Editing Self-harm (section)

==Treatment==
Several forms of [[psychosocial]] treatments can be used in self-harm including [[dialectical behavior therapy]].<ref name=Glenn2019>{{cite journal |vauthors=Glenn CR, Esposito EC, Porter AC, Robinson DJ |title=Evidence Base Update of Psychosocial Treatments for Self-Injurious Thoughts and Behaviors in Youth |journal=Journal of Clinical Child and Adolescent Psychology |volume=48 |issue=3 |pages=357–392 |date=2019 |pmc=6534465 |doi=10.1080/15374416.2019.1591281 |pmid=31046461}}</ref> Psychiatric and [[personality disorder]]s are common in individuals who self-harm and as a result self-harm may be an indicator of depression and/or other psychological problems.<ref>{{cite journal |last1=Singhal |first1=Arvind |last2=Ross |first2=Jack |last3=Seminog |first3=Olena |last4=Hawton |first4=Keith |last5=Goldacre |first5=Michael J |title=Risk of self-harm and suicide in people with specific psychiatric and physical disorders: comparisons between disorders using English national record linkage |journal=Journal of the Royal Society of Medicine |date=May 2014 |volume=107 |issue=5 |pages=194–204 |pmc=4023515 |doi=10.1177/0141076814522033 |pmid=24526464}}</ref> {{as of|2021}}, there is little or no evidence that [[antidepressant]]s, [[mood stabilizer]]s, or [[dietary supplement]]s reduce repetition of self-harm. In limited research into [[antipsychotic]]s, one small trial of [[flupentixol]] found a possible reduction in repetition, while one small trial of [[fluphenazine]] found no difference between low and ultra-low doses.<ref>{{harvnb|Witt|Hetrick|Rajaram|Hazell|2021a|pp=2, 19–20}}:
* "Flupenthixol may reduce repetition of SH compared with placebo by post‐intervention based on evidence from one trial ({{frac|3|14}} versus {{frac|12|16}}; OR&nbsp;0.09, 95%&nbsp;CI 0.02 to 0.50; N=30; k=1; I<sup>2</sup>=not applicable). According to GRADE criteria, we judged the evidence to be of low certainty" (p.&nbsp;19).
* "There was no evidence of an effect on repetition of SH by post‐intervention for low‐dose fluphenazine in this trial ({{frac|12|27}} versus {{frac|9|26}}; OR&nbsp;1.51, 95%&nbsp;CI 0.50 to 4.58; N=53; k=1; I<sup>2</sup>=not applicable). According to GRADE criteria, we judged the evidence to be of low certainty" (p.&nbsp;20).</ref> {{as of|2012}}, no clinical trials have evaluated the effects of [[pharmacotherapy]] on adolescents who self-harm.{{sfn|Hawton|Saunders|O'Connor|2012|p=2380}}

[[Emergency department]]s are often the first point of contact with healthcare for people who self-harm. As such they are crucial in supporting them and can play a role in preventing suicide.<ref>{{cite journal |vauthors=Robinson J, Bailey E |title=Experiences of care for self-harm in the emergency department: the perspectives of patients, carers and practitioners |journal=BJPsych Open |volume=8 |issue=2 |pages=e66 |date=March 2022 |pmc=8935906 |doi=10.1192/bjo.2022.35 |pmid=35264275}}</ref> At the same time, according to a study conducted in England, people who self-harm often experience that they do not receive meaningful care at the emergency department. Both people who self-harm and staff in the study highlighted the failure of the healthcare system to support, the lack of specialist care. People who self-harm in the study often felt shame or being judged due to their condition, and said that being listened to and validated gave them hope. At the same time staff experienced frustration from being powerless to help and were afraid of being blamed if someone died by suicide.<ref>{{cite journal |vauthors=Saygin D, Tabib T, Bittar HE, Valenzi E, Sembrat J, Chan SY, Rojas M, Lafyatis R |display-authors=6 |title=Transcriptional profiling of lung cell populations in idiopathic pulmonary arterial hypertension |journal=Pulmonary Circulation |volume=10 |issue=1 |date=2022-03-07 |publisher=National Institute for Health and Care Research |pmc=7052475 |type=Plain English summary |doi=10.3310/alert_49221 |pmid=32166015}}</ref><ref>{{cite journal |vauthors=Saygin D, Tabib T, Bittar HE, Valenzi E, Sembrat J, Chan SY, Rojas M, Lafyatis R |display-authors=6 |title=Transcriptional profiling of lung cell populations in idiopathic pulmonary arterial hypertension |journal=Pulmonary Circulation |volume=10 |issue=1 |pages=e175 |date=22 September 2021 |pmc=8485342 |doi=10.1192/bjo.2021.1006 |pmid=32166015}}</ref>

