About Self-Harm

Definitions

• The issue of self-harm is complex both from a definitional perspective and in relation to the scarcity of data regarding frequency and patterns of self-harm in Australia.  There is no ‘universal definition’ of self-harm and additionally, there are diverse views concerning the reasons or risk factors for self-harming behaviours.
• In general, self-harm (sometimes referred to as self-injury) is understood to involve a person deliberately causing him or herself physical pain as a means of managing difficult or painful emotions, or as a way of communicating their distress to others.ⁱ
• There are many forms of self-harming behaviours. Reckless driving and other high-risk behaviours can in some cases be indicators of self-harm. The act of self-harming is not directly or necessarily an attempt by a person to end their life (although acts of self-harm can result in disability or death in severe cases of physical injury).
• The relationship between self-harm and suicidality is complex (see below:Self-harm and Suicide).

Risk Factors

• Individual motives for self-harming behaviour are diverse and may be a short or long term response to emotional difficulty, low self-esteem, anger, isolation, grief or traumatic life experiences including childhood emotional, physical or sexual abuse.ⁱⁱ
• Self-harming behaviours typically commence in adolescenceⁱⁱⁱ, although this may not be the case for all individuals.
• Self-harming behaviours may be linked with mental illness, in particular depression, anxiety, personality disorder, phobias, conduct disorders and substance abuse^iv. Recent studies, however, suggests that self-harm is a ‘phenomenon in and of itself’^v as self-harming behaviours can reflect the level of a person’s distress independent of mental illness^vi.
• Other research suggests that individual, and social and environmental influences that may contribute to a person’s risk of self-harm include: poor problem solving skills, impulsivity, emotionally and physically abusive environments, war and poverty. However some people who self-harm may have no experience of any of these factors.

Self-Harm & Suicide

• The relationship between self-harm and suicide is complex. Most commonly the motivation for self-harming behaviour is to cope with, or to gain a sense of relief from painful emotions and distressing personal experiences, not to result in death.
• Any action that is deliberately intended to cause death is best regarded as a suicide attempt.^vii Any deliberate attempt on one’s life that results in death is best understood to be a suicide.
• Since most self-harm experts agree that self-harm and suicide are distinct and separate acts, some have suggested that self-harm should be established as an independent clinical syndrome^viii.
• According to published research, more than half of individuals who self-harm do not have suicidal thoughts at the time of self-harm and self-harm has been described as a way to avoid suicide^ix. In one study^x a participant reported that her self-harming behaviours helped her to feel more ‘in control’ whereas her suicidal behaviour occurred when she felt out of control.
• This being said, acts of self-harm need to be taken seriously. Individuals who self-harm may be considered at higher risk of further, more severe self-harm and later suicide^xi. Self-harm and suicide attempts can be performed by the same individual – and in some cases the intent may not be completely clear. A British study^xii observed that 16% of people who self-harm repeat their self-harm within one year and 7% suicide within nine years. 
• Regardless of the specific intent in any single instance, acts of self-harm or attempted suicide reflect a degree of emotional distress by an individual that requires skilled assessment and support.

 [i] RANZCP (2005). Self-harm. Australian Treatment Guide for Consumers and Carers. The Royal Australian and New Zealand College of Psychiatrists: Melbourne