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자살 의도가 없는 자해의 근거기반치료

Evidence-Based Treatments of Nonsuicidal Self-Injury

허지원
한국임상심리학회 (Korean Clinical Psychology Association)|2019.11|Korean Journal of Clinical Psychology|제38권 제4호|pp. 415-426

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참고문헌

키워드

self-harmself-injury근거기반치료자살 의도가 없는 자해자기위해자해nonsuicidal self-injuryself-mutilationevidence-based treatments
주제분류심리과학

초록

지난 10여 년간, 자살 의도가 없는 상태에서 신체 조직을 손상하는 형태로 가하는 자발적인 자기 위해인 ‘자살 의도 없는 자해’에 대한 우려가 높아져왔다. 그 어떤 정신질환보다 높은 유병률을 보이고 있으며 개인의 생물학적, 사회적 발달에 유의한 장해로 작용하기에, 정신건강영역에서 다각도의 치료적 개입이 개발되고 검증되어 왔다. 그러나 전통적인 심리치료에서 약물치료에 이르기까지, 자살 의도가 없는 자해에 대한 개입 중 타 치료들에 비해 그 효과의 우월성이 두드러지는 특정한 치료는 현재까지 정립된 바는 없다. 이는 모든 연령대에서 그러하지만 특히 소아, 청소년에 두드러지는 양상이며, 일부 치료는 치료자의 변인이 이들 자살의도가 없는 자해를 오히려 악화시키는 데 기여하는 것으로 보인다. 결국, 많은 연구자는 자살 의도가 없는 자해에 대해 특정 치료 유형을 강조하는 것에 대해 유보적인 태도를 취하고 있다. 다만 현재로서는 인지행동치료 및 정서조절훈련 기반 치료들이 유망한 근거기반치료 후보군으로 보이며, 치료자들이 자살 의도가 없는 자해문제에 개입하는 과정에서치료의 효용성과 치료순응도를 확보할 수 있는 일련의 가이드라인을 수립하려는 노력이 병행되고 있다.

Abstract

Over the past decade, there has been growing concern about nonsuicidal self-injury (NSSI), which refers to deliberate selfharming behaviors aimed at the destruction of one’s own body tissue without suicidal intent. A series of therapeutic interventions have been developed and have verified that NSSI has a higher prevalence than any other mental illness and is a significant obstacle to the biological and social development of individuals. However, from traditional psychotherapy to drug therapy, no specific treatment has been established to date for intervention of NSSI. These findings are consistent across different age groups, but especially for children and adolescents. Even an untrained therapist’s approach seems to contribute to aggravating NSSI. As a result, many researchers have a taken reserved attitude towards the level of effectiveness of certain types of NSSI treatment, but at present significant efforts are being made to establish a set of guidelines for clinicians to ensure the efficiency and compliance of therapeutic intervention of individuals who engage in NSSI.

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