Understanding Self-Harm “Skin has a good memory. Skin is like the ground we walk on every day; you can read a whole history in it if you know how to look.” - Kettlewell, 1999 MERVE AĞAN 1730407

OUTLINE What is self- harm behavior? Why do people do it? Common forms Prevalence Why do people do it? How can one stop ? References

What is self- harm behavior? Any behavior where the intent is to deliberately hurt oneself without suicidal intent. The methods of it : self- injury and self- poisoning The location of self- harm are often areas of the body that are easily hidden and concealed from the detection of others. http://www.howardleague.org/fileadmin/howard_league/user/pdf/SP/Self-injury_by_David_F._Duffy.pdf

Forms of self- harm Cutting or burning Taking overdoses Hitting oneself, walls, or hard objects Pulling hair or picking skin Trichotillomania (Hair-Pulling Disorder) Excoriation (Skin-Picking Disorder ) Self-strangulation http://www.howardleague.org/fileadmin/howard_league/user/pdf/SP/Self-injury_by_David_F._Duffy.pdf

Prevalence Common among young people Age of onset between 14- 24 Hard to know true prevalence as it’s very secretive But, it is known that more common in females than males- may be due to ; More females report whereas males likely underreport Jacobson, CM et al. (2007) The Epidemiology and Phenomenology of Non-Suicidal Self-Injurious Behavior Among Adolescents: A Critical Review of the Literature, Archives of Suicide Research, 11: 2, 129 — 147

Prevalence conducted a systematic review of current (2005 - 2011) empirical studies reporting on the prevalence of NSSI and DSH in adolescent samples across the globe Average Prevalence of Self- harm (NSSI and DSH) by Year of Study Muehlenkamp et al. Child and Adolescent Psychiatry and Mental Health 2012 6:10   doi:10.1186/1753-2000-6-10

Causes of self- harm Biological factors Environmental factors Neurotransmitters Environmental factors Psychological factors False cognitive beliefs Mental disorders

Biological Factors (Neurotransmitters) Serotonin Model (Duffy, D. F., 2009) Deficient in normal levels of serotonin which cause irritability may result in aggressive and impulsive behavior including self-injury http://www.howardleague.org/fileadmin/howard_league/user/pdf/SP/Self-injury_by_David_F._Duffy.pdf

Biological Factors (Neurotransmitters) Endorphin Model Low endorphin level in individuals with self-harm During self- harm the brain release endorphins Whose effect are similar to morphine Lead to; Decreasing the sensation of the pain Cause pleasant physical sensation ‘‘ RUSH’’ Trigger the dopamine reward pathway suggesting a biological cause for “addictive patterns” http://www.cedu.niu.edu/~shumow/itt/doc/selfinjury.pdf

Environmental factors Individuals who experienced traumatic abuse most notably childhood sexual abuse or rape  Family relationship difficulties Peer relationship break up / difficulties SH behavior in other students / the media Exam pressure Time of change (new school, parents split etc.) Receive attention from other people http://www.cedu.niu.edu/~shumow/itt/doc/selfinjury.pdf

Psychological factors http://www.slideshare.net/pookyh/self-harm-16143627?qid=3a8c9619-bc49-4944-905b-b28e97a7b060&v=default&b=&from_search=8

False cognitive beliefs For example : feeling of loss of control http://www.slideshare.net/pookyh/self-harm-16143627?qid=3a8c9619-bc49-4944-905b-b28e97a7b060&v=default&b=&from_search=8

False cognitive beliefs (Cont’d) For example: cope with emotion http://www.slideshare.net/pookyh/self-harm-16143627?qid=3a8c9619-bc49-4944-905b-b28e97a7b060&v=default&b=&from_search=8

False cognitive beliefs (Cont’d) For example : feeling of punishment http://www.slideshare.net/pookyh/self-harm-16143627?qid=3a8c9619-bc49-4944-905b-b28e97a7b060&v=default&b=&from_search=8

Mental disorders People diagnosed as having certain types of mental disorder are much more likely to self- harm Such mental disorders : Depression Bipolar Borderline personality disorder Eating Disorder Substance abuse PTSD Anxiety disorder http://www.riverviewbehavioralhealth.com/self-injury/effects-symptoms-signs

Mental disorders (Cont’d) In one survey of a sample of the British population, people with current symptoms of a mental disorder were up to 20 times more likely to report having harmed themselves in the past (Meltzer et al., 2002) Meltzer, H., Lader, D., Corbin, T., et al. (2002a) Non-Fatal Suicidal Behaviour Among Adults aged16 to 74 in Great Britain. London: The Stationery Office

Different interventions for stopping Accept reality and find ways to make the present moment more tolerable Identify feelings and talk them out rather than acting on them Distract themselves from feelings of self- harm (for example: counting to ten, waiting 15 minutes, saying ‘‘ NO’’ or ‘‘ STOP’’ Develop better social skills Hospitalization http://www.slideshare.net/ashihabeddin/deliberate-self-harm

REFERENCES Duffy, D. F. (2009). Self- injury. Retrieved from: http://www.howardleague.org/fileadmin/howard_league/user/pdf/SP/Selfinjury_by_David_F._Duffy.pdf Knigge,J. Self injury for teachers Retrieved frrom: http://www.cedu.niu.edu/~shumow/itt/doc/selfinjury.pdf Meltzer, H., Lader, D., Corbin, T., et al. (2002) Non-Fatal Suicidal Behaviour Among Adults aged 16 to 74 in Great Britain. London: The Stationery Office Muehlenkamp et al. (2012). International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child and Adolescent Psychiatry and Mental Health,6 :10. Riverwiew Behavioral Health. Self- harm causes, symptoms and signs. Retrieved from: http://www.riverviewbehavioralhealth.com/self-injury/effects-symptoms-signs Jacobson, CM et al. (2007) The Epidemiology and Phenomenology of Non-Suicidal Self-Injurious Behavior Among Adolescents: A Critical Review of the Literature, Archives of Suicide Research, 11: 2, 129 — 147.