Deliberate self-harm

Self-harm, also known as self-injury, is defined as the intentional, direct injuring of body tissue, done without the intent to commit suicide. Other terms such as cutting and self-mutilation have been used for any self-harming behavior regardless of suicidal intent. The most common form of self-harm is using a sharp object to cut one's skin. Other forms include behaviour such as burning, scratching, or hitting body parts. While older definitions included behaviour such as interfering with wound healing, excessive skin picking (dermatillomania), hair pulling (trichotillomania) and the ingestion of toxic substances or objects as self-harm, in current terminology those are differentiated from the term self-harm. Behaviours associated with substance abuse and eating disorders are not considered self-harm because the resulting tissue damage is ordinarily an unintentional side effect. 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 and self-harm is found in 40–60% of suicides. However, generalising individuals who self-harm to be suicidal is, in the majority of cases, inaccurate. The desire to self-harm is a common symptom of some personality disorders. People with other mental disorders may also self-harm, including those with depression, anxiety disorders, substance abuse, eating disorders, post-traumatic stress disorder, schizophrenia, and dissociative disorders. Studies also provide strong support for a self-punishment function, and modest evidence for anti-dissociation, interpersonal-influence, anti-suicide, sensation-seeking, and interpersonal boundaries functions. Self-harm can also occur in high-functioning individuals who have no underlying mental health diagnosis. The motivations for self-harm vary. Some use it as a coping mechanism to provide temporary relief of intense feelings such as anxiety, depression, stress, emotional numbness, or a sense of failure. Self-harm is often associated with a history of trauma, including emotional and sexual 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 therapy 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 between the ages of 12 and 24. Self-harm is more common in females than males with this risk being five times greater in the 12–15 age group. Self-harm in childhood is relatively rare but the rate has been increasing since the 1980s. Self-harm can also occur in the elderly population. The risk of serious injury and suicide is higher in older people who self-harm. Captive animals, such as birds and monkeys, are also known to participate in self-harming behaviour. Self-harm (SH), also referred to as self-injury (SI), self-inflicted violence (SIV), nonsuicidal self injury (NSSI) or self-injurious behaviour (SIB), are different terms to ascribe behaviours where demonstrable injury is self-inflicted. The behaviour involves deliberate tissue damage that is usually performed without suicidal intent. The most common form of self-harm involves cutting of the skin using a sharp object, e. g. a knife or razor blade. The term self-mutilation is also sometimes used, although this phrase evokes connotations that some find worrisome, inaccurate, or offensive. Self-inflicted wounds is a specific term associated with soldiers to describe non-lethal injuries inflicted in order to obtain early dismissal from combat. This differs from the common definition of self-harm, as damage is inflicted for a specific secondary purpose. A broader definition of self-harm might also include those who inflict harm on their bodies by means of disordered eating. The older literature has used several different terms. For this reason research in the past decades has inconsistently focused on self-harming behavior without and with suicidal intent (including suicide attempts) with varying definitions leading to inconsistent and unclear results. Nonsuicidal self-injury (NSSI) has been listed as a proposed disorder in the DSM-5 under the category 'Conditions for Further Study'. It is noted that this proposal of diagnostic criteria for a future diagnosis is not an officially approved diagnosis and may not be used for clinical use but is meant for research purposes only. The disorder is defined as intentional self-inflicted injury without the intent of committing suicide. Criteria for NSSI include five or more days of self-inflicted harm over the course of one year without suicidal intent, and the individual must have been motivated by seeking relief from a negative state, resolving an interpersonal difficulty, or achieving a positive state. A common belief regarding self-harm is that it is an attention-seeking behaviour; however, in many cases, this is inaccurate. Many self-harmers are very self-conscious of their wounds and scars and feel guilty about their behaviour, leading them to go to great lengths to conceal their behaviour from others. They may offer alternative explanations for their injuries, or conceal their scars with clothing. Self-harm in such individuals may not be associated with suicidal or para-suicidal behaviour. People who self-harm are not usually seeking to end their own life; it has been suggested instead that they are using self-harm as a coping mechanism to relieve emotional pain or discomfort or as an attempt to communicate distress. Alternatively, interpretations based on the supposed lethality of a self-harm may not give clear indications as to its intent: seemingly superficial cuts may have been a suicide attempt, whereas life-threatening damage may have been done without the intent to die.