Editing Self-harm

{{Short description|Intentional injury to one's body}}
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{{Use American English|date=August 2023}}
{{More medical citations needed|date=August 2023}}
{{Infobox medical condition
| name = Self-harm
| image = SelfHarm2017.jpg<!-- Do not remove this image -- Wikipedia is not censored. See WP:NOTCENSORED and article talk page. -->
| alt = Healed scars on the forearm
| caption = Healed [[scar]]s on the forearm from prior self-harm
| pronounce = 
| field = [[Psychiatry]], [[surgery]], or [[emergency medicine]] if serious injuries occur
| synonyms = Deliberate self-harm (DSH), self-injury (SI), nonsuicidal self-injury (NSSI), cutting
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'''Self-harm''' refers to intentional behaviors that cause harm to oneself. This is most commonly regarded as direct injury of one's own skin [[tissue (biology)|tissues]], usually without [[suicidal]] intention.<ref name=Gindhu05>{{cite journal |vauthors=Laye-Gindhu A, Schonert-Reichl KA |title=Nonsuicidal Self-Harm Among Community Adolescents: Understanding the 'Whats' and 'Whys' of Self-Harm |journal=Journal of Youth and Adolescence |volume=34 |year=2005 |pages=447–457 |issue=5 |s2cid=145689088 |doi=10.1007/s10964-005-7262-z}}</ref><ref name="Klonsky07">{{cite journal |vauthors=Klonsky ED |title=The functions of deliberate self-injury: a review of the evidence |journal=Clinical Psychology Review |volume=27 |issue=2 |pages=226–239 |date=March 2007a |s2cid=1321836 |doi=10.1016/j.cpr.2006.08.002 |pmid=17014942}}</ref><ref name="Muehlenkamp05">{{cite journal |vauthors=Muehlenkamp JJ |title=Self-injurious behavior as a separate clinical syndrome |journal=The American Journal of Orthopsychiatry |volume=75 |issue=2 |pages=324–333 |date=April 2005 |doi=10.1037/0002-9432.75.2.324 |pmid=15839768}}</ref> Other terms such as '''cutting''', '''self-abuse''', '''self-injury''', and '''self-mutilation''' have been used for any self-harming behavior regardless of suicidal intent.<ref name="Klonsky07"/><ref>{{cite journal |vauthors=Groschwitz RC, Plener P |title=The Neurobiology of Non-suicidal Self-injury (NSSI): A review |journal=Suicidology Online |volume=3 |pages=24–32 |url=http://www.suicidology-online.com/pdf/SOL-2012-3-24-32.pdf |access-date=2018-03-07}}</ref> Common forms of self-harm include damaging the skin with a sharp object or scratching with the fingernails, [[strike (attack)|hitting]], or [[burn]]ing. The exact bounds of ''self-harm'' are imprecise, but generally exclude tissue damage that occurs as an unintended side-effect of [[eating disorder]]s or [[substance abuse]], as well as more societally acceptable [[body modification]] such as [[tattoo]]s and [[body piercing|piercings]].<ref>{{harvnb|Klonsky|2007b|p=1040}}: "[B]ehaviors associated with substance and eating disorders—such as alcohol abuse, binging, and purging—are usually not considered self-injury because the resulting tissue damage is ordinarily an unintentional side effect. In addition, body piercings and tattoos are typically not considered self-injury because they are socially sanctioned forms of cultural or artistic expression. However, the boundaries are not always clear-cut. In some cases behaviors that usually fall outside the boundaries of self-injury may indeed represent self-injury if performed with explicit intent to cause tissue damage."</ref>

Although self-harm is by definition non-suicidal, it may still be life-threatening.<ref>{{cite journal |vauthors=Farber SK, Jackson CC, Tabin JK, Bachar E |title=Death and annihilation anxieties in anorexia nervosa, bulimia, and self-mutilation |journal=Psychoanalytic Psychology |volume=24 |issue=2 |pages=289–305 |year=2007 |doi=10.1037/0736-9735.24.2.289}}</ref> People who do self-harm are more likely to die by suicide,<ref name="Muehlenkamp05"/><ref name="Skegg05">{{cite journal |vauthors=Skegg K |title=Self-harm |journal=Lancet |volume=366 |issue=9495 |pages=1471–1483 |year=2005 |s2cid=208794175 |doi=10.1016/s0140-6736(05)67600-3 |pmid=16243093}}</ref> and self-harm is found in 40–60% of suicides.<ref name="Hawton_BMJ_03">{{cite journal |vauthors=Hawton K, Zahl D, Weatherall R |title=Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital |journal=The British Journal of Psychiatry |volume=182 |issue=6 |pages=537–542 |date=June 2003 |doi=10.1192/bjp.182.6.537 |doi-access=free |pmid=12777346}}</ref> Still, only a minority of those who self-harm are suicidal.<ref name="fox_hawton">{{cite book |vauthors=Fox C, Hawton K |title=Deliberate Self-Harm in Adolescence |place=London |publisher=Jessica Kingsley |isbn=978-1-84310-237-3 |year=2004}}</ref><ref name="Suyemoto98">{{cite journal |vauthors=Suyemoto KL |title=The functions of self-mutilation |journal=Clinical Psychology Review |volume=18 |issue=5 |pages=531–554 |date=August 1998 |s2cid=15468889 |doi=10.1016/S0272-7358(97)00105-0 |pmid=9740977}}</ref>

The desire to self-harm is a common symptom of some [[personality disorder]]s. People with other [[mental disorder]]s may also self-harm, including those with [[major depressive disorder|depression]], [[anxiety disorders]], [[substance abuse]], [[mood disorder]]s, [[eating disorder]]s, [[post-traumatic stress disorder]], [[schizophrenia]], [[dissociative disorders]], [[psychotic disorders]], as well as [[gender dysphoria]] or [[dysmorphia]]. Studies also provide strong support for a [[self-flagellation|self-punishment]] function, and modest evidence for anti-dissociation, interpersonal-influence, anti-suicide, sensation-seeking, and interpersonal boundaries functions.<ref name="Klonsky07" /> Self-harm can also occur in high-functioning individuals who have no underlying mental health diagnosis.

The motivations for self-harm vary; some use it as a [[coping mechanism]] to provide temporary relief of intense feelings such as [[anxiety]], [[depression (mood)|depression]], [[psychological stress|stress]], [[reduced affect display|emotional numbness]], or a [[impostor syndrome|sense of failure]]. Self-harm is often associated with a history of [[psychological trauma|trauma]], including [[emotional abuse|emotional]] and [[sexual abuse]].<ref name="meltzer">{{cite book |vauthors=Meltzer H, Lader D, Corbin T, Singleton N, Jenkins R, Brugha T |year=2000 |title=Non Fatal Suicidal Behaviour Among Adults aged 16 to 74 |place=Great Britain |publisher=The Stationery office |isbn=978-0-11-621548-2 |url=https://webarchive.nationalarchives.gov.uk/ukgwa/20160105160709/http://www.ons.gov.uk/ons/rel/psychiatric-morbidity/non-fatal-suicidal-behaviour-among-adults/non-fatal-suicidal-behaviour-among-adults-aged-16-74-in-great-britain/non-fatal-suicidal-behaviour---among-adults-aged-16-74-in-great-britain.pdf}}</ref><ref name="rea">{{cite journal |vauthors=Rea K, Aiken F, Borastero C |title=Building therapeutic staff: client relationships with women who self-harm |journal=Women's Health Issues |volume=7 |issue=2 |pages=121–125 |year=1997 |doi=10.1016/S1049-3867(96)00112-0 |pmid=9071885}}</ref> There are a number of different methods that can be used to treat self-harm, which concentrate on either treating the underlying causes, or on treating the behavior itself. 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.<ref name="Klonsky08">{{cite journal |vauthors=Klonsky ED, Glenn CR |title=Resisting Urges to Self-Injure |journal=Behavioural and Cognitive Psychotherapy |volume=36 |issue=2 |pages=211–220 |date=March 2008 |pmc=5841247 |doi=10.1017/S1352465808004128 |pmid=29527120}}</ref>

<!-- Epidemiology, society, and culture -->
Self-harm tends to begin in [[adolescence]]. Self-harm in childhood is relatively rare, but the rate has been increasing since the 1980s.<ref name="ThomasHardy1997">{{cite book |vauthors=Thomas B, Hardy S, Cutting P |title=Stuart and Sundeen's mental health nursing: principles and practice |year=1997 |publisher=Elsevier Health Sciences |isbn=978-0-7234-2590-8 |page=[https://archive.org/details/stuartsundeensme0000unse/page/343 343] |url=https://archive.org/details/stuartsundeensme0000unse/page/343}}</ref> Self-harm can also occur in the elderly population.<ref name=Pierce87>{{cite journal |vauthors=Pierce D |title=Deliberate self-harm in the elderly |journal=International Journal of Geriatric Psychiatry |volume=2 |pages=105–110 |year=1987 |issue=2 |s2cid=145408278 |doi=10.1002/gps.930020208}}</ref> The risk of serious injury and suicide is higher in older people who self-harm.<ref name=NICE04>{{cite book |author=National Institute for Clinical Excellence |title=National Clinical Practice Guideline Number 16: Self-harm |publisher=The British Psychological Society |year=2004 |url=http://www.nice.org.uk/nicemedia/pdf/CG16FullGuideline.pdf |access-date=2009-12-13}}</ref> [[Captive animal]]s, such as birds and monkeys, are also known to harm themselves.<ref name=Jones07>{{cite journal |vauthors=Jones IH, Barraclough BM |title=Auto-mutilation in animals and its relevance to self-injury in man |journal=Acta Psychiatrica Scandinavica |volume=58 |issue=1 |pages=40–47 |date=July 1978 |s2cid=24737213 |doi=10.1111/j.1600-0447.1978.tb06918.x |pmid=99981}}</ref>

