Getting to grips with self-harm in Ireland

Deliberate self-harm is recognized worldwide as a major public-health problem with young people being particularly at risk. A team of researchers from Ireland (where the rate of self-harm in adolescents is estimated as between 8% and 12%) examined this issue more closely in a study of 3,881 teenagers in 39 schools. Among both sexes drug use and knowing a friend who harmed themselves were associated with an increased risk of self-harm. In girls poor self-esteem, forced sexual activity, self-harm by a family member, fights with parents and problems with friends increased the risk of self-harm while in boys bullying, problems with schoolwork, impulsivity and anxiety increased the risk.

McMahon, E.M. ... [et al] - Factors associated with deliberate self-harm among Irish adolescents Psychological Medicine November 2010, 40(11), 1811-1819

Missing self-harm in girls with eating disorders

Teenagers with eating disorders could also be cutting themselves. Researchers from Stanford University School of Medicine studied 1,432 eating-disorder patients, aged between 10 and 21, who were admitted to the hospital's eating-disorder programme between 1997 and 2008. They found that 40.8% of them were physically harming themselves. The average age of those who engaged in self-harm was 16, many of them had a history of bingeing and purging and 85.2% of them cut themselves. However, less than half of the girls' medical records showed that they had been asked about self-harm indicating that elsewhere a number of patients with eating disorders could go without this aspect of their behaviour being picked up.

Young Black women self-harm more but get less help

Young Black women in the U.K. are significantly more likely to harm themselves than people from other ethnic groups but slightly less likely to receive specialist psychiatric assessment and access to follow-up services. Researchers from the Universities of Manchester and Oxford studied 14,997 people who attended emergency departments in Derby, Oxford and Manchester after having harmed themselves. They found that the rate of self-harm among young Black women in Manchester was 10. 3 per 1,000 compared to 6.6 per 1,000 in the White population. The rates of self-harm were not significantly higher among young Black men. The young Black women were slightly less likely to receive a specialist psychiatric assessment after self-harming than White ones.

You can find out more about this research by clicking on the title of this post.

Borderline personality disorder, self-harm and suicide

People with borderline personality disorder (BPD) are said to be 'stable in their instability.' They have a terror of being alone with great efforts being made to avoid real or imagined abandonment. People's moods are extremely unstable and inappropriate anger and impulsive behaviour are common. People with BPD are much more likely to engage in self-harm and suicidal behaviour and researchers from the University of Bristol carried out an in-depth study interviewing four women with a history of self-injury and overdosing. They found that suicide and self-harm attempts could be triggered off by distressing events either a long time ago (such as child abuse) or more recently e.g. interpersonal conflict or negative thoughts about themselves. An overdose was seen as a last resort once self-injury had become insufficient as a means of self-help to manage feelings of desperation and isolation. The study found that the women felt ambivalence towards death with an overdose "appearing to depict an attempt to resolve unbearable feelings through an unarticulated 'cry for help.'"

Brooke, Stu and Horn, Nick - The meaning of self-injury and overdosing amongst women fulfilling the diagnostic criteria for 'borderline personality disorder.' Psychology and psychotherapy: theory, research and practice June 2010, 83(2), 113-128

Self-harm: it's in the blood

Catherine Glenn and David Klonsky from the University of British Columbia have been looking into the role of blood in people's experience of self-harm. They studied 64 undergraduate students who cut themselves. The participants had an average age of 19 and 82% of them were girls. Just over half of them said it was important to see blood when they self-harmed saying that it helped them to relieve tension and induce calmness. Other explanations were that 'it makes me feel real,' and shows that 'I did it right/deep enough.' The group who said that seeing blood was important had cut themselves more than seven times as often and were more likely to say that they self-harmed as a way of regulating their own emotions. They also reported more symptoms consistent with bulimia and borderline personality disorder.

You can find out more about this research at

http://bps-research-digest.blogspot.com/2010/03/sight-of-their-own-blood-is-important.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+BpsResearchDigest+%28BPS+Research+Digest%29&utm_content=Google+Reader

Royal College calls for ban on self-harm websites

In the U.K. the Royal College of Psychiatrists has called for a ban on web sites which promote self-harm in teenagers. The latest figures show that 2,727 people under 25 were admitted to hospital after deliberately harming themselves with a sharp object, up from 1,758 in 2004/5. One in ten people are thought to engage in self-harm at some point in their lives and Britain has one of the highest rates in Europe.

