About Self-Harm

What is self-harm?

The issue of self-harm is complex. There is no ‘universal definition’ of self-harm and additionally, there are diverse views concerning the reasons or risk factors for self-harming behaviours. Self-harm (also known as self injury) refers to the behavior of deliberately causing oneself pain or injury.

Self-harming behaviour can include, but is not limited to, biting, burning or cutting oneself, overdosing on prescription or illegal drugs, binge eating or starvation, alcohol or drug abuse, or repeatedly placing oneself in dangerous situations. Some people who engage in self-harming behaviors report that self-harm becomes addictive¹. It can become their main way to deal with any emotional pain or stressor in their life and they become unable to deal with things in any other way².

Research shows that females are more likely to self-harm than males. The highest rate of self-harm behaviour occurs in people aged 15 to 44, with the highest prevalence within this age group being in the 25 to 44 year old age bracket. There is a low prevalence of self-harm for people under 14 and over 65 years of age³.

Why does a person self-harm?

People may self-harm for a number of reasons. These include;

• To reduce psychological pain and distress in the short term⁴;
• To communicate their emotional pain to others⁵;
• To escape from, or control, emotions such as anger, despair, self hatred, low self esteem or intense sadness⁶ ;
• To achieve emotional numbness: which is based on the assumption that feeling physical pain is better than feeling nothing at all⁷; 
• Living with a mental illness such as anxiety or depression⁸.

Risk factors for self harm

Research has revealed a number of risk factors which increase the likelihood that a person may self- harm. These include:

• Early childhood experiences - physical or sexual abuse, neglect, loss or separation during childhood or poor attachment to parent or caregivers⁹;
• Age - self-harming behaviors usually begin in adolescence and are more prevalent in people aged 25 to 44¹⁰;
• Gender- self-harming behaviours are more common in females than males¹¹;
• History of self-harm - if a person has self-harmed before they have a much higher chance of self- harming again when placed under stress or crisis, or experience emotions they are unable to cope with¹²;
• Individual factors - impulsivity, poor problem solving skills, being highly sensitive to emotions and over reactivity to emotional stimuli;
• Environmental factors - emotional and physically abusive environments, war or poverty;
• Mental illness - depression, anxiety, personality disorders, substance abuse and eating disorders¹³.

* NEW * Guidelines for helping someone who is at risk of non-suicidal self-injury

Provided by Mental Health First Aid Program www.mhfa.com.au

Myths about self harm

MYTH: Self-harm is just attention-seeking

• Research shows about two thirds of young people who self-harm don’t tell anyone¹⁴ and go lengths to try to cover up- such as wearing a long shirt if they are cutting their forearm.
• Self-harm is usually a response to distress and an attempt to make the person feel better. People who self-harm report using these behaviors to reduce psychological pain and distress in the short term and to communicate their emotional pain to others.

MYTH: Self-harm is an attempt to take one’s own life

• 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. 
• The motivation for suicide is very different. People may take their own life to end emotional or physical pain, or because they cannot see a solution to their problem. 
• 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 suicide¹⁵. In one study¹⁶ 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.

MYTH: Self-harm is a way to manipulate others

• People who self harm have problems with being able to express their emotions in a verbal way. 
• People who self-harm are trying to relive, escape from, or control intense emotions such as anger, sadness, self loathing or low self esteem. People see this as a way to express their inner pain.

MYTH: People who self-harm have a mental illness

• It is a common misconception that people who self harm must have a mental illness. However, the research evidence which looks at the linkage between self-harm and suicide is mixed. 
• A study by Skegg, Nada-Raja and Moffitt¹⁷ examined the prevalence of psychiatric disorders among individuals who self-harm. The results showed that all 25 males and females who reported self-harm behaviour met the diagnostic criteria for at least one psychiatric disorder within that year. 
• These results are not supported by a study which found that two thirds of young people who self- harmed did not have a mental illness¹⁸. Recent studies suggest that self-harm is a ‘phenomenon in and of itself¹⁹ as self-harming behaviours can reflect the level of a person’s distress independent of mental illness²⁰.

MYTH: Only teenage girls self-harm

• It is true that self-harm is more prevalent in females than males²¹. However, 
• The prevalence of self-harm behaviours in males is increasing. 
• People who self harm can be of any age. One study on self-harm found that 28% of people who self-harmed were aged 15 to 24 years, while 47% were aged 25 to 44 years²².

Self-harm and 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. The motivation for suicide is very different. People may take their own life to end emotional or physical pain, or because they cannot see a solution to their problem.

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 suicide²³. In one study²⁴ 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.

Individuals who self-harm may be considered at higher risk of further, more severe self-harm and later suicide²⁵. 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 study²⁶ observed that 16% of people who self-harm repeat their self-harm within one year and 7% suicide within nine years.

References

1. Children, Youth and Women’s Health. (2009). Self-harm. Retrieved 11 March 2009, from http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=243&np=293&id=2464

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

3. Auseinet. (2007). Australian Self-harm Statistics: Key Findings. Adelaide: Australian Network for Promotion, Prevention and Early Intervention for Mental Health.

4. RANZCP (2005). Op cit

5. Ibid

6. Better Health Victoria. (2007). Self harm. Retrieved March 11 2009, from http://www.betterhealth.vic.gov.au/bhcv2/bhcArticles.nsf/pages/Self_harm?OpenDocument

7. Hodgson, S. (2004). Cutting through the silence: A sociological construction of self-injury. Sociological Inquiry, 74 (2), 162-179.

8. Skegg, K., Nada-Raja, S., & Moffitt, T. E. (2004). Minor self-harm and psychiatric disorder: A population-based study. Suicide and Life Threatening Behaviour, 34 (2), 187- 196.

9. Gratz, K. L. (2003). Risk factors for and functions of deliberate self-harm: An empirical and conceptual review. Psychology: Science and Practice, 10, 192 – 205.

10. Auseinet. (2007). Op cit.

11. Ibid.

12. Hawton, K., Zahl, D., & Weatherall, R. (2003). Suicide following deliberate self-harm: long term follow-up of patients who presented to a general hospital. British Journal of Psychiatry, 182, 537 – 542.

13. Skegg, K., Nada-Raja, S., & Moffitt, T. E. (2004). Op cit.

14. Children, Youth and Women’s Health. (2009). Op cit.

15. Stanley, B., Gameroff, M., Michalsen, V & Mann, J. (2001). Are suicide attempters who self-mutilate a unique population? American Journal of Psychiatry, 158 (3), 427-432.

16. Farrand, J. & Solomon, Y. (1996). ‘Why don’t you do it properly? Young women who self-injure. Journal of Adolescence, 19 (2), 111-119

17. Skegg, K., Nada-Raja, S., & Moffitt, T. E. (2004). Op cit.

18. Hodgson, S. (2004). Op cit.

19. Ibid.

20. RANZCP (2005). Op cit.

21. Auseinet. (2007). Op cit.

22. Ibid.

23. Stanley, B., Gameroff, M., Michalsen, V & Mann, J. (2001). Op cit.

24. Farrand, J. & Solomon, Y. (1996). Op cit.

25. Connor, K., Langley, J., Tomaszewski, K. & Conwell, Y. (2003). Injury hospitalisation and risks for subsequent self-injury and suicide: A national study from New Zealand. American Journal of Public Health, 93, 1128-1131.

26. Owens, D., Horrocks, J. & House, A. (2002). Fatal and non-fatal repetition of self-harm. British Journal of Psychiatry, 181, 193-199.