==History==
{{Synthesis|section|date=August 2023}}
[[File:A day of mourning, annual celebration of Muharram in Bahrain.jpg|thumb|The results of self-flagellation, as part of an annual Shia mourning ritual during [[Mourning of Muharram#Self-flagellation|Muharram]] ([[Tatbir]])]]
[[File:Maya Cave 224, mural of the Mourning of the Buddha with drawing.jpg|thumb|Mural of the Mourning of the Buddha, with various figures in ethnic costumes]]
[[File:flagellants.png|right|thumb|[[Consequences of the Black Death#Religion|One of the consequences]] of the [[Black Death]] was practiced [[self-flagellation|self-flogging]].]]
[[File:Zanjir b&w.jpg|thumb|A ritual flagellation tool known as a ''zanjir'', used in Shia Muharram observances]]
Although the 20th-century psychiatrist [[Karl Menninger]] is often credited with the initial clinical characterization of self-harm, self-harm is not a new phenomenon.{{sfn|Angelotta|2015}} There is frequent reference in 19th-century clinical literature and asylum records which make a clear clinical distinction between self-harm with and without suicidal intent.{{sfn|Chaney|2012}} This differentiation may have been important to both safeguard the reputations of asylums against accusations of medical neglect and to protect patients and their families from the legal or religious consequences of a suicide attempt.{{sfn|Chaney|2012}} In 1896, the American ophthalmologists George Gould and Walter Pyle categorized self-mutilation cases into three groups: those resulting from "temporary insanity from hallucinations or melancholia; with suicidal intent; and in a religious frenzy or emotion".{{sfn|Gould|Pyle|1896}}

Self-harm was, and in some cases continues to be, a [[ritual]] practice in many cultures and religions.

The [[Maya priesthood]] performed auto-[[sacrifice]] by cutting and piercing their bodies in order to draw blood.<ref>{{cite book |vauthors=Gualberto A |year=1991 |title=An Overview of the Maya World |pages=207–208 |publisher=Produccion Editorial Dante |isbn=978-968-7232-19-5}}</ref> A reference to the priests of [[Baal]] "cutting themselves with blades until blood flowed" can be found in the Hebrew Bible.<ref>{{Bibleverse|1|Kings|18:28|HE}}</ref> However, in Judaism, such self-harm is forbidden under [[Mosaic law]].<ref>Maimonides, [[Mishneh Torah]], ''Hilchot Khovel u-Mazik'' ch. 5, etc. ''See also'' [[Damages (Jewish law)]].</ref> It occurred in ancient Canaanite mourning rituals, as described in the [[Ras Shamra]] tablets.

Self-harm is practised in [[Hinduism]] by the ascetics known as ''[[sadhu]]''s. In [[Catholicism]], it is known as [[mortification of the flesh]]. Some branches of Islam mark the [[Day of Ashura]], the commemoration of the martyrdom of Imam Hussein, with [[mourning of Muharram#Self-flagellation|a ritual of self-flagellation]], using chains and swords.<ref>{{citation |publisher=Jafariya news |vauthors=Zabeeh I |title=Ashura observed with blood streams to mark Karbala tragedy |url=https://www.jafariyanews.com/2k5_news/feb/20ashur.htm |access-date=2011-09-04}}</ref>

[[Dueling scar]]s such as those acquired through [[academic fencing]] at certain traditional German universities are an early example of [[scarification]] in European society.<ref name="DeMello p 237">{{cite book |vauthors=DeMello M |year=2007 |title=Encyclopedia of body adornment |publisher=Greenwood Publishing Group |page=237 |isbn=978-0-313-33695-9}}</ref> Sometimes, students who did not fence would scar themselves with razors in imitation.<ref name="DeMello p 237"/>

[[Constance Lytton]], a prominent [[suffragette]], used a stint in [[Holloway Prison]] during March 1909 to mutilate her body. Her plan was to carve 'Votes for Women' from her breast to her cheek, so that it would always be visible. But after completing the ''V'' on her breast and ribs she requested sterile dressings to avoid [[bacteremia|blood poisoning]], and her plan was aborted by the authorities.<ref name="BBC Schama 1">{{cite web |work=BBC |title=Victoria's Sisters by Simon Schama, Lady Lytton's self mutilation gesture for 'Votes' |url=https://www.bbc.co.uk/pressoffice/pressreleases/stories/2002/05_may/09/victoria_sisters.shtml}}</ref> She wrote of this in her memoir ''Prisons and Prisoners''.

[[Kikuyu people|Kikuyu]] girls cut each other's vulvas in the 1950s as a symbol of defiance, in the context of the [[campaign against female genital mutilation in colonial Kenya]]. The movement came to be known as ''Ngaitana'' ("I will circumcise myself"), because to avoid naming their friends, the girls said they had cut themselves. Historian Lynn Thomas described the episode as significant in the history of [[FGM]] because it made clear that its victims were also its perpetrators.<ref>{{cite book |vauthors=Thomas LM |chapter='Ngaitana (I Will Circumcise Myself)': Lessons from Colonial Campaigns to Ban Excision in Meru, Kenya. |veditors=Shell-Duncan B, Hernlund Y |title=Female "circumcision" in Africa: culture, controversy, and change |date=2000 |publisher=Lynne Rienner Publishers |location=Boulder |isbn=978-1-55587-995-2 |chapter-url=https://books.google.com/books?id=rhhRXiJIGEcC&pg=PA129 |pages=129–131}}(131 for the girls as "central actors")</ref><ref>{{cite book |vauthors=Thomas L |title=Politics of the Womb: Women, Reproduction, and the State in Kenya |location=Berkeley |publisher=University of California Press |year=2003 |pages=89–91}}{{pb}}
Also see {{cite journal |ref=none |vauthors=Thomas LM |title="Ngaitana (I will circumcise myself)": the gender and generational politics of the 1956 ban on clitoridectomy in Meru, Kenya |journal=Gender & History |volume=8 |issue=3 |pages=338–363 |date=November 1996 |doi=10.1111/j.1468-0424.1996.tb00062.x |pmid=12322506}}</ref>

===Classification===
[[Karl Menninger]] considered self-mutilation as a non-fatal expression of an attenuated death wish and thus coined the term ''partial suicide''. He began a classification system of six types:
# neurotic – [[nail-biting|nail-biters]], pickers, extreme hair removal, and unnecessary cosmetic surgery
# religious – self-flagellants and others
# puberty rites – hymen removal, circumcision, or clitoral alteration
# psychotic – eye or ear removal, genital self-mutilation, and extreme amputation
# organic brain diseases – which allow repetitive [[Stereotypic_movement_disorder|head-banging]], hand-biting, finger-fracturing, or [[autoenucleation|eye removal]]
# conventional – nail-clipping, trimming of hair, and shaving beards.<ref name="1935 Menninger article">{{cite journal |vauthors=Menninger K |year=1935 |title=A psychoanalytic study of the significance of self-mutilation |journal=[[Psychoanalytic Quarterly]] |volume=4 |issue=3 |pages=408–466 |doi=10.1080/21674086.1935.11925248}}</ref>

Pao (1969) differentiated between ''delicate'' (low lethality) and ''coarse'' (high lethality) self-mutilators who cut. The "delicate" cutters were young, multiple episodic of superficial cuts and generally had borderline [[personality disorder]] diagnosis. The "coarse" cutters were older and generally psychotic.<ref name="Pao (1969)">{{cite journal |vauthors=Pao PN |title=The syndrome of delicate self-cutting |journal=The British Journal of Medical Psychology |volume=42 |issue=3 |pages=195–206 |date=August 1969 |doi=10.1111/j.2044-8341.1969.tb02071.x |pmid=5808710}}</ref> Ross and McKay (1979) categorized self-mutilators into nine groups: ''cutting'', ''biting'', ''abrading'', ''severing'', ''inserting'', ''burning'', ''ingesting or inhaling'', ''hitting'', and ''constricting''.<ref name="Ross and McKay (1979)">{{cite book |vauthors=Ross RR, McKay HB |year=1979 |title=Self-Mutilation |publisher=Lexington Books |isbn=978-0-669-02116-5 |url=https://www.ojp.gov/ncjrs/virtual-library/abstracts/self-mutilation |access-date=2024-03-27}}</ref>

