Editing Self-harm (section)

==Causes==

===Mental disorder===
Although some people who self-harm do not have any form of recognized mental disorder,<ref>{{harvnb|Klonsky|2007b|p=1040}}: "Indeed, it has become apparent that self-injury occurs even in nonclinical and high-functioning populations such as secondary school students, college students, and active-duty military personnel".</ref> self-harm often co-occurs with psychiatric conditions. Self-harm is, for example, associated with eating disorders,<ref>{{cite journal |last1=Cucchi |first1=A. |last2=Ryan |first2=D. |last3=Konstantakopoulos |first3=G. |last4=Stroumpa |first4=S. |last5=Kaçar |first5=A. ş. |last6=Renshaw |first6=S. |last7=Landau |first7=S. |last8=Kravariti |first8=E. |date=May 2016 |title=Lifetime prevalence of non-suicidal self-injury in patients with eating disorders: a systematic review and meta-analysis |journal=Psychological Medicine |language=en |volume=46 |issue=7 |pages=1345–1358 |s2cid=206255649 |issn=0033-2917 |doi=10.1017/S0033291716000027 |doi-access=free |pmid=26954514}}</ref> [[autism]],<ref name="Johnson">{{cite journal |vauthors=Johnson CP, Myers SM |date=November 2007 |title=Identification and evaluation of children with autism spectrum disorders |journal=Pediatrics |volume=120 |issue=5 |pages=1183–1215 |s2cid=218028 |doi=10.1542/peds.2007-2361 |pmid=17967920 |url=http://pediatrics.aappublications.org/cgi/content/full/120/5/1183 |url-status=dead |archive-url=https://web.archive.org/web/20090208013449/http://pediatrics.aappublications.org/cgi/content/full/120/5/1183 |archive-date=2009-02-08}} For a lay summary, see {{citation |title=New AAP Reports Help Pediatricians Identify and Manage Autism Earlier |publisher=[[American Academy of Pediatrics]] |date=2007-10-29 |url=http://aap.org/advocacy/releases/oct07autism.htm |url-status=dead |archive-url=https://web.archive.org/web/20110324003106/http://aap.org/advocacy/releases/oct07autism.htm |archive-date=2011-03-24}}</ref><ref name="Dominick">{{cite journal |vauthors=Dominick KC, Davis NO, Lainhart J, Tager-Flusberg H, Folstein S |year=2007 |title=Atypical behaviors in children with autism and children with a history of language impairment |journal=Research in Developmental Disabilities |volume=28 |issue=2 |pages=145–162 |doi=10.1016/j.ridd.2006.02.003 |pmid=16581226}}</ref> [[borderline personality disorder]], [[dissociative disorders]], [[bipolar disorder]],<ref>{{cite journal |vauthors=Joyce PR, Light KJ, Rowe SL, Cloninger CR, Kennedy MA |title=Self-mutilation and suicide attempts: relationships to bipolar disorder, borderline personality disorder, temperament and character |journal=The Australian and New Zealand Journal of Psychiatry |volume=44 |issue=3 |pages=250–257 |date=March 2010 |s2cid=12374927 |doi=10.3109/00048670903487159 |pmid=20180727}}</ref> [[major depressive disorder|depression]],<ref name="meltzer"/><ref name="oxford">{{cite journal |vauthors=Hawton K, Kingsbury S, Steinhardt K, James A, Fagg J |title=Repetition of deliberate self-harm by adolescents: the role of psychological factors |journal=Journal of Adolescence |volume=22 |issue=3 |pages=369–378 |date=June 1999 |doi=10.1006/jado.1999.0228 |pmid=10462427}}</ref> [[phobia]]s,<ref name="meltzer"/> and [[conduct disorder]]s.<ref>{{cite journal |vauthors=Wessely S, Akhurst R, Brown I, Moss L |title=Deliberate self harm and the Probation Service; an overlooked public health problem? |journal=Journal of Public Health Medicine |volume=18 |issue=2 |pages=129–132 |date=June 1996 |doi=10.1093/oxfordjournals.pubmed.a024471 |doi-access=free |pmid=8816309}}</ref> As many as 70% of individuals with borderline personality disorder engage in self-harm.<ref>{{cite journal |vauthors=Urnes O |date=April 2009 |title=[Self-harm and personality disorders] |journal=Tidsskrift for den Norske Laegeforening |volume=129 |issue=9 |pages=872–876 |doi=10.4045/tidsskr.08.0140 |doi-access=free |pmid=19415088}}</ref> An estimated 30% of autistic individuals engage in self-harm at some point, including eye-poking, [[skin-picking]], hand-biting, and head-banging.<ref name="Johnson"/><ref name="Dominick"/> According to a meta-analysis that did not distinguish between suicidal and non-suicidal acts, self-harm is common among those with [[schizophrenia]] and is a significant predictor of suicide.{{sfn|Haw|Hawton|Sutton|Sinclair|2005|pp=50-51}} There are parallels between self-harm and [[Factitious disorder imposed on self|factitious disorder]], a psychiatric disorder in which individuals feign illness or trauma.<ref name=Munchausens88>{{cite journal |vauthors=Humphries SR |title=Munchausen syndrome. Motives and the relation to deliberate self-harm |journal=The British Journal of Psychiatry |volume=152 |issue=3 |pages=416–417 |date=March 1988 |s2cid=11881655 |doi=10.1192/bjp.152.3.416 |pmid=3167380}}</ref> There may be a common ground of inner distress culminating in self-directed harm in patients with this condition. However, a desire to deceive medical personnel in order to gain treatment and attention is more important in factitious disorder than in self-harm.<ref name=Munchausens88/>