You can find out more about this story at

http://www.telegraph.co.uk/technology/news/7427813/Ban-demand-on-websites-that-allow-promotion-of-self-harm-among-teens.html

Self-harm and car accidents

A study of newly-licensed drivers by researchers at the George Institute in Australia has found that those who had engaged in self-harm were more likely to be involved in car accidents. The researchers studied 18,871 newly-licensed Australian drivers aged between 17 and 24. 4.6% of the sample had engaged in self-harm - defined as: cutting and burning, poisoning, self-battering, road-related harm, risk-taking and attempted suicide - of whom 58.7% were women. Of those who had reported self-harm 10.1% had been involved in a crash and 84% of those who had had a crash were involved in multi-car pile-ups. The risks associated with self harm were significant even after age, sex, average driving hourse per week, psychological distress and amount of sleep had been taken into account.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/11/091116131708.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceDaily%3A+Latest+Science+News%29&utm_content=Google+Reader

Self-harm in Northern Ireland

Researchers from Queen's University and the University of Ulster in Northern Ireland have been asking 941 sixteen-year-olds about self-harm. One in ten had self-harmed in the past year and another 14% had thought about it but had not done so. Girls were much more likely than boys to say that they had thought about harming themselves (18% vs 7%) or had actually done so (13% vs 5%). There were strong links between self-harm and high levels of stress, high expectations the youngsters felt they could not fulfil and experiences of bullying in school. 25% of the sample said that they had suffered from serious mental and emotional health problems in the past year for which they felt they needed professional help although only 9% had actually asked for it. Youngsters from less well-off backgrounds were significantly more likely to be affected by mental-health issues and to have self-harmed or considered self-harming.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/07/090730073921.htm

Prison staff and self harm

Self-harm is now a major public-health concern. It is estimated to result in 200,000 hospital visits a year and the risk of suicide increases up to 100 times within the first year following self-harm. Self-harm among prisoners has increased by 37% in the last five years and, in women, rose by 48% between 2003 and 2007. Rates are higher among women than men and in 2005 56% of self-harm incidents occured in women's prisons. Researchers from the University of Manchester looked into the attitudes of prison staff towards female prisoners who self-harm. They interviewed eight prison officers and five healthcare staff from a women's prison in the North of England. They found that the staff made a distinction between what they saw as 'genuine' and 'non-genuine' self-harm with those who engaged in the latter being seen as 'rational manipulators' harming themselves to play the system. The staff felt resentful towards these women. The prison staff also found it hard to balance their roles contributing to the welfare of the prisoners and maintaining security and found the security part of the job easier. They felt untrained and unsupported in the welfare part of their role and pressurised due to a lack of time and staff. This combination of factors led to most of the prison staff feeling a lack of confidence in dealing with women who self-harm.

Short, Vicky ... [et al] - Custody vs care: attitudes of prison staff to self-harm in women prisoners - a qualitative study Journal of Forensic Psychiatry and Psychology June 2009, 20(3), 408-426

Self-harm: what do service users say?

Self-harm is increasingly common in many countries, is often repeated and is associated with a range of other problems including an increased risk of suicide. A review of the international literature on service users' satisfaction with clinical services looked at 31 studies. Service users' experiences had a lot in common all over the world. Poor communication between patients and staff and a perceived lack of knowledge of staff were common themes and many participants suggested that psychosocial assessments and access to after-care needed to be improved.

Taylor, Tatiana L. ... [et al] - Attitudes towards clinical services among people who self-harm: systematic review British Journal of Psychiatry February 2009, 194(2), 104-110

Tackling self-harm in Sheffield

The incidence of self-harm among teenagers has been rising year-on-year and the UK now has the highest rates of this behaviour in Europe. It is estimated that one in ten adolescents in the UK will self-harm, something that leads to around 24,000 hospital admissions per year. Particular groups at risk include girls (who are seven times more at risk than boys), prisoners and young Asian women. The Oakwood Young People's Centre in Sheffield (an adolescent inpatient psychiatric unit) experienced a sevenfold increase in self-harm in the last few months of 2002 from an average of 1.2 incidents per month to an average of 8.1. Staff at the unit drew up a new policy on self-harm. They offered a range of support and alternative coping techniques including the use of ice, rubber bands and marker pens instead of sharp objects. Diaries, relaxation techniques and distraction were also used as well as a wide range of therapeutic interventions to address the patients' underlying distress and problems. Self-harm was viewed in the same light as the use of alcohol or illegal drugs; as completely unacceptable and resulting in suspension from the unit. Service users were able to return after a suspension but any repeated self-harm was seen as grounds for discharge. The new policy led to a steep decline in the incidence of self-harm to 0.2 incidents per month, below the levels before the increase in 2002.