After the 1970s the focus of self-harm shifted from [[Freudian]] psycho-sexual drives of the patients.<ref name="Roe-Sepowitz">{{cite thesis |vauthors=Roe-Sepowitz DE |degree=Ph.D. |title=Indicators of Self-Mutilation: Youth in Custody |year=2005 |publisher=The Florida State University College of Social Work |pages=8–10, 77–88 |url=http://etd.lib.fsu.edu/theses_1/available/etd-09132005-192859/unrestricted/DominiqueRoeSepowitzDissertation.pdf |access-date=2009-06-15 |url-status=dead |archive-url=https://web.archive.org/web/20120225213713/http://etd.lib.fsu.edu/theses_1/available/etd-09132005-192859/unrestricted/DominiqueRoeSepowitzDissertation.pdf |archive-date=2012-02-25}}</ref>

Walsh and Rosen (1988) created four categories numbered by Roman numerals I–IV, defining ''Self-mutilation'' as rows II, III and IV.<ref name="Walsh and rosen (1988)">{{cite book |vauthors=Walsh BW, Rosen PM |year=1988 |title=Self Mutilation: Theory, Research and Treatment |publisher=Guilford. of N..Y, NY. |isbn=978-0-89862-731-2 |url=https://archive.org/details/selfmutilationth0000wals |page=7|url-access=registration}}</ref><!-- this is the source for the entire table below -->

{| class="wikitable"
|-
! Classification
! Examples of behavior
! Degree of Physical Damage
! Psychological State
! Social Acceptability
|-
| I
| Ear-piercing, nail-biting, small tattoos, cosmetic surgery (not considered self-harm by the majority of the population)
| Superficial to mild
| Benign
| Mostly accepted
|-
| II
| Piercings, saber scars, ritualistic clan scarring, [[sailor tattoos]], [[gang tattoos]], minor wound-excoriation, [[trichotillomania]]
| Mild to moderate
| Benign to agitated
| Subculture acceptance
|-
| III
| Wrist- or body-cutting, self-inflicted cigarette burns and tattoos, major wound-excoriation
| Mild to moderate
| Psychic crisis
| Possibly accepted by a handful of similar-minded friends but not by the general population
|-
| IV
| [[Castration|Auto-castration]], [[self-enucleation]], [[amputation]]
| Severe
| Psychotic decompensation
| Unacceptable
|}

Favazza and Rosenthal (1993) reviewed hundreds of studies and divided self-mutilation into two categories: ''culturally sanctioned self-mutilation'' and ''deviant self-mutilation''.<ref name="Favazza and Rosenthal (1993)">{{cite journal |vauthors=Favazza AR, Rosenthal RJ |title=Diagnostic issues in self-mutilation |journal=Hospital & Community Psychiatry |volume=44 |issue=2 |pages=134–140 |date=February 1993 |doi=10.1176/ps.44.2.134 |pmid=8432496}}</ref> Favazza also created two subcategories of sanctioned self-mutilations; ''rituals'' and ''practices''. The ''rituals'' are mutilations repeated generationally and "reflect the traditions, symbolism, and beliefs of a society" (p.&nbsp;226). ''Practices'' are historically transient and cosmetic such as piercing of earlobes, nose, eyebrows as well as male [[circumcision#History|circumcision]] while ''deviant self-mutilation'' is equivalent to self-harm.<ref name="Roe-Sepowitz"/><ref name="Favazza (1996)">{{cite book |vauthors=Favazza AR |year=1996 |title=Bodies Under Siege, 2nd ed |publisher=Baltimore: Johns Hopkins Press. |isbn=978-0-8018-5300-5 |url=https://books.google.com/books?id=BwQT9fdZNdgC&q=Favazza,+A.+R.+(1996).+Bodies+Under+Siege,+2nd+ed.+Baltimore:+Johns+Hopkins+Press.&pg=PR9 |access-date=2009-06-22}}</ref>

==Classification and terminology==
''Self-harm'' (SH), ''self-injury'' (SI), ''nonsuicidal self-injury'' (NSSI) and ''self-injurious behavior'' (SIB) are different terms to describe tissue damage that is performed intentionally and usually without suicidal intent.{{sfnm|1a1=McAllister|1y=2003|1p=178|2a1=Plener|2a2=Schumacher|2a3=Munz|2a4=Groschwitz|2y=2015|2p=1|3a1=Butler|3a2=Malone|3y=2013|4a1=Jacobson|4a2=Gould|4y=2007|4p=131}} The adjective "deliberate" is sometimes used, although this has become less common, as some view it as presumptuous or judgmental.{{sfn|NCCMH|2012|loc=[https://www.ncbi.nlm.nih.gov/books/NBK126787/ §&nbsp;2.1.1 Terminology]}} Less common or more dated terms include ''parasuicidal behavior'', ''self-mutilation'', ''self-destructive behavior'', ''self-inflicted violence'', ''self-injurious behavior'', and ''self-abuse''.{{sfn|Connors|1996|p=198}} Others use the phrase ''self-soothing'' as intentionally positive terminology to counter more negative associations.{{sfn|McAllister|2003|p=178}} ''[[Self-inflicted wound]]'' or ''self-inflicted injury'' refers to a broader range of circumstances, including wounds that result from [[organic brain syndrome]]s, [[substance abuse]], and [[autoeroticism]].{{sfn|David|Rifkin|Chiu|2018|p=S82}}

Different sources draw various distinctions between some of these terms. Some sources define ''self-harm'' more broadly than ''self-injury'', such as to include [[drug overdose]], [[eating disorder]]s, and other acts that do not directly lead to visible injuries.<ref>{{harvnb|McAllister|2003|p=178}}: "Some authors differentiate self harm from self injury&nbsp;.... Self harm may be defined as any act that causes psychological or physical harm to the self without a suicide intention, and which is either intentional, accidental, committed through ignorance, apathy or poor judgement. By far the most common form of self harm is drug overdose which requires standard medical management in the first instance. Self injury, on the other hand, is a kind of self harm which leads to visible, direct, bodily injury. Self injury includes cutting, burning, scalding and injurious insertion of objects into the body[.]"</ref> Others explicitly exclude these.{{sfn|NCCMH|2012|loc=[https://www.ncbi.nlm.nih.gov/books/NBK126787/ §&nbsp;2.1.1 Terminology]}} Some sources, particularly in the United Kingdom, define ''deliberate self-harm'' or ''self-harm'' in general to include suicidal acts.{{sfnm|1a1=Jacobson|1a2=Gould|1y=2007|1p=131|2a1=Gillies|2a2=Christou|2a3=Dixon|2a4=Featherston|2y=2018|2pp=4-5}} (This article principally discusses non-suicidal acts of self-inflicted skin damage or self-poisoning.) The inconsistent definitions used for self-harm have made research more difficult.{{sfnm|1a1=Gillies|1a2=Christou|1a3=Dixon|1a4=Featherston|1y=2018|1p=6|2a1=Muehlenkamp|2a2=Claes|2a3=Havertape|2a4=Plener|2y=2012|2pp=1-2|3a1=Butler|3a2=Malone|3y=2013|3p=325}}

Nonsuicidal self-injury (NSSI) is listed in [[DSM-5#Section II: Diagnostic criteria and codes|Section II (''Diagnostic criteria and codes'')]] of the latest, {{As of|2025|April|lc=y}}, edition of the ''[[Diagnostic and Statistical Manual of Mental Disorders]]'' ([[DSM-5-TR]]) under the category "other conditions that may be a focus of clinical attention".<ref name=":0">{{cite web |date=2022 |title=Addition of Diagnostic Codes for Suicidal Behavior and Nonsuicidal Self- Injury |website=American Psychiatric Association |url=https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/apa-dsm5tr-suicidalbehaviorandnonsuicidalselfinjury.pdf |access-date=May 23, 2022}}</ref> While NSSI is not a separate mental disorder, the DSM-5-TR adds a diagnostic code for the condition in-line with the [[International Classification of Diseases|ICD]]. The disorder is defined as intentional self-inflicted injury without the intent of dying by suicide. [[DSM-5#Section III: Emerging measures and models|Section III (''Emerging measures and models'')]] of the previous edition of the DSM ([[DSM-5]]) contains the proposed diagnosis along with criteria and description of ''Nonsuicidal Self-injury''.<ref name=":4">{{Cite book |title=Diagnostic and statistical manual of mental disorders: DSM-5 |date=2013 |publisher=American psychiatric association |isbn=978-0-89042-554-1 |edition=5th |location=Washington |pages=803–806 |chapter=Conditions for Further Study}}</ref> Criteria for NSSI include five or more days of self-inflicted harm over the course of one year without suicidal intent, and the individual must have been motivated by seeking [[Relief (emotion)|relief]] from a negative state, resolving an interpersonal difficulty, or achieving a positive state.<ref>{{cite news |vauthors=Stetka BS, Correll CU |date=21 May 2013 |work=Medscape |title=A Guide to DSM-5: Section 3 Disorders |url=https://www.medscape.com/viewarticle/803884_15}}</ref><ref name=":4" />

