, afektovou kombinaci, která vede k
opakování sebepoškozujícího jednání.
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