Deliberate self harm

• What is Deliberate Self-Harm
• Statistics on Deliberate Self-Harm
• Risk Factors for Deliberate Self-Harm
• Progression of Deliberate Self-Harm
• Symptoms of Deliberate Self-Harm
• Clinical Examination of Deliberate Self-Harm
• How is Deliberate Self-Harm Diagnosed?
• Prognosis of Deliberate Self-Harm
• How is Deliberate Self-Harm Treated?
• Deliberate Self-Harm References

What is Deliberate Self-Harm

“Self-harm” refers to the deliberate, direct destruction of the body that results in tissue damage.
When someone engages in self-harm, they may have a variety of intentions; these are discussed below. However, the person’s intention is NOT to kill themselves. You may have heard self-harm referred to as “parasuicide,” “self-mutilation,” “self-injury,” “self-abuse,” “cutting,” “self-inflicted violence,” and so on.

Statistics on Deliberate Self-Harm

Self-harm is not well-understood and has not yet been extensively studied. The rates of self-harm revealed through research vary tremendously depending on how researchers pose their questions about this behavior. One widely cited estimate of the incidence of impulsive self-injury is that it occurs in at least 1 person per 1,000 annually.
Cases of DSH (also known as parasuicide) are more than 30 times more common than suicide, although they differ in that there is no direct intention of killing oneself. However, the suicide rate in the following year in these cases is 100 times greater than for the general population.

Risk Factors for Deliberate Self-Harm

Several studies have indicated that individuals who engage in self-harm report unusually high rates of prior:

• Childhood abuse either sexual/physical or both.
• Emotional neglect.
• Insecure attachment.
• Prolonged separation from caregivers.

How is Deliberate Self-Harm Diagnosed?

Many people who self-harm have spoken to their relatives, friends or doctors in the weeks running-up to the actual act of DSH. Therefore, it is likely that a proportion of self-harming acts are potentially preventable with the right help. Enquiring about suicidal feelings is important – it helps sufferers believe that their hopeless plight is appreciated and sympathetically understood.
Inquiring as to the frequency and intensity of any suicidal thoughts and whether any active plans to end life are being considered currently. Feelings of worthlessness and despair are worrying.
Depressed mood, weight loss, insomnia and delusions are also very serious risk factors. A doctor should always be approached to assess such symptoms.

Prognosis of Deliberate Self-Harm

Assessing the risk for further deliberate self-harm or suicide is a vital task for the G.P. and the hospital doctor. Research shows that of people who die from suicide, two thirds had consulted their G.P. in the previous month, a third had consulted in the previous week.

How is Deliberate Self-Harm Treated?

People at risk of suicide should be treated urgently in hospital to recognise and treat underlying problems. Antidepressants or, in certain cases, even ECT together with constant psychiatric nursing supervision may be required. Social intervention, follow-up and counselling can be extremely effective. Most people who self-harm improve when their coping skills improve and when personal and social problems are properly resolved. So on-going counselling is also important.

References

1. Boudewyn, A.C., & Liem, J.H. (1995). Childhood sexual abuse as a precursor to depression and self-destructive behavior in adulthood. Journal of Traumatic Stress, 8, 445 – 459.
2. Gratz, K.L., Conrad, S.D., & Roemer, L. (2002). Risk factors for deliberate self-harm among college students. American Journal of Orthopsychiatry, 72, 128 – 140.
3. Zlotnick, C., Shea, M.T., Pearlstein, T., Simpson, E., Costello, E., & Begin, A. (1996). The relationship between dissociative symptoms, alexithymia, impulsivity, sexual abuse, and self-mutilation. Comprehensive Psychiatry, 37, 12 – 16.