===Psychological factors===

Self-harm is frequently described as an experience of [[depersonalization]] or a [[dissociation (psychology)|dissociative]] state.<ref>Antai-Otong, D. 2008. Psychiatric Nursing: Biological and Behavioral Concepts. 2nd edition. Canada: Thompson Delmar Learning</ref> [[Child abuse|Abuse during childhood]] is accepted as a primary social factor increasing the incidence of self-harm,<ref name="strong">{{cite book |vauthors=Strong M |year=1999 |title=A Bright Red Scream: Self-Mutilation and the Language of Pain |publisher=Penguin |isbn=978-0-14-028053-1 |title-link=A Bright Red Scream}}</ref> as is [[grief|bereavement]],<ref name="BBC"/> and troubled parental or partner relationships.<ref name="fox_hawton"/><ref name="rea"/> Factors such as war, poverty, unemployment, and substance abuse may also contribute.<ref name="fox_hawton"/><ref name="meltzer"/><ref>{{cite web |title=Third World faces self-harm epidemic |date=1998-07-10 |work=BBC News |url=http://news.bbc.co.uk/1/hi/health/129684.stm |access-date=2008-05-26}}</ref><ref>{{cite web |vauthors=Fikette L |title=The deportation machine: unmonitored and unimpeded |publisher=Institute of Race Relations |year=2005 |url=http://www.irr.org.uk/2005/april/ha000011.html |access-date=2008-04-26 |url-status=dead |archive-url=https://web.archive.org/web/20080303135533/http://www.irr.org.uk/2005/april/ha000011.html |archive-date=2008-03-03}}</ref> Other predictors of self-harm and suicidal behavior include feelings of entrapment, defeat, lack of belonging, and perceiving oneself as a burden along with having an impulsive personality and/or less effective social problem-solving skills.<ref name="fox_hawton"/>{{sfn|Hawton|Saunders|O'Connor|2012}}{{Page needed|date=August 2023}} Two studies have indicated that self-harm correlates more with [[pubertal phase]], particularly the end of puberty (peaking around 15 for girls), rather than with age. Adolescents may be more vulnerable neurodevelopmentally in this time, and more vulnerable to social pressures, with depression, alcohol abuse, and sexual activity as independent contributing factors.<ref>{{harvnb|Hawton|Saunders|O'Connor|2012|p=2374}} and {{harvnb|Patton|Viner|2007|p=1133}}, citing {{harvnb|Patton|Hemphill|Beyers|Bond|2007}}. {{harvnb|Knipe|John|Padmanathan|Eyles|2022|p=11}} ("the incidence of suicidal behaviours varies seasonally and increases rapidly at this age (e.g. puberty effects)"), citing {{harvnb|Roberts|Joinson|Gunnell|Fraser|2020}}.</ref> [[Transgender]] adolescents are significantly more likely to engage in self-harm than their cisgender peers.<ref>{{cite journal |vauthors=Connolly MD, Zervos MJ, Barone CJ, Johnson CC, Joseph CL |title=The Mental Health of Transgender Youth: Advances in Understanding |journal=The Journal of Adolescent Health |volume=59 |issue=5 |pages=489–495 |date=November 2016 |doi=10.1016/j.jadohealth.2016.06.012 |pmid=27544457}}</ref><ref name=":2">{{cite journal |vauthors=Butler C, Joiner R, Bradley R, Bowles M, Bowes A, Russell C, Roberts V |title=Self-harm prevalence and ideation in a community sample of cis, trans and other youth |journal=The International Journal of Transgenderism |volume=20 |issue=4 |pages=447–458 |date=2019-10-02 |pmc=6913646 |doi=10.1080/15532739.2019.1614130 |pmid=32999629}}</ref> This can be attributed to distress caused by [[gender dysphoria]] as well as increased likelihoods of experiencing bullying, abuse, and mental illness.<ref name=":2"/><ref>{{cite web |title=Transgender youths who self-harm: perspectives from... |website=MHT |language=en |url=https://www.mentalhealthtoday.co.uk/transgender-youths-who-self-harm-perspectives-from-those-seeking-support |access-date=2021-12-26}}</ref>

