Self Harm

Self-harm (SH) or deliberate self-harm (DSH) includes self-injury (SI) and self-poisoning and is defined as the intentional, direct injuring of body tissue most often done without suicidal intentions. These terms are used in the more recent literature in an attempt to reach a more neutral terminology. The most common form of self-harm is skin-cutting but self-harm also covers a wide range of behaviours including, but not limited to, burning, scratching, banging or hitting body parts, interfering with wound healing, hair-pulling (trichotillomania) and the ingestion of toxic substances or objects.[2][4][5] Behaviours associated with substance abuse and eating disorders are usually not considered self-harm because the resulting tissue damage is ordinarily an unintentional side effect.[6] However, the boundaries are not always clearly defined and in some cases behaviours that usually fall outside the boundaries of self-harm may indeed represent self-harm if performed with explicit intent to cause tissue damage.[6] Although suicide is not the intention of self-harm, the relationship between self-harm and suicide is complex, as self-harming behaviour may be potentially life-threatening.[7] There is also an increased risk of suicide in individuals who self-harm[4][8] to the extent that self-harm is found in 40–60% of suicides.[9] However, generalising self-harmers to be suicidal is, in the majority of cases, inaccurate.[10][11]

The motivations for self-harm vary and it may be used to fulfil a number of different functions.[12] These functions include self-harm being used as a coping mechanism which provides temporary relief of intense feelings such as anxiety, depression, stress, emotional numbness or a sense of failure or self-loathingand other mental traits including low self-esteem[13] or perfectionism. Self-harm is often associated with a history of trauma and abuse, including emotional andsexual abuse.[14][15] There are a number of different methods that can be used to treat self-harm and which concentrate on either treating the underlying causes or on treating the behaviour itself. When self-harm is associated with depression, antidepressant drugs and treatments may be effective.[8] Other approaches involve avoidance techniques, which focus on keeping the individual occupied with other activities, or replacing the act of self-harm with safer methods that do not lead to permanent damage.[16]

Self-harm is most common in adolescence and young adulthood, usually first appearing between the ages of 12 and 24.[1][5][6][17][18] Self-harm in childhood is relatively rare but the rate has been increasing since the 1980s.[19] However, self-harm behaviour can nevertheless occur at any age,[12] including in the elderly population.[20] The risk of serious injury and suicide is higher in older people who self-harm.[18]

2. Klonsky, E. D. (2007), “The functions of deliberate self-injury: A review of the evidence”, Clinical Psychology Review27 (2): 226–239,doi:10.1016/j.cpr.2006.08.002, PMID17014942

4. Skegg, K. (2005), “Self-harm”, Lancet 336: 1471

5.Truth Hurts Report, Mental Health Foundation, 2006, ISBN978-1-903645-81-9, http://www.mentalhealth.org.uk/publications/?EntryId5=38712, retrieved 2008-06-11

6. Klonsky, E. D. (2007), “Non-Suicidal Self-Injury: An Introduction”, Journal of Clinical Psychology63 (11): 1039, doi:10.1002/jclp.20411, PMID17932979

7. Farber, S. et al. (2007), “Death and annihilation anxieties in anorexia nervosa, bulimia, and self-mutilation”, Psychoanalytic Psychology24 (2): 289–305,doi:10.1037/0736-9735.24.2.289

8. Haw, C. et al. (2001), “Psychiatric and personality disorders in deliberate self-harm patients”, British Journal of Psychiatry178 (1): 48–54,doi:10.1192/bjp.178.1.48, PMID11136210

9. Hawton K., Zahl D. and Weatherall, R. (2003), “Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital”,British Journal of Psychiatry182: 537–542, doi:10.1192/bjp.182.6.537, PMID12777346

10. Fox, C; Hawton, K (2004), Deliberate Self-Harm in Adolescence, London: Jessica Kingsley, ISBN978-1-84310-237-3

11. Suyemoto, K. L. (1998), “The functions of self-mutilation”, Clinical Psychology Review18 (5): 531–554, doi:10.1016/S0272-7358(97)00105-0, PMID9740977

12. Swales, M., Pain and deliberate self-harm, The Welcome Trust, http://www.wellcome.ac.uk/en/pain/microsite/culture4.html, retrieved 2008-05-26

see 13. Impression formation.

14. Meltzer, Howard, et al. (2000), Non Fatal Suicidal Behaviour Among Adults aged 16 to 74, Great Britain: The Stationary office, ISBN0-11-621548-8

15. Rea, K., Aiken, F., and Borastero, C. (1997), “Building Therapeutic Staff: Client Relationships with Women who Self-Harm”, Women’s Health Issues7 (2): 121–125, doi:10.1016/S1049-3867(96)00112-0

16. Klonsky, E. D. and Glenn, C. R. (2008), “Resisting Urges to Self-Injure”, Behavioural and Cognitive Psychotherapy36 (02): 211–220,doi:10.1017/S1352465808004128

17. Schmidtke A, et al. (1996), “Attempted suicide in Europe: rates, trends and sociodemographic characteristics of suicide attempters during the period 1989–1992”, Acta Psychiatrica Scandinavica93 (5): 327–338, doi:10.1111/j.1600-0447.1996.tb10656.x, PMID8792901

18. National Institute for Clinical Excellence (2004), National Clinical Practice Guideline Number 16: Self-harm, The British Psychological Society,http://www.nice.org.uk/nicemedia/pdf/CG16FullGuideline.pdf, retrieved 2009-12-13

19. Thomas B; Hardy S; Cutting P (1997), Stuart and Sundeen’s mental health nursing: principles and practice, Elsevier Health Sciences, p. 343, ISBN978-0-7234-2590-8, http://books.google.com/books?id=7TFTELQR2roC&pg=PA343, retrieved 2011-03-12

20. Pierce, D. (1987), “Deliberate self-harm in the elderly”, International Journal of Geriatric Psychiatry2 (2): 105–110, doi:10.1002/gps.930020208