Managing deliberate self-harm: the A & E perspective

Self-Harm: Cutting the Bad out of Me

“…Whereas this finding has complicated the picture for researchers and professionals in these fields, we have now reached a point where we recognize that although some acts may have suicidal or parasuicidal intent, there is a further body of acts that do not have this intent (Spandler, 1996, p. 2). There is currently very little known about these acts of self-harm, although there is evidence from British accident and emergency (A&E) departments that taken as a whole, acts of self-harm are increasing (Department of Health and Social Security, 1984), that they are undertaken mainly during the night (Greenwood & Bradley, 1997), and that the number of men engaged in these practices is increasing (see Temple, Harris, Patel, & Bradley, in press). …”

“…Therefore, a majority of studies have aimed to log the rise in deliberate self-harm and isolate the precipitating factors without attempting to ascertain individual root causes or even explore the diversity of practices. Practitioner research has concentrated on damage limitation to overstretched medical services, which is fuelled by pecuniary reasoning (see Greenwood & Bradley, 1997). For these reasons, the quantitative paradigm has been extensively used, not only because it appears to satisfy the medics' overweening positivist obsession with validity, reliability, and generalizability, but also because, more than these, it speaks in the commonly understood language of statistics.…”

Clarifying self-harm through evolutionary concept analysis

“…There is agreement that self‐cutting (1, 2, 22, 29), self‐hanging (2, 8, 11, 20, 21, 22) and banging one’s head/hitting one’s self (8, 43, 53) are self‐harming acts. Additional forms of harm to exterior body mentioned in the nursing science articles are as follows: pulling out hair (8, 22), skin scratching (22), piercing (22, 25), bone breaking/amputation (8, 44), purposefully being harmed by vehicles (8, 20), promiscuity (8, 48), jumping off high places (20, 47), self‐biting (9, 21), self‐scalding (2), provoking violence to cause harm to self (8, 48), and the tying together of body parts (3, 43, 54). The medicine articles looked at in this study also mention shooting one’s self (30) and aggravating medical conditions (48).…”

“…In the articles included here, the authors disagree whether self‐harm is an absence of illness, a coping mechanism, or a poor way of solving problems. Is self‐harm a coping mechanism (51) which creates unity between body and psyche (8), which creates a feeling of reality (2) and reduces aggressive feelings (2, 11), or is it a poor way of solving problems (3, 47) in a communicate message of pain and crisis (8) with others (2, 13, 44)? For some researchers, self‐harm is the communicating of mental pain from one individual to others (2, 13, 44), yet there is a difference in whether self‐harm occurs as an impulse due to mental illness and drug abuse or not.…”

“…Child abuse may also be another variable associated with self-harm (8,22,26,44). Individuals who self-harm seem to be more exposed to violence (29,43,45), sexual abuse by family members or others (2,3,11,29), and bullying/victimization (3,8,30) and appear to have problems at school (3,24,40,46).…”