A common belief regarding self-harm is that it is an [[attention-seeking]] behavior; however, in many cases, this is inaccurate. Many self-harmers are very self-conscious of their wounds and scars and feel guilty about their behavior, leading them to go to great lengths to conceal their behavior from others.<ref name="MHF">{{cite book |title=Truth Hurts Report |isbn=978-1-903645-81-9 |publisher=Mental Health Foundation |year=2006 |url=https://www.mentalhealth.org.uk/explore-mental-health/publications/truth-hurts-report |access-date=2024-03-27}}</ref><ref name=":3">{{cite journal |last1=Burke |first1=Taylor A. |last2=Ammerman |first2=Brooke A. |last3=Hamilton |first3=Jessica L. |last4=Stange |first4=Jonathan P. |last5=Piccirillo |first5=Marilyn |date=November 2020 |title=Nonsuicidal self-injury scar concealment from the self and others |journal=Journal of Psychiatric Research |volume=130 |pages=313–320 |issn=0022-3956 |pmc=10266527 |doi=10.1016/j.jpsychires.2020.07.040 |pmid=32871456}}</ref> They may offer alternative explanations for their injuries, or conceal their scars with clothing.<ref name=":3"/><ref name="spandler">{{cite book |year=1996 |title=Who's Hurting Who? Young people, self-harm and suicide |place=Manchester |publisher=42nd Street |isbn=978-1-900782-00-5 |vauthors=Spandler H}}</ref><ref name="pembroke">{{cite book |veditors=Pembroke LR |year=1994 |title=Self-harm – Perspectives from personal experience |publisher=Chipmunka/Survivors Speak Out |isbn=978-1-904697-04-6 |url=https://archive.org/details/selfharmperspect0000unse |url-access=registration}}</ref> Self-harm in such individuals may not be associated with [[suicide|suicidal]] or [[parasuicide|para-suicidal]] behavior. People who self-harm are not usually seeking to end their own life; it has been suggested instead that they are using self-harm as a [[coping (psychology)|coping mechanism]] to relieve [[emotional pain]] or discomfort or as an attempt to communicate distress.<ref name="fox_hawton"/><ref name="Suyemoto98"/>

Studies of individuals with developmental disabilities (such as [[intellectual disability]]) have shown self-harm being dependent on environmental factors such as obtaining attention or escape from demands.<ref name="iwata">{{cite journal |vauthors=Iwata BA, Dorsey MF, Slifer KJ, Bauman KE, Richman GS |title=Toward a functional analysis of self-injury |journal=Journal of Applied Behavior Analysis |volume=27 |issue=2 |pages=197–209 |year=1994 |pmc=1297798 |doi=10.1901/jaba.1994.27-197 |pmid=8063622}}</ref> Some individuals may have [[dissociation (psychology)|dissociation]] harboring a desire to feel real or to fit into society's rules.<ref>{{cite book |vauthors=Claveirole A, Gaughan M |title=Understanding Children and Young People's Mental Health |year=2011 |publisher=John Wiley & Sons |location=West Sussex, UK |isbn=978-0-470-72345-6 |page=75 |url=https://books.google.com/books?id=FoIFSPnpoNcC&q=dissociation+self+harm&pg=PA75 |access-date=9 February 2011}}</ref>

==Signs and symptoms==
The most common form of self-harm for adolescents, according to studies conducted in six countries, is stabbing or cutting the skin with a sharp object.{{sfn|Greydanus|Shek|2009|pp=145-146}} For adults ages 60 and over, self-[[poison]]ing (including [[intentional drug overdose]]) is by far the most common form.{{sfn|Troya|Babatunde|Polidano|Bartlam|2019|pp=189-190}} Other self-harm methods include [[burn]]ing, head-banging, biting, scratching, hitting, preventing wounds from healing, [[self-embedding]] of objects, and hair-pulling.{{sfn|Gillies|Christou|Dixon|Featherston|2018|pp=4-5}} The locations of self-harm are often areas of the body that are easily hidden and concealed from the sight of others.<ref>{{cite journal |vauthors=Hodgson S |year=2004 |title=Cutting Through the Silence: A Sociological Construction of Self-Injury |journal=Sociological Inquiry |volume=74 |issue=2 |pages=162–179 |doi=10.1111/j.1475-682X.2004.00085.x}}</ref> 

==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>

==Pathophysiology==
[[File:Self-injury.svg|right|thumb|A flow chart of two theories of self-harm]]

Self-injury may result in serious injury and scarring. While non-suicidal self-injury by definition lacks suicidal intent, it may nonetheless result in accidental death.{{sfnm|1a1=Lofthouse|1a2=Yager-Schweller|1y=2009|1p=644|2a1=Lengel|2a2=Styer|2y=2019|2pp=130-131}}

While the motivations for self harm vary, the most commonly endorsed reason for self harm given by adolescents is "to get relief from a terrible state of mind".{{sfn |Rasmussen |Hawton |Philpott-Morgan |O'Connor |2016 |pp=176–183}}{{sfn |Troya |Babatunde |Polidano |Bartlam |2019 |pp=186–200}} Young people with a history of repeated episodes of self harm are more likely to self-harm into adulthood,{{Sfn |Doyle |Sheridan |Treacy |2017 |pp=134–142}}{{sfn |Moran |Coffey |Romaniuk |Olsson |2012 |pp=236–243}} and are at higher risk of suicide.{{sfn |Zahl |Hawton |2004 |pp=70–75}} In older adults, influenced by a combination of interconnected individual, societal, and healthcare factors, including financial and interpersonal problems and comorbid physical conditions and pain, with increased loneliness, perceived burdensomeness of ageing, and loss of control reported as particular motivations.{{sfn |Troya |Babatunde |Polidano |Bartlam |2019 |pp=186–200}}
There is a positive statistical correlation between self-harm and physical, sexual, and emotional abuse.<ref name="meltzer"/>{{rp|p=63}}<ref name="rea"/>{{Better source needed|date=August 2023}}
Self-harm may become a means of managing and controlling [[pain]], in contrast to the pain experienced earlier in the person's life over which they had no control (e.g., through abuse).<ref name="helpguide">{{cite web |vauthors=Cutter D, Jaffe J, Segal J |year=2008 |title=Self-Injury: Types, Causes and Treatment |publisher=HELPGUIDE.org |url=http://www.helpguide.org/mental/self_injury.htm |access-date=2008-05-26 |url-status=dead |archive-url=https://web.archive.org/web/20080511155535/http://helpguide.org/mental/self_injury.htm |archive-date=2008-05-11}}</ref>{{Medical citation needed|date=August 2023}}

Assessment of motives in a medical setting is usually based on precursors to the incident, circumstances, and information from the patient.<ref name="fox_hawton"/> However, limited studies show that professional assessments tend to suggest more manipulative or punitive motives than personal assessments.<ref>{{cite journal |vauthors=Hawton K, Cole D, O'Grady J, Osborn M |title=Motivational aspects of deliberate self-poisoning in adolescents |journal=The British Journal of Psychiatry |volume=141 |issue=3 |pages=286–291 |date=September 1982 |s2cid=38556782 |doi=10.1192/bjp.141.3.286 |pmid=7139213}}</ref>

A UK [[Office for National Statistics]] study reported only two motives: "to draw attention" and "because of anger".<ref name="meltzer"/> For some people, harming themselves can be a means of drawing attention to the need for help and to ask for assistance in an indirect way. It may also be an attempt to affect others and to manipulate them in some way emotionally.<ref name="welcometrust"/><ref name="helpguide"/>{{Medical citation needed|date=August 2023}} However, those with chronic, repetitive self-harm often do not want attention and hide their scars carefully.<ref>{{cite web |title=Myths about self harm |url=https://harmless.org.uk/faq.php?%20cat_id=2 |access-date=2022-01-19 |url-status=dead |archive-url=https://web.archive.org/web/20191102211258/https://harmless.org.uk/faq.php?%20cat_id=2 |archive-date=2019-11-02}}</ref>{{Medical citation needed|date=August 2023}}

Many people who self-harm state that it allows them to "go away" or [[dissociation (psychology)|dissociate]], separating the mind from feelings that are causing anguish. This may be achieved by tricking the mind into believing that the present suffering being felt is caused by the self-harm instead of the issues they were facing previously: the [[pain|physical pain]] therefore acts as a distraction from the original emotional pain.<ref name="spandler"/>{{Medical citation needed|date=August 2023}} To complement this theory, one can consider the need to "stop" feeling emotional pain and mental agitation.<ref name="lifesigns-precursors">{{cite web |title=Precursors to Self Injury |publisher=LifeSIGNS |url=http://www.lifesigns.org.uk/what/precursors |access-date=2012-10-05}}</ref>{{Medical citation needed|date=August 2023}}

Alternatively, self-harm may be a means of feeling ''something'', even if the sensation is unpleasant and painful. Those who self-harm sometimes describe feelings of [[emptiness]] or numbness ([[anhedonia]]), and physical pain may be a relief from these feelings.<ref name="lifesigns-precursors"/>{{Medical citation needed|date=August 2023}}

