Table of Contents
1 Introduction 3
2 Types of Self Injury 3
3 Risk Factors 3
3.1 Childhood Risk Factors 3
3.2 Adult Risk Factors 3
3.3 Co-existing Medical Conditions 3
4 Complications 4
4.1 Medical Complications 4
4.2 Emotional Complications 4
4.3 Practical Complications 4
5 Presentation and Diagnosis 4
6 Prevention and Management 5
6.1 Medical Management 5
6.2 Therapeutical Management 5
6.3 Psychiatric Management 5
7 Conclusion 5
8 References 6
9 Help and Support 6
1. Introduction
Self-injury is a term which describes a variety of behaviours in which there are two critical elements: the damage is acute and the damage is intentional. Self injury is generally an unhealthy effort to cope with overwhelming emotions, such as intense anger, rage, terror or shame. There is often a distinction made by psychiatrists between attempted suicide and self-injury as these acts are most often done without suicidal intent. The damage caused is generally severe enough to leave a bruise, scar or other mark, or cause health issues.
2. Types of self injury
Self injury includes, but is not limited to, cutting, burning, branding, overdosing, bone breaking, interfering with wound healing, scratching, biting, hair pulling (Trichotillomania) and puncturing the skin. It may also include eating disorders, excessive drinking and drug use, although these are disputed by some physicians.
3. Risk factors
3.1 Childhood risk factors
Sexual abuse
Neglect
Emotional abuse
Physical abuse
Loss or separation
Parental mental health issues
Parental substance abuse
3.2 Adult risk factors
Rape or sexual abuse
Psychiatric diagnoses
Substance misuse
Absence of emotional support
Intense and distressing emotions
3.3 Co-existing m...
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Hawton, K et al: Self-harm in adolescents: self-report survey in schools in Scotland, The British Journal of Psychiatry (2009)
Royal College of Psychiatrists College Report CR 158: Self-harm, suicide and risk: helping people who self-harm (2010)
Suicide and deliberate self-harm in young people (2005). Hawton, K. & James, A., BMJ, 330, p.891-894
In what way are adolescents who engage in self-harm, or experience thoughts of self-harm, different in terms of help-seeking, communications and coping strategies? (2005). Evans, E., Hawton, K. & Rodham, K., Journal of Adolescence, 28, p.573-587
Self-harm, or self-mutilation, is the intentional action of harming oneself, generally without the intent to kill. It is estimated that over two million people self-harm in the United States alone (Pomere). When involved with depression, self-harm is generally used as a method of coping with stress and various feelings that they may be having. If depression manifests with feelings of inadequacies, one could feel like they deserve to be injured (Bartha). Over time, the act of self-injury could become an addiction. It could become an obsession (Pomere).
Self-harm, or also known as attempted suicide, or parasuicide, is a way to physically express emotional distress. For people who do self-harm, it is a way to cope with their problem, to distract them from the emotional pain. In simple words, it is a quick temporary band-aid for their inner wounds. After hurting themselves, people wou...
Murphy, E., Kapur, N., Webb, R., & Cooper, J. (2011). Risk assessment following self-harm: comparison of mental health nurses and psychiatrists. Journal Of Advanced Nursing, 67(1), 127-139. doi:10.1111/j.1365-2648.2010.05484.x
Self harm occurs most often in young women, along with veterans of the armed forces, gay, lesbian, or people that are bisexual, and people that have been physical, emotional or sexual abuse during their childhood.
Why do people hurt themselves? In a journal article from the American Journal of Psychotherapy, Louise Ruberman notes that about 2.1 million teens suffer from nonsuicidal self-injury, or NSSI. Young women between the ages of 14 and 18 years old take part in NSSI due to poor development of the relationship with their mothers, childhood abuse, and psychiatric disorders. Although there are multiple ways of causing injury to oneself, cutting of the skin as a means of self-mutilation is said to be the most common (Ruberman 119). We will start out by examining the problems that occur during the relationship development between a mother and a daughter at a young age.
D, S., & L., C. (1999). Methods of adolescent suicide prevention. Journal of Clinical Psychiatry, 60(suppl 2):70-4.
Suicide in adolescents is the third-leading cause of death in the United States between the ages of 10 though 19 (National Center for Health Statistics, 2012, 292). More adolescents who think even about attempting suicide are mostly the ones who are unsuccessful at it. Females for example, are more likely than males to attempt to commit suicide by either over dosing on sleeping pills or self harming. Most adolescents’ girls will not succeed in actually committing suicide. Males on the other hand, use more drastic ways of committing suicide, adolescent boys usually with a firearm rather than another meth...
