Deliberate Self Harm

Prof Craig JacksonHead of Psychology

health.bcu.ac.uk/craigjackson

Deliberate Self HarmBehavioural Markers

Female:Male ratio. 2:115-21 largest age group

At risk: Female Isolated Negative life events Pre-existing psychiatric conditions Familial history Intolerable stress Impulsive, immature, aggressive personality

Additional ConditionsHigh levels of dissociation ("going numb")

Borderline Personality Disorder

Substance abuse disorders

Post-Traumatic Stress Disorder

Antisocial Personality Disorder (int. explosive)

Eating Disorders

Mood Disorders

Deliberate Self Harm

Deliberate Self Harm

Art form

Follie a deux

Celebrity cache

Deliberate Self Harm

Deliberate Self Harm

MechanicsCutting Forearms Wrists GenitaliaBurningBangingPills / ToxinsSharps

4% of English hospital admissions (Carroll 2006)Fifth biggest cause of admissions

Use of an rubbers or friction to burn skinBurning with heat, chemicals or cigarettesBruisingPulling fingernails and toenailsRefusing to take needed medicationsHitting selfBanging one's headIngesting sharp or toxic objectsPicking scabs / keeping wounds from healingDeep scratchingInserting objects into body openingsInserting needles or sharp objects under the skinSome forms of hair-pullingTooth-pullingBone-breakingCarving symbols, names or images

Premeditation

Prohibits sympathy

Saving pills / blades

Avoiding detection Long sleeves Bandage / dressing stockpiles Prepared excuses

Deliberate Self Harm

Motivation 1

• Cry for help• Attention seeking• Coping strategy• Destruction• Escapism• Control & Mastery• Punish others Loved ones Family Failing relationships

Motivation 2

• Negative self-esteem• Hypersensitivity to rejection• Supressed anger and sadness• Chronic Anxiety• Relationship problems• Poor functioning in school, home or work• More common in females than males• Typical onset is at puberty• History of physical and/or sexual abuse• Average to high intelligence• Middle to upper-class background

Motivation 3

• Feels "empty" and isolated• Drug or alcohol abuse• Early history of medical illness or surgical

procedures requiring hospitalization• Imprisonment or institutionalization in drug treatment centres• Inability to express or tolerate negative feelings• Poor academic performance or truancy• Has a background of emotional neglect

Secondary Gain

Factitious InjuryFeigned physical / psychological symptoms

Aimed to receive medical / psychological care

Mostly female, many working in healthcare

Don't confront without good evidence

Supportive confrontation Aware of role of behaviour in illness Offer psychological help

Patients may stop but usually move on