Those who engage in self-harm face the contradictory reality of harming themselves while at the same time obtaining relief from this act. It may even be hard for some to actually initiate cutting, but they often do because they know the relief that will follow. For some self-harmers this relief is primarily psychological while for others this feeling of relief comes from the [[endorphin|beta endorphins]] released in the brain.<ref name="welcometrust">{{cite web |vauthors=Swales M |title=Pain and deliberate self-harm |publisher=The Wellcome Trust |url=http://www.wellcome.ac.uk/en/pain/microsite/culture4.html |access-date=2008-05-26 |url-status=dead |archive-url=https://web.archive.org/web/20080916095230/http://www.wellcome.ac.uk/en/pain/microsite/culture4.html |archive-date=2008-09-16}}</ref>{{Medical citation needed|date=August 2023}} Endorphins are endogenous opioids that are released in response to physical injury, acting as natural painkillers and inducing pleasant feelings, and in response to self-harm would act to reduce tension and emotional distress.<ref name="Klonsky07"/> Many people do not feel physical pain when self-harming.{{sfn|Chapman|Gratz|Brown|2006|p=383}} Studies of clinical and non-clinical populations suggest that people who engage in self-harm have higher pain thresholds and tolerance in general, although a 2016 review characterized the evidence base as "greatly limited". There is no consensus as to the reason for this apparent phenomenon.{{sfn|Kirtley|O'Carroll|O'Connor|2016|p=361}}

As a coping mechanism, self-harm can become psychologically [[behavioral addiction|addictive]] because, to the self-harmer, it works; it enables them to deal with intense stress in the current moment. The patterns sometimes created by it, such as specific time intervals between acts of self-harm, can also create a behavioral pattern that can result in a wanting or craving to fulfill thoughts of self-harm.<ref name="Nixon02">{{cite journal |vauthors=Nixon MK, Cloutier PF, Aggarwal S |title=Affect regulation and addictive aspects of repetitive self-injury in hospitalized adolescents |journal=Journal of the American Academy of Child and Adolescent Psychiatry |volume=41 |issue=11 |pages=1333–1341 |date=November 2002 |doi=10.1097/00004583-200211000-00015 |pmid=12410076}}</ref>

===Autonomic nervous system===
Emotional pain activates the same regions of the brain as physical pain,<ref>{{cite journal |vauthors=Kross E, Berman MG, Mischel W, Smith EE, Wager TD |title=Social rejection shares somatosensory representations with physical pain |journal=Proceedings of the National Academy of Sciences of the United States of America |volume=108 |issue=15 |pages=6270–6275 |date=April 2011 |pmc=3076808 |bibcode=2011PNAS..108.6270K |doi=10.1073/pnas.1102693108 |doi-access=free |pmid=21444827}}</ref> so emotional stress can be a significantly intolerable state for some people. Some of this is environmental and some of this is due to physiological differences in responding.<ref>{{cite journal |vauthors=Porges SW |title=The polyvagal theory: phylogenetic substrates of a social nervous system |journal=International Journal of Psychophysiology |volume=42 |issue=2 |pages=123–146 |date=October 2001 |doi=10.1016/s0167-8760(01)00162-3 |pmid=11587772}}</ref> The [[autonomic nervous system]] is composed of two components: the [[sympathetic nervous system]] controls arousal and physical activation (e.g., the [[fight-or-flight response]]) and the [[parasympathetic nervous system]] controls physical processes that are automatic (e.g., saliva production). The sympathetic nervous system innervates (e.g., is physically connected to and regulates) many parts of the body involved in stress responses. Studies of adolescents have shown that adolescents who self-injure have greater physiological reactivity (e.g., skin conductance) to stress than adolescents who do not self-injure.<ref>{{cite journal |vauthors=Crowell SE, Beauchaine TP, McCauley E, Smith CJ, Stevens AL, Sylvers P |title=Psychological, autonomic, and serotonergic correlates of parasuicide among adolescent girls |journal=Development and Psychopathology |volume=17 |issue=4 |pages=1105–1127 |year=2005 |s2cid=12056367 |doi=10.1017/s0954579405050522 |doi-broken-date=1 November 2024 |pmid=16613433}}</ref><ref>{{cite journal |vauthors=Nock MK, Mendes WB |title=Physiological arousal, distress tolerance, and social problem-solving deficits among adolescent self-injurers |journal=Journal of Consulting and Clinical Psychology |volume=76 |issue=1 |pages=28–38 |date=February 2008 |citeseerx=10.1.1.506.4280 |doi=10.1037/0022-006x.76.1.28 |pmid=18229980}}</ref>

==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>

==Epidemiology==
[[File:Self-harm world map-Deaths per million persons-WHO2012.svg|thumb|upright=1.3|Deaths from self-harm per million people in 2012 {{Div col|small=yes|colwidth=10em}}
{{legend|#b3b3b3|no data}}
{{legend|#ffff20|3–23}}
{{legend|#ffe820|24–32}}
{{legend|#ffd820|33–49}}
{{legend|#ffc020|50–61}}
{{legend|#ffa020|62–76}}
{{legend|#ff9a20|77–95}}
{{legend|#f08015|96–121}}
{{legend|#e06815|122–146}}
{{legend|#d85010|147–193}}
{{legend|#d02010|194–395}}
{{Div col end}}]]
[[File:Self-inflicted injuries world map - DALY - WHO2004.svg|thumb|upright=1.3|World-map showing the [[disability-adjusted life year]], which is a measure of each country's disease burden, for self-inflicted injuries per 100,000&nbsp;inhabitants in 2004{{Div col|small=yes|colwidth=10em}}
{{legend|#b3b3b3|no data}}
{{legend|#ffff65|less than 80}}
{{legend|#fff200|80–160}}
{{legend|#ffdc00|160–240}}
{{legend|#ffc600|240–320}}
{{legend|#ffb000|320–400}}
{{legend|#ff9a00|400–480}}
{{legend|#ff8400|480–560}}
{{legend|#ff6e00|560–640}}
{{legend|#ff5800|640–720}}
{{legend|#ff4200|720–800}}
{{legend|#ff2c00|800–850}}
{{legend|#cb0000|more than 850}}
{{Div col end}}]]
It is difficult to gain an accurate picture of incidence and prevalence of self-harm.<ref>{{harvnb|Bowen|John|2001|pp=360–361}}. {{harvnb|Claassen|Trivedi|Shimizu|Stewart|2006|p=193}}: "[N]ational rates of self-harm have not been well established in most countries, including the United States."</ref> Even with sufficient monitoring resources, self-harm is usually unreported, with instances taking place in private and wounds being treated by the self-harming individual.{{sfn|Bowen|John|2001|pp=360-361}} Recorded figures can be based on three sources: psychiatric samples, hospital admissions and general population surveys.<ref name="Rodham05">{{cite journal |vauthors=Rodham K, Hawton K, Evans E |title=Deliberate Self-Harm in Adolescents: the Importance of Gender |journal=Psychiatric Times |volume=22 |issue=1 |year=2005}}</ref> A 2015 meta-analysis of reported self-harm among 600,000 adolescents found a lifetime prevalence of 11.4% for suicidal or non-suicidal self-harm (i.e. excluding self-poisoning) and 22.9% for non-suicidal self-injury (i.e. excluding suicidal acts), for an overall prevalence of 16.9%.{{sfn|Gillies|Christou|Dixon|Featherston|2018|p=4}} The difference in SH and NSSI rates, compared to figures of 16.1% and 18.0% found in a 2012 review, may be attributable to differences in methodology among the studies analyzed.<ref>{{harvnb|Gillies|Christou|Dixon|Featherston|2018|p=6}}, citing {{harvnb|Muehlenkamp|Claes|Havertape|Plener|2012}}.</ref>

The World Health Organization estimates that, as of 2010, 880,000 deaths occur as a result of self-harm (including suicides).<ref name=Loz2012>{{cite journal |vauthors=Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, De Leo D, Degenhardt L, Delossantos A, Denenberg J, Des Jarlais DC, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD, Forouzanfar MH, Fowkes FG, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D, Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N, Keren A, Khoo JP, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MacIntyre MF, Mallinger L, March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGrath J, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KM, Nasseri K, Norman P, O'Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De León FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T, Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD, Wulf S, Yeh PH, Yip P, Zabetian A, Zheng ZJ, Lopez AD, Murray CJ, AlMazroa MA, Memish ZA |display-authors=6 |title=Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 |journal=Lancet |volume=380 |issue=9859 |pages=2095–2128 |date=December 2012 |pmc=10790329 |hdl-access=free |s2cid=1541253 |hdl=10536/DRO/DU:30050819 |doi=10.1016/S0140-6736(12)61728-0 |pmid=23245604 |url=http://www.cobiss.si/scripts/cobiss?command=DISPLAY&base=cobib&rid=1537267652&fmt=11 }}{{Dead link|date=August 2024 |bot=InternetArchiveBot |fix-attempted=yes }}</ref> About 10% of admissions to medical wards in the UK are as a result of self-harm, the majority of which are [[drug overdose]]s.<ref name=BBC>{{cite web |title=Self-harm |publisher=British Broadcasting Corporation |date=2004-12-06 |url=http://news.bbc.co.uk/1/hi/health/medical_notes/4067129.stm |access-date=2010-01-04 |url-status=dead |archive-url=https://web.archive.org/web/20090319065604/http://news.bbc.co.uk/1/hi/health/medical_notes/4067129.stm |archive-date=2009-03-19}}</ref> However, studies based only on hospital admissions may hide the larger group of self-harmers who do not need or seek hospital treatment for their injuries,<ref name="fox_hawton"/> instead treating themselves. Many adolescents who present to general hospitals with deliberate self-harm report previous episodes for which they did not receive medical attention.<ref name="Rodham05"/> In the United States up to 4% of adults self-harm with approximately 1% of the population engaging in chronic or severe self-harm.<ref name=kerr2010>{{cite journal |vauthors=Kerr PL, Muehlenkamp JJ, Turner JM |title=Nonsuicidal self-injury: a review of current research for family medicine and primary care physicians |journal=Journal of the American Board of Family Medicine |volume=23 |issue=2 |pages=240–259 |year=2010 |doi=10.3122/jabfm.2010.02.090110 |doi-access=free |pmid=20207935}}</ref>