There are also difficulties in meeting the need of patients that self-harm in mental healthcare. Studies have shown that staff found the care for people who self-harm emotionally challenging and they experienced an overwhelming responsibility in preventing the patients from self-harming<ref>{{cite journal |last1=O'Connor |first1=Sophie |last2=Glover |first2=Lesley |date=September 2017 |title=Hospital staff experiences of their relationships with adults who self-harm: A meta-synthesis |journal=Psychology and Psychotherapy: Theory, Research and Practice |language=en |volume=90 |issue=3 |pages=480–501 |s2cid=13088706 |doi=10.1111/papt.12113 |pmid=28035740 |url=https://onlinelibrary.wiley.com/doi/10.1111/papt.12113}}</ref> and the care focuses mainly on maintaining the safety for the patients, for example by removing dangerous items or physical restraint, even if it is believed to be ineffective.<ref>{{cite journal |last1=Murphy |first1=Caroline |last2=Keogh |first2=Brian |last3=Doyle |first3=Louise |date=October 2019 |title='There is no progression in prevention' – The experiences of mental health nurses working with repeated self-harm |journal=International Journal of Mental Health Nursing |language=en |volume=28 |issue=5 |pages=1145–1154 |hdl=2262/89600 |s2cid=195658429 |issn=1445-8330 |hdl-access=free |doi=10.1111/inm.12626 |pmid=31240823 |url=https://onlinelibrary.wiley.com/doi/10.1111/inm.12626}}</ref>

===Therapy===
A meta-analysis from [[Cochrane (organisation)|Cochrane]] in 2016 found low-quality evidence suggesting that CBT-based psychotherapy can reduce the number of adults repeating self-harm. For those with repeated self-harm or probable personality disorder, group-based emotion-regulation psychotherapy, mentalization, and DBT showed promise in reducing repetition or frequency of self-harm, though the evidence quality varied from low to moderate.<ref>{{cite journal |vauthors= Hawton K, G Witt K, Salisbury T, Arensman E, Gunnel D, Hazel P, Townsend E, Heeringen K |title= Psychosocial interventions for self-harm in adults |journal=The Cochrane Database of Systematic Reviews |volume=2016 |date=May 2016 |issue= 9 |pages= CD012189 |doi= 10.1002/14651858.CD012189 |pmid= 27168519|pmc= 8786273 |hdl= 1983/12ff9a4b-493f-494c-8fa2-d213dd368219 |hdl-access= free }}</ref> This meta-analysis was repeated again in 2021, and found uncertain evidence for many psychosocial interventions in reducing self-harm repetition in adults, noting significant methodological limitations across studies. While CBT-based therapies might reduce repetition at longer follow-ups (however with low certainty of evidence), MBT and group-based emotion regulation therapy showed promise in single or related trials, warranting further research.<ref>{{cite journal |vauthors= G Witt K, Hetrick S, Rajaram G, Hazel P, Salisbury T, Townsend E, Hawton K |title= Psychosocial interventions for self-harm in adults |journal=The Cochrane Database of Systematic Reviews |date= 2021 |volume=2021 |issue= 4 |pages= CD013668 |doi=10.1002/14651858.CD013668.pub2|pmid= 33884617 |pmc= 8094743 |hdl=1983/12ff9a4b-493f-494c-8fa2-d213dd368219 |hdl-access=free }}</ref>

