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Self-harm

Self-harm
Other namesDeliberate self-harm (DSH), self-injury (SI), nonsuicidal self-injury (NSSI), cutting
Healed scars on the forearm
Healed scars on the forearm from prior self-harm
SpecialtyPsychiatry, surgery, or emergency medicine if serious injuries occur

Self-harm refers to intentional behaviors that cause harm to oneself. This is most commonly regarded as direct injury of one's own skin tissues, commonly with suicidal intention.[1][2][3] Other terms such as cutting, self-injury, and self-mutilation have been used for any self-harming behavior regardless of suicidal intent.[2][4] Common forms of self-harm include damaging the skin with a sharp object or scratching with the fingernails, hitting, or burning. The exact bounds of self-harm are imprecise, but generally exclude tissue damage that occurs as an unintended side-effect of eating disorders or substance abuse, as well as more societally acceptable body modification such as tattoos and piercings.[5]

Although self-harm is by definition non-suicidal, it may still be life-threatening.[6] People who do self-harm are more likely to die by suicide,[3][7] and self-harm is found in 40–60% of suicides.[8] Still, only a minority of those who self-harm are suicidal.[9][10]

The desire to self-harm is a common symptom of some personality disorders. People with other mental disorders may also self-harm, including those with depression, anxiety disorders, substance abuse, mood disorders, eating disorders, post-traumatic stress disorder, schizophrenia, dissociative disorders, psychotic disorders, as well as gender dysphoria or dysmorphia. Studies also provide strong support for a self-punishment function, and modest evidence for anti-dissociation, interpersonal-influence, anti-suicide, sensation-seeking, and interpersonal boundaries functions.[2] Self-harm can also occur in high-functioning individuals who have no underlying mental health diagnosis.

The motivations for self-harm vary; some use it as a coping mechanism to provide temporary relief of intense feelings such as anxiety, depression, stress, emotional numbness, or a sense of failure. Self-harm is often associated with a history of trauma, including emotional and sexual abuse.[11][12] There are a number of different methods that can be used to treat self-harm, which concentrate on either treating the underlying causes, or on treating the behavior itself. 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.[13]

Self-harm tends to begin in adolescence. Self-harm in childhood is relatively rare, but the rate has been increasing since the 1980s.[14] Self-harm can also occur in the elderly population.[15] The risk of serious injury and suicide is higher in older people who self-harm.[16] Captive animals, such as birds and monkeys, are also known to harm themselves.[17]

  1. ^ Laye-Gindhu A, Schonert-Reichl KA (2005). "Nonsuicidal Self-Harm Among Community Adolescents: Understanding the 'Whats' and 'Whys' of Self-Harm". Journal of Youth and Adolescence. 34 (5): 447–457. doi:10.1007/s10964-005-7262-z. S2CID 145689088.
  2. ^ a b c Klonsky ED (March 2007a). "The functions of deliberate self-injury: a review of the evidence". Clinical Psychology Review. 27 (2): 226–239. doi:10.1016/j.cpr.2006.08.002. PMID 17014942. S2CID 1321836.
  3. ^ a b Muehlenkamp JJ (April 2005). "Self-injurious behavior as a separate clinical syndrome". The American Journal of Orthopsychiatry. 75 (2): 324–333. doi:10.1037/0002-9432.75.2.324. PMID 15839768.
  4. ^ Groschwitz RC, Plener P. "The Neurobiology of Non-suicidal Self-injury (NSSI): A review" (PDF). Suicidology Online. 3: 24–32. Retrieved 2018-03-07.
  5. ^ Klonsky 2007b, p. 1040: "[B]ehaviors associated with substance and eating disorders—such as alcohol abuse, binging, and purging—are usually not considered self-injury because the resulting tissue damage is ordinarily an unintentional side effect. In addition, body piercings and tattoos are typically not considered self-injury because they are socially sanctioned forms of cultural or artistic expression. However, the boundaries are not always clear-cut. In some cases behaviors that usually fall outside the boundaries of self-injury may indeed represent self-injury if performed with explicit intent to cause tissue damage."
  6. ^ Farber SK, Jackson CC, Tabin JK, Bachar E (2007). "Death and annihilation anxieties in anorexia nervosa, bulimia, and self-mutilation". Psychoanalytic Psychology. 24 (2): 289–305. doi:10.1037/0736-9735.24.2.289.
  7. ^ Skegg K (2005). "Self-harm". Lancet. 366 (9495): 1471–1483. doi:10.1016/s0140-6736(05)67600-3. PMID 16243093. S2CID 208794175.
  8. ^ Hawton K, Zahl D, Weatherall R (June 2003). "Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital". The British Journal of Psychiatry. 182 (6): 537–542. doi:10.1192/bjp.182.6.537. PMID 12777346.
  9. ^ Fox C, Hawton K (2004). Deliberate Self-Harm in Adolescence. London: Jessica Kingsley. ISBN 978-1-84310-237-3.
  10. ^ Suyemoto KL (August 1998). "The functions of self-mutilation". Clinical Psychology Review. 18 (5): 531–554. doi:10.1016/S0272-7358(97)00105-0. PMID 9740977. S2CID 15468889.
  11. ^ Meltzer H, Lader D, Corbin T, Singleton N, Jenkins R, Brugha T (2000). Non Fatal Suicidal Behaviour Among Adults aged 16 to 74 (PDF). Great Britain: The Stationery office. ISBN 978-0-11-621548-2.
  12. ^ Rea K, Aiken F, Borastero C (1997). "Building therapeutic staff: client relationships with women who self-harm". Women's Health Issues. 7 (2): 121–125. doi:10.1016/S1049-3867(96)00112-0. PMID 9071885.
  13. ^ Klonsky ED, Glenn CR (March 2008). "Resisting Urges to Self-Injure". Behavioural and Cognitive Psychotherapy. 36 (2): 211–220. doi:10.1017/S1352465808004128. PMC 5841247. PMID 29527120.
  14. ^ Thomas B, Hardy S, Cutting P (1997). Stuart and Sundeen's mental health nursing: principles and practice. Elsevier Health Sciences. p. 343. ISBN 978-0-7234-2590-8.
  15. ^ Pierce D (1987). "Deliberate self-harm in the elderly". International Journal of Geriatric Psychiatry. 2 (2): 105–110. doi:10.1002/gps.930020208. S2CID 145408278.
  16. ^ National Institute for Clinical Excellence (2004). National Clinical Practice Guideline Number 16: Self-harm (PDF). The British Psychological Society. Retrieved 2009-12-13.
  17. ^ Jones IH, Barraclough BM (July 1978). "Auto-mutilation in animals and its relevance to self-injury in man". Acta Psychiatrica Scandinavica. 58 (1): 40–47. doi:10.1111/j.1600-0447.1978.tb06918.x. PMID 99981. S2CID 24737213.

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