The onset of self-harm tends to occur around [[puberty]], although scholarship is divided as to whether this is usually before puberty or later in adolescence. Meta-analyses have not supported some studies' conclusion that self-harm rates are increasing among adolescents. It is generally thought that self-harm rates increase over the course of adolescence, although this has not been studied thoroughly.{{sfn|Gillies|Christou|Dixon|Featherston|2018|pp=1-2}} The earliest reported incidents of self-harm are in children between 5 and 7 years old.<ref name="MHF"/> In addition there appears to be an increased risk of self-harm in college students than among the general population.{{sfn|Greydanus|Shek|2009}}{{Page needed|date=August 2023}}<ref name=kerr2010/> In a study of undergraduate students in the US, 9.8% of the students surveyed indicated that they had purposefully cut or burned themselves on at least one occasion in the past. When the definition of self-harm was expanded to include head-banging, scratching oneself, and hitting oneself along with cutting and burning, 32% of the sample said they had done this.<ref>{{cite journal |vauthors=Vanderhoff H, Lynn SJ |title=The assessment of self-mutilation: Issues and clinical considerations |journal=Journal of Threat Assessment |volume=1 |pages=91–109 |year=2001 |doi=10.1300/J177v01n01_07}}</ref> In Ireland, a study found that instances of hospital-treated self-harm were much higher in city and urban districts, than in rural settings.<ref name="pmid20716390">{{cite journal |vauthors=Corcoran P, Reulbach U, Perry IJ, Arensman E |title=Suicide and deliberate self harm in older Irish adults |journal=International Psychogeriatrics |volume=22 |issue=8 |pages=1327–1336 |date=December 2010 |hdl=10468/2916 |s2cid=21390675 |hdl-access=free |doi=10.1017/S1041610210001377 |pmid=20716390}}</ref> The CASE (Child & Adolescent Self-harm in Europe) study suggests that the life-time risk of self-injury is ~1:7 for women and ~1:25 for men.<ref>{{cite journal |vauthors=Madge N, Hewitt A, Hawton K, de Wilde EJ, Corcoran P, Fekete S, van Heeringen K, De Leo D, Ystgaard M |display-authors=6 |title=Deliberate self-harm within an international community sample of young people: comparative findings from the Child & Adolescent Self-harm in Europe (CASE) Study |journal=Journal of Child Psychology and Psychiatry, and Allied Disciplines |volume=49 |issue=6 |pages=667–677 |date=June 2008 |doi=10.1111/j.1469-7610.2008.01879.x |pmid=18341543}}</ref>

===Gender differences===

Aggregated research has found no difference in the prevalence of self-harm between men and women.<ref name=kerr2010/> This contrasts with previous studies, which suggested that up to four times as many females as males have direct experience of self-harm,<ref name="fox_hawton"/> which many had argued was rather the result of data collection biases.{{sfn|Bowen|John|2001|p=361}}

The [[WHO]]/EURO Multicentre Study of Suicide, established in 1989, demonstrated that, for each age group, the female rate of self-harm exceeded that of the males, with the highest rate among females in the 13–24 age group and the highest rate among males in the 12–34 age group. However, this discrepancy has been known to vary significantly depending upon population and methodological criteria, consistent with wide-ranging uncertainties in gathering and interpreting data regarding rates of self-harm in general.<ref>{{cite web |vauthors=O'Brien A |title=Women and Parasuicide: a Literature Review |publisher=Women's Health Council |url=http://www.whc.ie/publications/reports_parasuicide.html |access-date=2008-05-26 |url-status=dead |archive-url=https://web.archive.org/web/20080428132657/http://www.whc.ie/publications/reports_parasuicide.html |archive-date=April 28, 2008}}</ref> Such problems have sometimes been the focus of criticism in the context of broader psychosocial interpretation. For example, feminist author Barbara Brickman has speculated that reported gender differences in rates of self-harm are due to deliberate socially biased methodological and sampling errors, directly blaming medical discourse for pathologising the female.<ref>{{cite journal |vauthors=Brickman BJ |year=2004 |title='Delicate' Cutters: Gendered Self-mutilation and Attractive Flesh in Medical Discourse |journal=Body and Society |volume=10 |issue=4 |pages=87–111 |s2cid=145191075 |doi=10.1177/1357034X04047857}}</ref>

This gender discrepancy is often distorted in specific populations where rates of self-harm are inordinately high, which may have implications on the significance and interpretation of psychosocial factors other than gender. A study in 2003 found an extremely high prevalence of self-harm among 428 homeless and runaway youths (aged 16–19) with 72% of males and 66% of females reporting a history of self-harm.<ref>{{cite journal |vauthors=Tyler KA, Whitbeck LB, Hoyt DR, Johnson KD |year=2003 |title=Self Mutilation and Homeless Youth: The Role of Family Abuse, Street Experiences, and Mental Disorders |journal=Journal of Research on Adolescence |volume=13 |issue=4 |pages=457–474 |doi=10.1046/j.1532-7795.2003.01304003.x |url=https://digitalcommons.unl.edu/sociologyfacpub/37}}</ref> However, in 2008, a study of young people and self-harm saw the gender gap widen in the opposite direction, with 32% of young females, and 22% of young males admitting to self-harm.<ref name=affinity08>{{citation |publisher=Affinity Healthcare |year=2008 |title=New survey reveals almost one in three young females have tried to self-harm |url=http://www.affinityhealth.co.uk/pdf/SHS.pdf |access-date=2009-12-13 |url-status=dead |archive-url=https://web.archive.org/web/20081201220154/http://www.affinityhealth.co.uk/pdf/SHS.pdf |archive-date=2008-12-01}}</ref> Studies also indicate that males who self-harm may also be at [[Gender differences in suicide|a greater risk of completing suicide]].<ref name=Hawton_BMJ_03/>

There does not appear to be a difference in motivation for self-harm in adolescent males and females. Triggering factors such as low self-esteem and having friends and family members who self-harm are also common between both males and females.<ref name="Rodham05"/> One limited study found that, among those young individuals who do self-harm, both genders are just as equally likely to use the method of skin-cutting.<ref>{{cite journal |vauthors=Marchetto MJ |title=Repetitive skin-cutting: Parental bonding, personality and gender |journal=Psychology and Psychotherapy: Theory, Research and Practice |volume=79 |issue=3 |date=September 2006 |pages=445–459(15) |doi=10.1348/147608305X69795 |doi-access=free |pmid=16945201}}</ref> However, females who self-cut are more likely than males to explain their self-harm episode by saying that they had wanted to punish themselves. In New Zealand, more females are hospitalized for intentional self-harm than males. Females more commonly choose methods such as self-poisoning that generally are not fatal, but still serious enough to require hospitalization.<ref>{{Citation|url=http://www.nzhis.govt.nz/moh.nsf/pagesns/323?Open |title=Hospitalisation for intentional self-harm |publisher=New Zealand Health Information Service |access-date=2008-05-03 |url-status=dead |archive-url=https://web.archive.org/web/20081015044544/http://www.nzhis.govt.nz/moh.nsf/pagesns/323?Open |archive-date=October 15, 2008}}</ref>

===Elderly===

In a study of a district general hospital in the UK, 5.4% of all the hospital's self-harm cases were aged over 65. The male to female ratio was 2:3, although the self-harm rates for males and females over 65 in the local population were identical. Over 90% had depressive conditions, and 63% had significant physical illness. Under 10% of the patients gave a prior history of earlier self-harm, while both the repetition and suicide rates were very low, which could be explained by the absence of factors known to be associated with repetition, such as personality disorder and alcohol abuse.<ref name=Pierce87/> However, NICE Guidance on Self-harm in the UK suggests that older people who self-harm are at a greater risk of completing suicide, with 1 in 5 older people who self-harm going on to end their life.<ref name=NICE04/> A study completed in Ireland showed that older Irish adults have high rates of deliberate self-harm, but comparatively low rates of suicide.<ref name="pmid20716390"/>

===Developing world===

Only recently have attempts to improve health in the developing world concentrated on not only physical illness but also mental health.<ref name="Eddleston98">{{cite journal |vauthors=Eddleston M, Sheriff MH, Hawton K |title=Deliberate self harm in Sri Lanka: an overlooked tragedy in the developing world |journal=BMJ |volume=317 |issue=7151 |pages=133–135 |date=July 1998 |pmc=1113497 |doi=10.1136/bmj.317.7151.133 |pmid=9657795}}</ref> Deliberate self-harm is common in the developing world. Research into self-harm in these areas is however, still very limited. Though an important case study is that of Sri Lanka, which is a country exhibiting a high incidence of suicide<ref>Ministry of Health. Annual health bulletin, Sri Lanka, 1995. Colombo, Sri Lanka: Ministry of Health (1997)</ref> and self-poisoning with agricultural [[pesticide]]s or natural poisons.<ref name="Eddleston98"/> Many people admitted for deliberate self-poisoning during a study by Eddleston ''et al.''<ref name="Eddleston98"/> were young and few expressed a desire to die, but death was relatively common in the young in these cases. The improvement of medical management of acute poisoning in the developing world is poor and improvements are required in order to reduce mortality.