In 2011, the Centers for Disease Control and Prevention established that 6.3% of high school students have attempted suicide in the preceding year. Given the lethal consequences of suicide attempts, determining risk factors among adolescents becomes especially important. Generally speaking, psychiatric disorders and substantial psychosocial impairments are known to be associated with suicide attempts. However, previous research attempting to identify specific risk factors in adolescents is somewhat ambiguous. Nonetheless, one thing is consistent. When measuring the risk of an adolescent committing suicide, information must come from a variety of sources and perspectives. These sources may include but are not limited to a clinical interview with the adolescent, information provided by the parent or guardian, standardized assessments and previous psychiatric documents from the individual.
Styer, Denise M. "An Understanding of Self-Injury and Suicide." Prevention Researcher Integrated Research Services, Inc., Vol. 13, Supplement. Dec. 2006: 10-12. SIRS Issues Researcher. Web. 16 Apr. 2014. .
Wilkinson P, Kelvin R, Roberts C, Dubika B, Goodyer I (2011) “Clinical & Psychosocial Predictors of Suicide Attempts and Nonsuicidal Self-Injury in the Adolescents Depression, Anti-Depressants & Psychotherapy Trial (ADAPT)” The American Journal of Psychiatry 168(5) page 495-501
Some say that the teenage years are one of the most challenging and trying times in an individual’s life. Many changes take place, both emotionally and physically, which sometimes can give the feeling of excitement… or in other cases… complete confusion and utter turmoil. Because emotions tend to run high during this period of life due to hormones, some teens resort to an unhealthy way of coping to deal with their emotional pain. This unhealthy way of dealing with emotional pain is also known as self injury. Self injury (or self harm) is widely known to take place during the teenage years up until the early years of adulthood (ages 14-24)when judgments become more defined, criticism becomes harsher, and limits are tested. The transition from childhood to adulthood may sound exciting and adventurous to some, but to others, it’s a nightmare they wish they could wake up from.
The key to understanding suicide and self-destructive behavior comes from the awareness of how some destructive thought processes control the need to end one’s life. Being cognizant of how these thoughts are veiled and can lead to a self-destructive downward spiral, enables clinicians to better assess risk and design interventions for depressed and suicidal clients. According to Nock and Banajii (2007) worldwide, suicides among adolescents have increased dramatically averaging one million each year. Many teenagers experience strong feelings of stress, confusion and self-doubt in the process of growing up. Pressures to succeed, the economy, and the environment can intensify these feelings. At present, self-report has been unsuccessful in the prevention of teen suicide; the tools available to help health care professionals detect potential suicide ideation are not sufficiently reliable (Nock & Banajii, 2007). In fact, Nock and Benajii stated that often during therapy, suicidal ideation may not be present and surfaces once the patient goes home or oftentimes, the patient will deliberately hide the urge to end his life. Because the existing tools rely solely on subjective statements, it is very challenging to decipher congruency between what is verbalized and what remains unsaid (Nock & Banajii, 2007).
Doyle, Treacy and Sheridan performed a study which found that the strongest correlation between self-harm and adolescent females were fighting with parents, followed by worries over their sexual orientation. In addition, peer relations, having friends or family members who self-harm and being bullied also were strong factors (Doyle et al. 2015). McCarthy and Hutz concluded that all forms of self-harm were, in fact, misdirected aggression, or aggression directed inward (77). In other words, their feelings of being angry with someone else or disappointed in their performance at school, the youth turns their anger inward, and cutting becomes a way to control the
So as you can see suicide and self harm are two slightly different things. However both are very serious. One can lead to the other and both should be taken seriously. Suicide is more than just another death. Self harm is more than just any other addiction.
Now the eighth-leading cause of death overall in the U.S. and the third-leading cause of death for young people between the ages of 15 and 24 years, suicide has become the subject of much recent focus. U.S. Surgeon General David Satcher, for instance, recently announced his Call to Action to Prevent Suicide, 1999, an initiative intended to increase public awareness, promote intervention strategies, and enhance research. The media, too, has been paying very close attention to the subject of suicide, writing articles and books and running news stories. Suicide among our nation’s youth, a population very vulnerable to self-destructive emotions, has perhaps received the most discussion of late. Maybe this is because teenage suicide seems the most tragic—lives lost before they’ve even started. Yet, while all of this recent focus is good, it’s only the beginning. We cannot continue to lose so many lives unnecessarily.