Self harm
Self-harm (SH) or deliberate self-harm (DSH) includes self-injury (SI) and self-poisoning (SP) and is defined as the intentional, direct injuring of body tissue without suicidal intent. These terms are used in the more recent literature in an attempt to reach a more neutral terminology. The older literature, especially that which predates the DSM-IV-TR, almost exclusively refers to self-mutilation. The term is synonymous with "self-injury." The most common form of self-harm is skin-cutting but self-harm also covers a wide range of behaviours including, but not limited to, burning, scratching, banging or hitting body parts, interfering with wound healing, hair-pulling (trichotillomania) and the ingestion of toxic substances or objects. Behaviours associated with substance abuse and eating disorders are usually not considered self-harm because the resulting tissue damage is ordinarily an unintentional side effect.[6] However, the boundaries are not always clear-cut and in some cases behaviours that usually fall outside the boundaries of self-harm may indeed represent self-harm if performed with explicit intent to cause tissue damage. Although suicide is not the intention of self-harm, the relationship between self-harm and suicide is complex, as self-harming behaviour may be potentially life-threatening. There is also an increased risk of suicide in individuals who self-harm to the extent that self-harm is found in 40–60% of suicides. However, generalising self-harmers to be suicidal is, in the majority of cases, inaccurate.
Self-harm in childhood is relatively rare but the rate has been increasing since the 1980s. Self-harm is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) as a symptom of borderline personality disorder. However patients with other diagnoses may also self-harm, including those with depression, anxiety disorders, substance abuse, eating disorders, post-traumatic stress disorder, schizophrenia, and several personality disorders. Self-harm is also apparent in high-functioning individuals who have no underlying clinical diagnosis. The motivations for self-harm vary and it may be used to fulfill a number of different functions. These functions include self-harm being used as a coping mechanism which provides temporary relief of intense feelings such as anxiety, depression, stress, emotional numbness and a sense of failure or self-loathing. Self-harm is often associated with a history of trauma and abuse, including emotional abuse, sexual abuse, drug dependence, eating disorders, or mental traits such as low self-esteem or perfectionism. There is also a positive statistical correlation between self-harm and emotional abuse. There are a number of different methods that can be used to treat self-harm and which concentrate on either treating the underlying causes or on treating the behaviour itself. When self-harm is associated with depression, antidepressant drugs and treatments may be effective. 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.
Self-harm is most common in adolescence and young adulthood, usually first appearing between the ages of 12 and 24. However, self-harm can occur at any age, including in the elderly population. The risk of serious injury and suicide is higher in older people who self-harm. Self-harm is not limited to humans. Captive non-human animals are also known to participate in self-mutilation, such as captive birds and monkeys.
History
Research on this type of behaviour began in the 1880s but were not generally differentiated from other behavioural problems. The term "self-mutilation" occurred in a study by L.E. Emerson in 1913. where he considered self-cutting a symbolic substitution for masturbation. The term reappeared in an article in 1935 and a book in 1938 when Karl Menninger refined his conceptual definitions of self-mutilation. His study on self-destructiveness differentiated between suicidal behaviours and self-mutilation. For Menninger, self-mutilation was a non-fatal expression of an attenuated death wish and thus coined the term partial suicide. He began a classification system of six types:
- neurotic – nail-biters, pickers, extreme hair removal and unnecessary cosmetic surgery.
- religious – self-flagellants and others.
- puberty rites – hymen removal, circumcision or clitoral alteration.
- psychotic – eye or ear removal, genital self-mutilation and extreme amputation
- organic brain diseases – which allow repetitive head-banging, hand-biting, finger-fracturing or eye removal.
- conventional – nail-clipping, trimming of hair and shaving beards.
- More information is available at [ Wikipedia:Karl Menninger ]
Pao (1969) differentiated between delicate (low lethality) and coarse (high lethality) self-mutilators who cut. The "delicate" cutters were young, multiple episodic of superficial cuts and generally had borderline personality disorder diagnosis. The "coarse" cutters were older and generally psychotic. Ross and McKay (1979) categorized self-mutilators into 9 groups: cutting, biting, abrading, severing, inserting, burning, ingesting or inhaling and hitting and constricting
- More information is available at [ Wikipedia:borderline personality disorder ]
After the 1970s the focus of self-harm shifted from Freudian psycho-sexual drives of the patients.
Walsh and Rosen (1988) created four categories numbered by Roman numerals I–IV, defining Self-mutilation as rows II, III and IV
| Classification | Examples of Behavior | Degree of Physical Damage | Psychological State | Social Acceptability |
|---|---|---|---|---|
| I | Ear-piercing, nail-biting, small tattoos, cosmetic surgery (not considered self-harm by the majority of the population) | Superficial to mild | Benign | Mostly accepted |
| II | Piercings, saber scars, ritualistic clan scarring, sailor and gang tattoos | Mild to moderate | Benign to agitated | Subculture acceptance |
| III | Wrist- or body-cutting, self-inflicted cigarette burns and tattoos, wound-excoriation | Mild to moderate | Psychic crisis | Accepted by some subgroups but not by the general population |
| IV | Auto-castration, self-enucleation, amputation | Severe | Psychotic decompensation | Unacceptable |
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