===Genetics===

The most distinctive characteristic of the rare genetic condition [[Lesch–Nyhan syndrome]] is uncontrollable self-harm and self-mutilation, and may include biting (particularly [[dermatophagia|of the skin]], [[nail biting|nails]], and lips)<ref>{{cite journal |last1=Cauwels |first1=R. G. E. C. |last2=Martens |first2=L. C. |date=1 September 2005 |title=Self-mutilation behaviour in Lesch-Nyhan syndrome |journal=Journal of Oral Pathology and Medicine |language=en |volume=34 |issue=9 |pages=573–575 |issn=0904-2512 |doi=10.1111/j.1600-0714.2005.00330.x |doi-access=free |pmid=16138897}}</ref> and head-banging.<ref>{{cite web |work=Genetics Home Reference |title=Lesch-Nyhan syndrome |publisher=U. S. National Library of Medicine |url=http://ghr.nlm.nih.gov/condition=leschnyhansyndrome |access-date=2010-01-13}}</ref> Genetics may contribute to the risk of developing other psychological conditions, such as anxiety or depression, which could in turn lead to self-harming behavior. However, the link between genetics and self-harm in otherwise healthy patients is largely inconclusive.<ref name=Skegg05/>

===Drugs and alcohol===

Substance misuse, dependence and withdrawal are associated with self-harm. [[Benzodiazepine dependence]] as well as [[benzodiazepine withdrawal]] is associated with self-harming behavior in young people.<ref>{{cite web |title=Drug misuse and dependence – UK guidelines on clinical management |author=National Treatment Agency for Substance Misuse |author-link=National Treatment Agency for Substance Misuse |year=2007 |publisher=Department of Health |location=United Kingdom |url=http://www.nta.nhs.uk/publications/documents/clinical_guidelines_2007.pdf |url-status=dead |archive-url=https://web.archive.org/web/20121011220848/http://www.nta.nhs.uk/uploads/clinical_guidelines_2007.pdf |archive-date=2012-10-11}}</ref> Alcohol is a major risk factor for self-harm.{{sfn|Greydanus|Shek|2009}} A study which analyzed self-harm presentations to emergency rooms in [[Northern Ireland]] found that alcohol was a major contributing factor and involved in 63.8% of self-harm presentations.<ref>{{Citation |title=Northern Ireland Registry of Deliberate Self-Harm Western Area, Two year report. January 1st 2007 – 31 December 2008 |vauthors=Bell M, O'Doherty E, O'Carroll A, McAnaney B, Graber S, McGale B, Hutchinson D, Moran P, Bonner B, O'Hagan D, Arensman E, Reulbach U, Corcoran P, Hawton K |work=[[Health and Social Care in Northern Ireland]] |date=21 January 2010 |publisher=CAWT |location=Northern Ireland |url=http://www.cawt.com/Site/11/Documents/NI%20Registry%20of%20Deliberate%20Self%20Harm%202%20year%20report.pdf |url-status=dead |archive-url=https://web.archive.org/web/20110708124700/http://www.cawt.com/Site/11/Documents/NI%20Registry%20of%20Deliberate%20Self%20Harm%202%20year%20report.pdf |archive-date=8 July 2011}}</ref> A 2009 study in the relation between [[cannabis (drug)|cannabis]] use and deliberate self-harm (DSH) in Norway and England found that, in general, cannabis use may not be a specific risk factor for DSH in young adolescents.<ref>{{cite journal |vauthors=Rossow I, Hawton K, Ystgaard M |title=Cannabis use and deliberate self-harm in adolescence: a comparative analysis of associations in England and Norway |journal=Archives of Suicide Research |volume=13 |issue=4 |pages=340–348 |year=2009 |s2cid=2409791 |doi=10.1080/13811110903266475 |pmid=19813111}}</ref> Smoking has also been associated with both non-suicidal self injury and suicide attempts in adolescents, although the nature of the relationship is unclear.{{sfn|Hawton|Saunders|O'Connor|2012|p=2376}} A 2021 [[meta-analysis]] on literature concerning the association between [[cannabis (drug)|cannabis]] use and self-injurious behaviors has defined the extent of this association, which is significant both at the cross-sectional ([[odds ratio]] = 1.569, 95% [[confidence interval]] [1.167-2.108]) and longitudinal (odds ratio = 2.569, 95% [[confidence interval]] [2.207-3.256]) levels, and highlighting the role of the chronic use of the substance, and the presence of depressive symptoms or of [[mental disorder]]s as factors that might increase the risk of self-injury among [[cannabis (drug)|cannabis]] users.<ref>{{cite journal |vauthors=Escelsior A, Belvederi Murri M, Corsini GP, Serafini G, Aguglia A, Zampogna D, Cattedra S, Nebbia J, Trabucco A, Prestia D, Olcese M, Barletta E, Pereira da Silva B, Amore M |display-authors=6 |title=Cannabinoid use and self-injurious behaviors: A systematic review and meta-analysis |journal=Journal of Affective Disorders |volume=278 |pages=85–98 |date=January 2021 |s2cid=221842572 |doi=10.1016/j.jad.2020.09.020 |pmid=32956965}}</ref>