[Scars from Nonsuicidal Self-Injury - What Plastic Surgery Can Do]. / Narben aus nichtsuizidalem selbstverletzendem Verhalten ­ therapeutische Möglichkeiten der plastischen Chirurgie.

Scars from Nonsuicidal Self-Injury - What Plastic Surgery Can Do Abstract. Objective: Nonsuicidal self-injury (NSSI) can induce characteristic scar patterns indicating the origin of these scars. This frequently results in the stigmatization of the involved patients with far-reaching consequences for their daily routine and quality of life. Despite patients being highly interested in scar correction, the potential of surgical therapy to alleviate NSSI-prone behavior and its help in destigmatizing surgical corrections and esthetic improvements in these situations are not well-known. Method: Over a period of 5 years, we analyzed 600 patients requesting NSSI scar treatment in our outpatient clinic. We collected data on the motivation for a scar correction, on the maturity of the scars, the involved body parts, and potential prior scar treatments as well as the amount, localization, and type of performed surgical procedures in our institution. Results: Stigmatization (57 %) and limitations in choice of clothing (18 %) were the most frequent reasons given for scar correction. We performed 358 dermabrasions and 55 serial excisions on these patients, nine combinations of both, and 13 other procedures. Conclusions: Plastic surgery offers multiple possibilities to reduce the stigmatization of patients with NSSI scars, who should thus be informed early about their choices.

[Alliance Ruptures in the Psychotherapy of Adolescents with Borderline Personality Pathology: Risk or Benefit?] / Alliance Ruptures in der Psychotherapie von Jugendlichen mit Borderline-Persönlichkeitspathologie: Gefahr oder Chance?

Alliance Ruptures in the Psychotherapy of Adolescents with Borderline Personality Pathology: Risk or Benefit? Adolescents with subthreshold or full-blown borderline personality disorders (borderline personality pathology (BPP)) are characterized by a pronounced instability in their self-image and their interpersonal relationships. The building of a stable therapeutic relationship is considerably challenged in patients with BPP. The concept of alliance ruptures and resolutions assumes that the resolution of ongoing relationship difficulties contributes to therapeutic change. Resolutions are strategies of the therapist to address ruptures, to explore their meaning with the patient and to enhance the therapeutic collaboration between the patient and the therapist. This article illustrates the use and benefits of alliance ruptures and resolutions among adolescents with BPP treated with the manualized treatment concept Adolescent Identity Treatment (AIT). Ten patients were treated with AIT. Three out of ten patients dropped out of treatment prematurely. A total of 187 therapy sessions were analyzed using the Rupture and Resolution Rating System (3RS; Eubanks, Lubitz, Muran, Safran, 2018). Alliance ruptures and resolutions are illustrated in session transcripts of a qualitative case vignette. Quantitative analyses show that alliance ruptures occur frequently over the complete treatment course in good outcome patients. However, frequent alliance ruptures at the beginning of treatment represent a risk for premature treatment termination. The concept of alliance ruptures and resolutions may help to improve the ongoing therapeutic alliance in the treatment of adolescents with BPP.