Self-harm

Abstract

The term self-harm is commonly used to describe a wide range of behaviours and intentions including attempted hanging, impulsive self-poisoning, and superficial cutting in response to intolerable tension. As with suicide, rates of self-harm vary greatly between countries. 5-9% of adolescents in western countries report having self-harmed within the previous year. Risk factors include socioeconomic disadvantage, and psychiatric illness--particularly depression, substance abuse, and anxiety disorders. Cultural aspects of some societies may protect against suicide and self-harm and explain some of the international variation in rates of these events. Risk of repetition of self-harm and of later suicide is high. More than 5% of people who have been seen at a hospital after self-harm will have committed suicide within 9 years. Assessment after self-harm includes careful consideration of the patient's intent and beliefs about the lethality of the method used. Strong suicidal intent, high lethality, precautions against being discovered, and psychiatric illness are indicators of high suicide risk. Management after self-harm includes forming a trusting relationship with the patient, jointly identifying problems, ensuring support is available in a crisis, and treating psychiatric illness vigorously. Family and friends may also provide support. Large-scale studies of treatments for specific subgroups of people who self-harm might help to identify more effective treatments than are currently available. Although risk factors for self-harm are well established, aspects that protect people from engaging in self-harm need to be further explored.

Non‐suicidal self‐injury in adolescence: A longitudinal study of the relationship between NSSI, psychological distress and perceived parenting

“…With regard to intrapersonal factors, current research shows that adolescents who self-injure report higher levels of subjective distress in response to aversive or stressful experiences (Najmi, Wegner, & Nock, 2007;Skegg, 2005) and exhibit lower levels of distress tolerance (Anestis, Knorr, Tull, Lavender, & Gratz, 2013;Nock & Mendes, 2008). According Nock (2009), adolescents may exhibit NSSI to cope with elevated levels of general psychological distress, conceptualized as a wide variety of psychological symptoms (Jacobson, Muehlenkamp, Miller, & Turner, 2008;Nock, Joiner, Gordon, Lloyd-Richardson, & Prinstein, 2006) including both elevated rates of internalizing (e.g., anxiety, depression; e.g., Andover, Pepper, Ryabchencko, Orrico, & Gibb, 2005) and externalizing symptoms (e.g., conduct behavioral problems; e.g., Baetens, Claes, Muehlenkamp, Grietens, & Onghena, 2012;Brunner, Parzer, Haffner, Steen, & Roos, 2007).…”

Accuracy and predictive value of incarcerated adults' accounts of their self-harm histories: findings froman Australian prospective data linkage study

“…50,51 This coding was per-formed manually based on the Australian Standard Offence Classification (Queensland Extension). 52 In light of the reported sex differences in self-harm prevalence, 6 we examined the possibility of effect modification in the adjusted model by fitting interaction terms between self-harm category at baseline and demographic variables (sex, age and Indigenous status). The Cox model was censored at date of death, the first medically verified self-harm event or the last day of the followup period, whichever occurred first.…”

“…Self-reported self-harm may therefore fail to identify a proportion of people at risk for subsequent (and medically more severe) self-harm and associated mental health problems. Underreporting may be particularly pronounced among those already marginalized, such as Indigenous people, 21 people with a mental illness 6 and those who identify as lesbian, gay, bisexual or transgender. 22,23 In Canada, historical underascertainment of self-harm events combined with a sharp increase in such events in prisons 24,25 has led to recent changes in reporting practices in the Correctional Service of Canada, such as allowing staff to report 1 incident under multiple incident categories.…”

Clinical diagnoses, characteristics of risk behaviour, differences between suicidal and non-suicidal subgroups of Hungarian adolescent outpatients practising self-injury

“…impulsive or planned selfpoisoning with substances and without a differentiation between the suicidal or non-suicidal intent of the patient. Skegg [45] tried to clarify the different definitions by collecting terms which are mistakenly used synonymously, from parasuicide to self-wounding. One of the main differences one has to be aware of from the clinical perspective is the issue of distinction between self-injurious and suicidal behaviour.…”