Self-injury

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Self-harm (SH) or deliberate self-harm (DSH) includes self-injury (SI) and self-poisoning and is defined as the intentional, direct injuring of body tissue without suicidal intent. These terms are used in the more recent literature in an attempt to reach a more neutral terminology. The older literature, especially that which predates the DSM-IV-TR, almost exclusively refers to self-mutilation. The term is synonymous with "self-injury."[1][2][3] The most common form of self-harm is skin-cutting but self-harm also covers a wide range of behaviours including, but not limited to, burning, scratching, banging or hitting body parts, interfering with wound healing, hair-pulling (trichotillomania) and the ingestion of toxic substances or objects.[2][4][5] Behaviours associated with substance abuse and eating disorders are usually not considered self-harm because the resulting tissue damage is ordinarily an unintentional side effect.[6] However, the boundaries are not always clear-cut and in some cases behaviours that usually fall outside the boundaries of self-harm may indeed represent self-harm if performed with explicit intent to cause tissue damage.[6] 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.[7] There is also an increased risk of suicide in individuals who self-harm[4][8] to the extent that self-harm is found in 40–60% of suicides.[9] However, generalising self-harmers to be suicidal is, in the majority of cases, inaccurate.[10][11]

Self-harm in childhood is relatively rare but the rate has been increasing since the 1980s.[12] Self-harm is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) as a symptom of borderline personality disorder. However patients with other diagnoses may also self-harm, including those with depression, anxiety disorders, substance abuse, eating disorders, post-traumatic stress disorder, schizophrenia, and several personality disorders.[2] Self-harm is also apparent in high-functioning individuals who have no underlying clinical diagnosis.[6] The motivations for self-harm vary and it may be used to fulfill a number of different functions.[13] These functions include self-harm being used as a coping mechanism which provides temporary relief of intense feelings such as anxiety, depression, stress, emotional numbness and a sense of failure or self-loathing. Self-harm is often associated with a history of trauma and abuse, including emotional abuse, sexual abuse, drug dependence, eating disorders, or mental traits such as low self-esteem or perfectionism. There is also a positive statistical correlation between self-harm and emotional abuse.[14][15] 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 treatments may be effective.[8] 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.[16]

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