What is Self-harm?
What is Self-harm?
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What is Self-harm?
Self-harm is usually defined as intentional self-poisoning or self-injury, irrespective of the nature of the harm, or its purpose, or motivation, or degree of suicidal intent. There are usually multiple motives underpinning self-harm
Self-harm covers a wide range of behaviours. This includes isolated and repeated events. Such events include self-cutting, poisoning, scratching, burning, banging, hitting, hair pulling, interfering with wound healing. Sometimes, particularly in older adults, it can include not taking medication. Self-harm behaviour challenges the individual, families and professionals alike.
Behaviours associated with substance misuse, lifestyle risk taking or eating disorders are generally not considered ‘self-harm’. This is because usually the harm is an unintentional side effect of the behaviour. So, taking eating disorders as an example, the harm due to weight loss is not necessarily due to a wish to harm the self but a wish to look and be thinner.
However, boundaries can be blurred. Meanings differ depending on the context. There are nevertheless often links. So, for example, self-harm is much more common if a person also has substance misuse or an eating disorder than in the general population.
Therefore, this definition of self-harm may seem very general. That’s because the method, nature of motivation and degree of suicidal intent are complex. These may change for any person over time.
Select the two images for more information about the complex nature of self-harm.
Understanding motivation is very important. There can be many motivations. More common ones include self-harm as a coping mechanism for the (i) management of distress or (ii) a way of expressing that emotional distress.
Such coping mechanisms may in the short term be ways of the person avoiding resorting to actual suicidal behaviours.
Self-harm may be hidden. The person may have mixed feelings about self-harm, wanting to do it and not wanting to. This may also be true for ideas or plans to end life by suicide.
Self-harm may be hidden. The person may have mixed feelings about self-harm, wanting to do it and not wanting to. This may also be true for ideas or plans to end life by suicide.
Long term outcome research in adults consistently highlights the association between self-harm and suicide (Suominen K et al, 2004; Zahl DL et al, 2004). Those who repeat self-harm are at significantly greater risk of dying by suicide than those who have a single episode.
Studies have shown that people who present to hospital with self-cutting are at higher risk of taking their own lives than those who self-poison and present to hospital (Geulayov et al, 2019). This highlights the importance of careful assessment and planning of care for all people who self-harm.
It can be difficult to differentiate behaviours where there is an intent to die (cutting with suicidal intent) from those where there is a pattern of self-harm with no suicidal intent (habitual self-cutting, and no intent to die). The latter is sometimes called ‘non-suicidal self-injury’ (NSSI). Experts are debating their understanding of self-harm (Kapur et al, 2013). Some consider all self-harm to be on the same continuum where for each individual methods, motivations and suicidal intent may change with each episode. Other experts think that there are a distinct group of people engaging in NSSI behaviour which is distinct from suicide attempts.
As a result there is no consensus about the usefulness of making these distinctions in definition for current daily clinical practice or prevention. It is therefore best to discuss each episode of self-harm with the individual, and to explore their intent and motivation, remaining aware of on-going risks.
People who engage in suicidal and non-suicidal self-harm share a number of risk factors. There may also be distinct groups within these populations.
Only a small fraction of those who engage in any type of self-harm go on to make suicide attempts or die by suicide. Nevertheless, on a population level, this group of people are much more likely than the general population to die by suicide in the longer term.
Select the image for information about why self-harm is an important public health problem.
There are many reasons why self-harm is an important public health problem and this is regardless of intent.
It is one of the top five causes of hospital admissions in the UK (PHE Southwest, 2019). Self-harm is also a major contributor to unscheduled unplanned care.
People presenting to A&E with self-harm have a higher rate of dying by suicide after 1 year. In fact, it is nearly double that of those with suicidal ideation (i.e. thoughts of suicide only) particularly men and those aged over 65 years (Westafer, 2019).
What are Suicidal Behaviours?
Suicidal behaviours range from specifically planning suicide with aborted attempts, attempting suicide, to death by suicide. It includes any self-injurious or self-poisoning behaviours accompanied by suicidal ideation. This also includes behaviour that is not life threatening. It may seem, to you, to be minor.
Select the Pictures for more information about suicidal behaviours.
Attempted suicide
Attempted suicide is any self- injurious or self-poisoning act intended to end one’s life but which does not result in death
Suicide
Suicide is any self-inflicted act intended to end one’s life and which results in death.
Suicidal ideation
Suicidal ideation is thinking about engaging in suicidal behaviour, with or without a specific suicide plan.
It is important to note that while most people who experience suicidal ideation do not die by suicide, some do go on to make attempts on their own lives.
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