Some of the causes of deliberate self-poisoning in Sri Lankan adolescents included [[grief|bereavement]] and harsh discipline by parents. The coping mechanisms are being spread in local communities as people are surrounded by others who have previously deliberately harmed themselves or attempted suicide.<ref name="Eddleston98"/> One way to reduce self-harm would be to limit access to poisons; however many cases involve pesticides or yellow [[Nerium oleander|oleander]] seeds, and the reduction of access to these agents would be difficult. Great potential for the reduction of self-harm lies in education and prevention, but limited resources in the developing world ultimately make these methods challenging.<ref name="Eddleston98"/>

===Prison inmates===

Deliberate self-harm is especially prevalent in prison populations. A proposed explanation for this is that prisons [[prison violence|are often violent places]], and prisoners who wish to avoid physical confrontations may resort to self-harm as a ruse, either to convince other prisoners that they are dangerously insane and resilient to pain or to obtain protection from the prison authorities.<ref>Diego Gambetta. ''Codes of the Underworld''. Princeton. {{ISBN|978-0-691-11937-3}}</ref> Prisoners are sometimes placed in cells with no furniture or objects to prevent them from harming themselves.<ref>{{Cite web |date=2022-04-14 |title=Walling up madness |url=https://www.prison-insider.com/en/articles/l-enfermement-a-la-folie |access-date=2024-05-14 |website=Prison Insider |language=en}}</ref> Self-harm also occurs frequently in inmates who are placed in [[solitary confinement]].<ref name=kaba2014>{{cite journal |vauthors=Kaba F, Lewis A, Glowa-Kollisch S, Hadler J, Lee D, Alper H, Selling D, MacDonald R, Solimo A, Parsons A, Venters H |display-authors=6 |title=Solitary confinement and risk of self-harm among jail inmates |journal=American Journal of Public Health |volume=104 |issue=3 |pages=442–447 |date=March 2014 |pmc=3953781 |doi=10.2105/ajph.2013.301742 |pmid=24521238}}</ref>

==Awareness==

There are many movements among the general self-harm community to make self-harm itself and treatment better known to mental health professionals, as well as the general public. For example, March 1 is designated as [[Self-injury Awareness Day]] (SIAD) around the world.<ref>{{citation |publisher=LifeSIGNS |title=Self injury awareness day |url=http://www.lifesigns.org.uk/siad/ |access-date=2012-05-10}}</ref> On this day, some people choose to be more open about their own self-harm, and awareness organizations make special efforts to [[raising awareness|raise awareness]] about self-harm.<ref name="lifesigns">{{citation |publisher=LifeSIGNS |title=LifeSIGNS web pages |url=http://www.lifesigns.org.uk |access-date=2012-05-10}}</ref>

==Other animals==
Self-harm in non-human mammals is a well-established but not widely known phenomenon. Its study under zoo or laboratory conditions could lead to a better understanding of self-harm in human patients.<ref name=Jones07/>

Zoo or laboratory rearing and isolation are important factors leading to increased susceptibility to self-harm in higher mammals, e.g., macaque monkeys.<ref name=Jones07/> Non-primate mammals are also known to mutilate themselves under laboratory conditions after administration of drugs.<ref name=Jones07/> For example, [[pemoline]], [[clonidine]], [[amphetamine]], and very high (toxic) doses of [[caffeine]] or [[theophylline]] are known to precipitate self-harm in lab animals.<ref>{{cite journal |vauthors=Mueller K, Nyhan WL |title=Clonidine potentiates drug induced self-injurious behavior in rats |journal=Pharmacology, Biochemistry, and Behavior |volume=18 |issue=6 |pages=891–894 |date=June 1983 |s2cid=43743590 |doi=10.1016/S0091-3057(83)80011-2 |pmid=6684300}}</ref><ref>{{cite journal |vauthors=Kies SD, Devine DP |title=Self-injurious behaviour: a comparison of caffeine and pemoline models in rats |journal=Pharmacology, Biochemistry, and Behavior |volume=79 |issue=4 |pages=587–598 |date=December 2004 |s2cid=11695905 |doi=10.1016/j.pbb.2004.09.010 |pmid=15582667}}</ref>

In dogs, canine obsessive-compulsive disorder can lead to self-inflicted injuries, for example canine [[lick granuloma]]. Captive birds are sometimes known to engage in [[feather-plucking]], causing damage to feathers that can range from feather shredding to the removal of most or all feathers within the bird's reach, or even the mutilation of skin or muscle tissue.{{sfn|Gill|2001|pp=474-475,482}}

Breeders of [[fancy mouse|show mice]] have noticed similar behaviors. One known as "barbering" involves a mouse obsessively grooming the whiskers and facial fur off themselves and cage-mates.<ref>{{cite journal |vauthors=Kalueff AV, Minasyan A, Keisala T, Shah ZH, Tuohimaa P |title=Hair barbering in mice: implications for neurobehavioural research |journal=Behavioural Processes |volume=71 |issue=1 |pages=8–15 |date=January 2006 |s2cid=9132709 |doi=10.1016/j.beproc.2005.09.004 |pmid=16236465}}</ref>

<gallery widths=180>
File:Moluccan Cockatoo (Cacatua moluccensis) -feather plucking.jpg|[[Feather-plucking]] in a [[Moluccan cockatoo]]
File:Canine lick granuloma.jpg|[[Lick granuloma]] from excessive licking
</gallery>

==See also==
* [[Self-destructive behavior]]
* [[Self-hatred]]
* [[Self-Injurious Behavior Inhibiting System]]

==References==

===Citations===
{{Reflist}}

===Sources===
{{Div col}}

====Medical books, chapters, and overview articles====
{{refbegin}}
* <!--K-->{{cite journal |last=Klonsky |first=E. David |title=Non-suicidal self-injury: an introduction |journal=Journal of Clinical Psychology |volume=63 |issue=11 |pages=1039–1043 |date=November 2007b |doi=10.1002/jclp.20411 |pmid=17932979}}
* <!--L-->{{cite book |last1=Lengel |first1=Gregory J. |last2=Styer |first2=Denise |editor1-last=Washburn |editor1-first=Jason J. |title=Nonsuicidal Self-injury: Advances in Research and Practice |date=2019 |publisher=Routledge |location=New York, London |isbn=978-1-315-16418-2 |chapter=Comprehensive Assessment of Nonsuicidal Self-Injury |s2cid=188571167 |doi=10.4324/9781315164182-8}}
* <!--N-->{{cite book |ref={{harvid |NCCMH |2012}} |last1=National Collaborating Centre for Mental Health |title=Self-harm: Longer-term Management |series=National Institute for Health and Care Excellence: Guidelines |date=2012 |pmid=23534084 |type=Clinical guidelines}}
{{Refend}}

