Why do people self-harm?

Here are references relating to different types of therapeutic interventions we can offer and different types of mental health issues, developmental disorders and other presenting problems.
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miriam
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Why do people self-harm?

Post by miriam » Sat Apr 07, 2007 2:27 am

The samaritans (and several other voluntary organisations) have great info on self-harm, and have recently done research on the frequency and reasons for self harm in teenagers. This seems a good starting point, with lots of references and a good overview...

I'm sure if you search from their website (http://www.samaritans.co.uk/)there will be some links. In fact a general internet search should lead you to all different kinds of information on self-harm, including Royal College of Psychiatry guidance, and chapters in many generic mental health books...

Superficial self harm seems to be part of alternative culture to a certain extent and can be perceived along with piercings and tattoos as a mark of rebellion against the norm. I find the prevalence quite high amongst teenage "greb" girls in our area. I think that self-cutting has been brought into popular culture through music and soap operas (think Richie Manic on the cover of NME, for example), before that it was not nearly as widespread in this age-group.

Another link you might like to look at www.lifesigns.org.uk Also, have a look at National Self-Harm Network website: http://www.nshn.co.uk and this also makes a good read.

I don't know if you've seen the BPS website, they have a link to a booklet on Self Harm that is free to download.

When assessing self harm there are a number of questions you ask to determine risk. These include whether or not the intention/expectation was to harm or kill themselves (it often isn't), whether the act was planned, whether they were alone, whether they told anyone, whether they used alcohol or drugs at the time etc. People who do self harm that intends to cause their death, who plan it in advance, who don't tell others (but may leave notes or otherwise prepare for after their death) show higher levels of risk and need to be taken more seriously. Northampton have a very good Deliberate Self-harm care pathway for children and adolescents that I think gives a good structure to completing self-harm assessments. As well as asking about antecedents, setting circumstances, intentions, mood, sources of support, etc there is also a brief checklist of PATHOS which predicts risk of future harm. I think the acronym stands for: Had they felt there were Problems for more than a month? Were they Alone at the time (and not expecting to be found)? Had they planned the harm for more than Three hours?Were they feeling Hopeless about the future? If it was an Overdose, had they taken all the tablets that were available? Were they feeling Sad at the time of the attempt? Each answer that is positive is a sign of increased risk.

Superficial cutting on visible skin (most normally parallel cuts on the top of the lower arms, perpendicular to the direction of the arm) have very little risk of lasting harm to the person and are quite cultural. Cuts that are parallel to the direction of the arm, deeper and on the underside carry much more risk. And cuts to other parts of the body (especially breasts, thighs, belly) show much more serious distress and can be associated with either self-loathing, body-image problems, or sexual abuse and should be taken very seriously even though the risk associated with the cuts themselves is low.

Experience shows that the actual risk of the behaviour is often not as important as the meaning of that behaviour to the person doing it (if a person takes 10 contraceptive pills thinking this will kill them it shows greater distress than someone who takes 10 paracetomol thinking this will help them sleep - even though the latter can kill and the former is unlikely to cause enduring harm). Obviously many things can be the outward signals of inner distress, be that rituals in OCD, changes in eating/weight, changes in lifestyle or appearance, etc. And visible self-harm is a clear distress signal, no matter what the cultural context.

I don't really believe there is such a thing as "attention seeking" except maybe a red flag to say that there is not enough positive attention reaching that person, so they have had to develop more extreme ways to communicate, and/or illicit care from those around them.

More on self harm, and assessment here.

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Content checked by a moderator on 01/03/12
Miriam

See my blog at http://clinpsyeye.wordpress.com

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