Livesey, Anthony E. - Self-harm in adolescent in-patients Psychiatric Bulletin 2009, 33, 10-12

Self-harm after hospital

The risk of suicide in the month after psychiatric inpatient care is about 100 times greater than that of the general population. Although the high risk of suicide shortly after discharge is well documented less is known about the rates of non-fatal self-harm. A study of 75,401 people discharged from psychiatric inpatient care between April 2004 and March 2005 found that 6.5% of them were admitted at least once for self-harm in the following 12 months. The risk of self-harm was greatest in the four weeks after discharge. The strongest risk factor for self-harm after discharge was an admission for self-harm in the previous 12 months. The risk of self-harm was also higher in women, younger people, those with diagnoses of depression, personality disorder and substance abuse and those with short lengths of stay.

Gunnell, David ... [et al] - Hospital admissions for self-harm after discharge from psychiatric inpatient care: cohort study British Medical Journal December 6, 2008, 1331-1334

Deliberate self-harm: the parents' story

Parents of children who deliberately harm themselves report finding incidents of self-harm extremely traumatic. They can experience feelings of helplessness and concerns about their ability to cope after their children are discharged from hospital and they also report a lack of information and support from healthcare professionals. There is an association between adolescent deliberate self-harm and family dysfunction and impaired adolescent-parent communication. Higher incidences of family disengagement, conflict, parental dissatisfaction and marital discord have been reported within these families as well as higher-than-average rates of affective disorder and substance abuse. A qualitative study of 25 parents involved in setting up a parents' support group in Ireland found that participants expressed the need for: support, information about suicidal behaviour in young people, skills for parenting an adolescent and advice on managing further incidents. Parents described significant difficulties in family communication, parent-child relationships and in the area of discipline following self-harm.

Byrne, Sinead ... [et al] - Deliberate self-harm in children and adolescents: a qualitative study exploring the needs of parents and carers Clinical Child Psychology and Psychiatry October 2008, 13(4), 493-504

Forecasting self-harm and suicide

The accuracy of weather forecasts is about 70% but if you say the weather tomorrow is going to be the same as today then you also have a 70% chance of success. In the same way the prediction of the behaviour of people with mental-health problems uses a mixture of assessments, questionnaires, the person's own predictions of their behaviour and the past history of their behaviour. Researchers at Harvard University compared the accuracy of people's forecasts of their own likelihood of engaging in self-injurious thoughts and behaviour (SITB) with forecasts based on their past history of such behaviour. Suicide is the third leading cause of death among adolescents in the U.S. and the study involved 64 adolescents with a past history of SITB. It found that their past histories of SITB was more accurate than their own predictions in forecasting future behaviour.

Janis, Irene Belle and Nock, Matthew K. - Behavioral forecasts do not improve the prediction of future behavior: a prospective study of self-injury Journal of Clinical Psychology October 2008, 64(10), 1164-1174

Emotional-regulation, self-harm and CBT

Emotional-regulation has been defined as 'the awareness, understanding and acceptance of emotions, as well as the ability to control behaviour in the context of emotional distress.' People who deliberately harm themselves often have trouble with emotional-regulation having lower emotional awareness and clarity, lower acceptance of emotions and difficulty in controlling their behaviour when experiencing negative emotions. A trial on 90 people aged between 15 and 35 looked at how cognitive behaviour therapy (CBT) affected people's tendency to harm themselves. The study found that the most important factor in the effectiveness of CBT was how much it was able to improve the participants' emotion-regulation, particularly their impulse control and goal-directed behaviours rather than its effect on depression, anxiety and suicidal cognitions.