Dialectical behavior therapy for adolescents (DBT-A) is a well-established treatment for self-injurious behavior in youth and is probably useful for decreasing the risk of non-suicidal self-injury.<ref name=Glenn2019/><ref>{{cite journal |vauthors=Witt KG, Hetrick SE, Rajaram G, Hazell P, Taylor Salisbury TL, Townsend E, Hawton K |title=Interventions for self-harm in children and adolescents |journal=The Cochrane Database of Systematic Reviews |volume=2021 |issue=3 |pages=CD013667 |date=March 2021b |pmc=8094399 |doi=10.1002/14651858.cd013667.pub2 |pmid=33677832}}</ref> Several other treatments including integrated CBT (I-CBT), attachment-based family therapy (ABFT), resourceful adolescent parent program (RAP-P), intensive interpersonal psychotherapy for adolescents (IPT-A-IN), mentalization-based treatment for adolescents (MBT-A), and integrated family therapy are probably efficacious.<ref name=Glenn2019/><ref name=":1">{{cite journal |vauthors=Hawton K, Witt KG, Taylor Salisbury TL, Arensman E, Gunnell D, Townsend E, van Heeringen K, Hazell P |display-authors=6 |title=Interventions for self-harm in children and adolescents |journal=The Cochrane Database of Systematic Reviews |volume=2021 |issue=12 |pages=CD012013 |date=December 2015 |pmc=8786270 |hdl-access=free |hdl=1854/LU-8573483 |doi=10.1002/14651858.CD012013 |pmid=26688129}}</ref> [[Cognitive behavioral therapy]] may also be used to assist those with [[Diagnostic and Statistical Manual#Multi-axial system|Axis I]] diagnoses, such as depression, [[schizophrenia]], and [[bipolar disorder]]. [[Dialectical behavior therapy]] (DBT) can be successful for those individuals exhibiting a personality disorder, and could potentially be used for those with other mental disorders who exhibit self-harming behavior.<ref name=":1"/> Diagnosis and treatment of the causes of self-harm is thought by many to be the best approach to treating self-harm.<ref name="Suyemoto98"/> In adolescents multisystem therapy shows promise.<ref>{{cite journal |vauthors=Ougrin D, Tranah T, Leigh E, Taylor L, Asarnow JR |title=Practitioner review: Self-harm in adolescents |journal=Journal of Child Psychology and Psychiatry, and Allied Disciplines |volume=53 |issue=4 |pages=337–350 |date=April 2012 |doi=10.1111/j.1469-7610.2012.02525.x |pmid=22329807}}</ref> According to the classification of Walsh and Rosen<ref name="Walsh and rosen (1988)"/> [[trichotillomania]] and [[nail biting]] represent class I and II self-mutilation behavior (see classification section in this article); for these conditions [[habit reversal training]] and [[decoupling for body-focused repetitive behaviors|decoupling]] have been found effective according to meta-analytic evidence.<ref>{{cite journal |last1=Lee |first1=Melissa T. |last2=Mpavaenda |first2=Davis N. |last3=Fineberg |first3=Naomi A. |date=2019-04-24 |title=Habit Reversal Therapy in Obsessive Compulsive Related Disorders: A Systematic Review of the Evidence and CONSORT Evaluation of Randomized Controlled Trials |journal=Frontiers in Behavioral Neuroscience |volume=13 |pages=79 |issn=1662-5153 |pmc=6491945 |doi=10.3389/fnbeh.2019.00079 |doi-access=free |pmid=31105537}}</ref>