Slee, Nadja ... [et al] - Emotion regulation as mediator of treatment outcome in therapy for deliberate self-harm Clinical Psychology and Psychotherapy July-August 2008, 15(4), 205-216

Eating disorders, personality and self-harm

Certain personality traits are though to predispose people towards eating disorders. Introversion, conformity, perfection and obsessive-compulsive behaviour have been associated with anorexia nervosa while impulsivity, low self esteem and antisocial personality traits have been associatd with bulima. Self-injurious behaviour is more common among people with eating disorders and a Swedish study of 115 people looked into the links between personality disorders, self-injurious behaviour and eating disorders comparing 38 people with eating disorders to 67 controls. Both the anorexic and bulimic patients had higher anxiety- and detachment-related traits than the control group and people with bulimia showed higher hostility. Anorexics scored lower than bulimics on scales measuring impulsivity, guilt and self-injurious behaviour was more frequent among bulimic patients.

Ahren-Moonja, Jennie ... [et al] - Personality traits and self-injurious behaviour in patients with eating disorders European Eating Disorders Review July-August 2008, 16(4), 268-275

Working with patients who deliberately self-harm

Deliberate self-harm can include a wide range of behaviours such as cutting, biting, picking, burning, insertion or ingestion of objects. It is common to a range of mental-health problems and its prevalence rate is estimated at between 2-6% of the population. Deliberate self-harm has the strongest correlation of all risk factors for suicide with up to 2% of people who self-harm dying within the following year, rising to 7% after nine years. A qualitative study involving eight community psychiatric nurses found that they struggled to conceptualize self-harm behaviour and found working with people who self-harm stressful, particularly in terms of managing the emotional impact upon themselves and the boundaries of their professional responsibilities in relation to managing risk. The therapeutic relationship was seen as crucial and a variety of coping methods to manage the impact of the work - which had largely developed through 'on-the-job' experience - were described in the study.

Thompson, Andrew R., Powis, Jane and Carradice, Angela - Community psychiatric nurses' experience of working with people who engage in deliberate self-harm International Journal of Mental Health Nursing June 2008, 17(3), 153-161

Suicide and early psychosis - what are the risk factors?

Suicide is the main cause of premature death among people with schizophrenia. There is some evidence that the risk factors for self-harm may be different for those with schizophrenia compared with other groups and there is some emerging evidence that risk factors for self-harm may alter during the course of a psychotic illness. Suicidal behaviour is more common during the early stages of psychosis and the period of time between the onset of psychotic symptoms and and individual's first contact with mental-health services can be particularly risky. A study of 496 people in South-East London and Nottingham presenting (turning up for treatment) for psychosis over a two-year period found that 11.3% of them had engaged in self-harm since the onset of their psychosis. Being male, being in a higher socio-economic group, depression, a prolonged period of psychosis before seeking treatment and increased insight (consciousness of being unwell) were all associated with an increased risk of self-harm.

Harvey, S.B. ... [et al] - Self-harm in first-episode psychosis British Journal of Psychiatry March 2008, 192(3), 178-184

Childhood sexual abuse and self-harm - is there a link?

Self-injurious behaviour can be defined as the causing of intentional, direct damage to one's body without suicidal intent. Common examples include cutting oneself and burning one's skin. Because such behaviour is associated with suicide and psychiatric disorders and because its treatment can be challenging it has attracted substantial attention in both the clinical and research literature. Little is known about its causes but some people have suggested that childhood sexual abuse is one of them. A number of studies have shown a link between childhood sexual abuse and later self-harm but other studies have found little or no association. Researchers have now got powerful and sophisticated tools which allow them to combine the results from a number of different studies - a process called meta-analysis. A meta-analysis of 45 different studies into the link between childhood sexual abuse and self-harm found that the significance of the relationship was very small and that in studies that take into account other psychiatric risk factors childhood sexual abuse explained little or no unique variance in self-injurious behaviour.

Klonsky, E. David and Moyer, Anne - Childhood sexual abuse and non-suicidal self-injury: meta-analysis British Journal of Psychiatry March 2008, 192(3), 166-170

Domestic violence and self-harm

Estimates of the rate of domestic violence against women range from 6% to 58% with the rates being much higher among psychiatric inpatients and even higher among inpatients with suicidal ideation. It is estimated that about 1% of the population engage in self-harm (e.g. cutting, hitting or scratching themselves) although again this rate is much higher among psychiatric inpatients. However, there has been little research into the links between domestic violence and self-harm. Researchers in America studied 113 women in psychiatric hospitals and found that a history of domestic violence was a statistically significant predictor of bodily self-harm even after controlling for age and marital status.

Sansone, Randy A., Chu, Jamie and Wiederman, Michael W. - Self-inflicted bodily harm among victims of intimate-partner violence Clinical Psychology and Psychotherapy September-October 2007, 14, 352-357