A meta-analysis found that psychological therapy is effective in reducing self-harm. The proportion of the adolescents who self-harmed over the follow-up period was lower in the intervention groups (28%) than in controls (33%). Psychological therapies with the largest effect sizes were dialectical behavior therapy (DBT), cognitive-behavioral therapy (CBT), and mentalization-based therapy (MBT).<ref>{{cite journal |vauthors=Ougrin D, Tranah T, Stahl D, Moran P, Asarnow JR |title=Therapeutic interventions for suicide attempts and self-harm in adolescents: systematic review and meta-analysis |journal=Journal of the American Academy of Child and Adolescent Psychiatry |volume=54 |issue=2 |pages=97–107.e2 |date=February 2015 |doi=10.1016/j.jaac.2014.10.009 |pmid=25617250}}</ref>

In individuals with developmental disabilities, occurrence of self-harm is often demonstrated to be related to its effects on the environment, such as obtaining attention or desired materials or escaping demands. As developmentally disabled individuals often have communication or social deficits, self-harm may be their way of obtaining these things which they are otherwise unable to obtain in a socially appropriate way (such as by asking). One approach for treating self-harm thus is to teach an alternative, appropriate response which obtains the same result as the self-harm.<ref name="bird">{{cite journal |vauthors=Bird F, Dores PA, Moniz D, Robinson J |title=Reducing severe aggressive and self-injurious behaviors with functional communication training |journal=American Journal of Mental Retardation |volume=94 |issue=1 |pages=37–48 |date=July 1989 |pmid=2751890}}</ref><ref name="carr">{{cite journal |vauthors=Carr EG, Durand VM |title=Reducing behavior problems through functional communication training |journal=Journal of Applied Behavior Analysis |volume=18 |issue=2 |pages=111–126 |year=1985 |pmc=1307999 |doi=10.1901/jaba.1985.18-111 |pmid=2410400}}</ref><ref name="sigafoos">{{cite journal |vauthors=Sigafoos J, Meikle B |title=Functional communication training for the treatment of multiply determined challenging behavior in two boys with autism |journal=Behavior Modification |volume=20 |issue=1 |pages=60–84 |date=January 1996 |s2cid=36780321 |doi=10.1177/01454455960201003 |pmid=8561770}}</ref>

===Avoidance techniques===

Generating alternative behaviors that the person can engage in instead of self-harm is one successful behavioral method that is employed to avoid self-harm.<ref name="Muehlenkamp06">{{cite journal |vauthors=Muehlenkamp JJ |title=Empirically supported treatments and general therapy guidelines for non-suicidal self-injury |journal=Journal of Mental Health Counseling |volume=28 |issue=2 |year=2006 |pages=166–185 |citeseerx=10.1.1.666.6159 |doi=10.17744/mehc.28.2.6w61cut2lxjdg3m7}}</ref> Techniques, aimed at keeping busy, may include journaling, taking a walk, participating in sports or exercise or being around friends when the person has the urge to harm themselves.<ref name="Klonsky08"/> The removal of objects used for self-harm from easy reach is also helpful for resisting self-harming urges.<ref name="Klonsky08"/> The provision of a card that allows the person to make emergency contact with counselling services should the urge to self-harm arise may also help prevent the act of self-harm.<ref name="Hawton98">{{cite journal |vauthors=Hawton K, Arensman E, Townsend E, Bremner S, Feldman E, Goldney R, Gunnell D, Hazell P, van Heeringen K, House A, Owens D, Sakinofsky I, Träskman-Bendz L |display-authors=6 |title=Deliberate self harm: systematic review of efficacy of psychosocial and pharmacological treatments in preventing repetition |journal=BMJ |volume=317 |issue=7156 |pages=441–447 |date=August 1998 |pmc=28637 |doi=10.1136/bmj.317.7156.441 |pmid=9703526}}</ref> Some providers may recommend harm-reduction techniques such as snapping of a rubber band on the wrist,{{sfn|Haris|Pitman|Mughal|Bakanaite|2022|p=3}} but there is no consensus as to the efficacy of this approach.<ref>{{harvnb|Townsend|2014|p=98}}, citing {{harvnb|NCCMH|2012|loc=[https://www.ncbi.nlm.nih.gov/books/NBK126779/#ch7.s124 §&nbsp;7.3.5 Narrative synthesis]}}.</ref>