====Medical reviews and meta-analyses====
{{refbegin}}
* <!--A-->{{cite journal |last1=Angelotta |first1=Cara |journal=The Journal of Nervous and Mental Disease |title=Defining and Refining Self-Harm: A Historical Perspective on Nonsuicidal Self-Injury |volume=203 |pages=75–80 |year=2015 |issue=2 |s2cid=8869537 |doi=10.1097/NMD.0000000000000243 |pmid=25594789}}
* <!--B-->{{cite journal |last1=Bowen |first1=Arabella C. L. |last2=John |first2=Alexandra M. H. |title=Gender differences in presentation and conceptualization of adolescent self-injurious behavior: implications for therapeutic practice |journal=Counselling Psychology Quarterly |volume=14 |year=2001 |pages=357–379 |issue=4 |s2cid=145405708 |doi=10.1080/09515070110100956}}
* <!--C-->{{cite journal |last1=Chapman |first1=Alexander L. |last2=Gratz |first2=Kim L. |last3=Brown |first3=Milton Z. |title=Solving the puzzle of deliberate self-harm: The experiential avoidance model |journal=Behaviour Research and Therapy |date=March 2006 |volume=44 |issue=3 |pages=371–394 |s2cid=1918485 |doi=10.1016/j.brat.2005.03.005 |pmid=16446150}}
* {{cite journal |last1=Chaney |first1=S |year=2012 |title=Anaesthetic bodies and the absence of feeling: Pain and self-mutilation in later nineteenth-century psychiatry |journal=Interdisciplinary Studies in the Long Nineteenth Century |issue=15 |doi=10.16995/ntn.646 |doi-access=free}}
* {{cite journal |last1=Claassen |first1=Cynthia A. |last2=Trivedi |first2=Madhukar H. |last3=Shimizu |first3=Iris |last4=Stewart |first4=Sunita |last5=Larkin |first5=Gregory Luke |last6=Litovitz |first6=Toby |title=Epidemiology of Nonfatal Deliberate Self-Harm in the United States as Described in Three Medical Databases |journal=Suicide and Life-Threatening Behavior |date=April 2006 |volume=36 |issue=2 |pages=192–212 |doi=10.1521/suli.2006.36.2.192 |pmid=16704324}}
* <!--D-->{{cite journal |last1=David |first1=Joshua A. |last2=Rifkin |first2=William J. |last3=Chiu |first3=Ernest S. |title=Current Management of Self-Inflicted Wounds in Surgery: A Critical Review |journal=Annals of Plastic Surgery |date=December 2018 |volume=81 |issue=6S |pages=S79–S88 |s2cid=53281359 |doi=10.1097/SAP.0000000000001706 |pmid=30383582}}
* <!--G-->{{cite journal |last1=Gillies |first1=Donna |last2=Christou |first2=Maria A. |last3=Dixon |first3=Andrew C. |last4=Featherston |first4=Oliver J. |last5=Rapti |first5=Iro |last6=Garcia-Anguita |first6=Alicia |last7=Villasis-Keever |first7=Miguel |last8=Reebye |first8=Pratibha |last9=Christou |first9=Evangelos |last10=Al Kabir |first10=Nagat |last11=Christou |first11=Panagiota A. |title=Prevalence and Characteristics of Self-Harm in Adolescents: Meta-Analyses of Community-Based Studies 1990–2015 |journal=Journal of the American Academy of Child & Adolescent Psychiatry |date=October 2018 |volume=57 |issue=10 |pages=733–741 |s2cid=52902235 |doi=10.1016/j.jaac.2018.06.018 |pmid=30274648}}
* {{cite journal |last1=Greydanus |first1=Donald E. |last2=Shek |first2=Daniel |title=Deliberate Self-harm and Suicide in Adolescents |journal=The Keio Journal of Medicine |date=September 2009 |volume=58 |issue=3 |pages=144–151 |hdl=10397/4495 |hdl-access=free |doi=10.2302/kjm.58.144 |doi-access=free |pmid=19826208}}
* <!--H-->{{cite journal |last1=Haw |first1=Camilla |last2=Hawton |first2=Keith |last3=Sutton |first3=Lesley |last4=Sinclair |first4=Julia |last5=Deeks |first5=Jonathan |title=Schizophrenia and Deliberate Self-Harm: A Systematic Review of Risk Factors |journal=Suicide and Life-Threatening Behavior |date=February 2005 |volume=35 |issue=1 |pages=50–62 |doi=10.1521/suli.35.1.50.59260 |pmid=15843323}}
* {{cite journal |last1=Hawton |first1=Keith |last2=Saunders |first2=Kate E. A. |last3=O'Connor |first3=Rory C. |title=Self-harm and suicide in adolescents |journal=Lancet |volume=379 |issue=9834 |pages=2373–2382 |date=June 2012 |s2cid=151486181 |doi=10.1016/S0140-6736(12)60322-5 |pmid=22726518 |url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60322-5/fulltext |url-access=registration}}{{cbignore}}
* <!--J-->{{cite journal |last1=Jacobson |first1=Colleen M. |last2=Gould |first2=Madelyn |title=The Epidemiology and Phenomenology of Non-Suicidal Self-Injurious Behavior Among Adolescents: A Critical Review of the Literature |journal=Archives of Suicide Research |date=21 March 2007 |volume=11 |issue=2 |pages=129–147 |s2cid=25482728 |doi=10.1080/13811110701247602 |pmid=17453692}}
* <!--K-->{{cite journal |last1=Kirtley |first1=Olivia J. |last2=O'Carroll |first2=Ronan E. |last3=O'Connor |first3=Rory C. |title=Pain and self-harm: A systematic review |journal=Journal of Affective Disorders |date=October 2016 |volume=203 |pages=347–363 |hdl=1893/23261 |hdl-access=free |doi=10.1016/j.jad.2016.05.068 |pmid=27323296}}
* {{cite journal |last1=Knipe |first1=Duleeka |last2=John |first2=Ann |last3=Padmanathan |first3=Prianka |last4=Eyles |first4=Emily |last5=Dekel |first5=Dana |last6=Higgins |first6=Julian P. T. |last7=Bantjes |first7=Jason |last8=Dandona |first8=Rakhi |last9=Macleod-Hall |first9=Catherine |last10=McGuinness |first10=Luke A. |last11=Schmidt |first11=Lena |last12=Webb |first12=Roger T. |last13=Gunnell |first13=David |title=Suicide and self-harm in low- and middle- income countries during the COVID-19 pandemic: A systematic review |journal=PLOS Global Public Health |date=1 June 2022 |volume=2 |issue=6 |pages=e0000282 |pmc=10021274 |doi=10.1371/journal.pgph.0000282 |doi-access=free |pmid=36962383}}
* <!--L-->{{cite journal |last1=Lofthouse |first1=Nicholas |last2=Yager-Schweller |first2=Jennifer |title=Nonsuicidal self-injury and suicide risk among adolescents |journal=Current Opinion in Pediatrics |date=October 2009 |volume=21 |issue=5 |pages=641–645 |s2cid=42707908 |doi=10.1097/MOP.0b013e3283306825 |pmid=19623077}}
* <!--M-->{{cite journal |last1=McAllister |first1=Margaret |title=Multiple meanings of self harm: A critical review |journal=[[International Journal of Mental Health Nursing]] |date=September 2003 |volume=12 |issue=3 |pages=177–185 |via=[[Academia.edu]] |doi=10.1046/j.1440-0979.2003.00287.x |pmid=17393644 |url=https://www.academia.edu/11982074 |access-date=2 January 2023}}
* {{cite journal |last1=Muehlenkamp |first1=Jennifer J |last2=Claes |first2=Laurence |last3=Havertape |first3=Lindsey |last4=Plener |first4=Paul L |title=International prevalence of adolescent non-suicidal self-injury and deliberate self-harm |journal=Child and Adolescent Psychiatry and Mental Health |date=December 2012 |volume=6 |issue=1 |page=10 |pmc=3348041 |doi=10.1186/1753-2000-6-10 |doi-access=free |pmid=22462815}}
* <!--P-->{{cite journal |last1=Patton |first1=George C. |last2=Hemphill |first2=Sheryl A. |last3=Beyers |first3=Jennifer M. |last4=Bond |first4=Lyndal |last5=Toumbourou |first5=John W. |last6=McMorris |first6=Barbara J. |last7=Catalano |first7=Richard F. |title=Pubertal Stage and Deliberate Self-Harm in Adolescents |journal=Journal of the American Academy of Child & Adolescent Psychiatry |date=April 2007 |volume=46 |issue=4 |pages=508–514 |doi=10.1097/chi.0b013e31803065c7 |pmid=17420686}}
* {{cite journal |last1=Plener |first1=Paul L |last2=Schumacher |first2=Teresa S |last3=Munz |first3=Lara M |last4=Groschwitz |first4=Rebecca C |title=The longitudinal course of non-suicidal self-injury and deliberate self-harm: a systematic review of the literature |journal=Borderline Personality Disorder and Emotion Dysregulation |date=2015 |volume=2 |issue=2 |page=2 |pmc=4579518 |doi=10.1186/s40479-014-0024-3 |doi-access=free |pmid=26401305}}
* <!--T-->{{cite journal |last1=Townsend |first1=Ellen |title=Self-harm in young people |journal=Evidence Based Mental Health |date=November 2014 |volume=17 |issue=4 |pages=97–99 |doi=10.1136/eb-2014-101840 |doi-access=free |pmid=25114299}}
* {{cite journal |last1=Troya |first1=M. Isabela |last2=Babatunde |first2=Opeyemi |last3=Polidano |first3=Kay |last4=Bartlam |first4=Bernadette |last5=McCloskey |first5=Erin |last6=Dikomitis |first6=Lisa |last7=Chew-Graham |first7=Carolyn A. |title=Self-harm in older adults: systematic review |journal=British Journal of Psychiatry |date=April 2019 |volume=214 |issue=4 |pages=186–200 |doi=10.1192/bjp.2019.11 |doi-access=free |pmid=30789112}}
* <!--W-->{{cite journal |last1=Witt |first1=Katrina G |last2=Hetrick |first2=Sarah E |last3=Rajaram |first3=Gowri |last4=Hazell |first4=Philip |last5=Taylor Salisbury |first5=Tatiana L |last6=Townsend |first6=Ellen |last7=Hawton |first7=Keith |title=Pharmacological interventions for self-harm in adults |journal=Cochrane Database of Systematic Reviews |date=10 January 2021a |volume=2021 |issue=3 |pages=CD013669 |pmc=8094615 |doi=10.1002/14651858.CD013669.pub2 |doi-access=free |pmid=35608866}}
{{Refend}}

====Other medical and scientific sources====
{{Refbegin}}
* <!--B-->{{cite journal |last1=Butler |first1=Aine M. |last2=Malone |first2=Kevin |title=Attempted suicide v. non-suicidal self-injury: behaviour, syndrome or diagnosis? |journal=British Journal of Psychiatry |date=May 2013 |volume=202 |issue=5 |pages=324–325 |type=Editorial |doi=10.1192/bjp.bp.112.113506 |doi-access=free |pmid=23637106}}
** ''Response'': {{cite journal |ref=none |last1=Kapur |first1=Navneet |last2=Cooper |first2=Jayne |last3=O'Connor |first3=Rory C. |last4=Hawton |first4=Keith |title=Non-suicidal self-injury v. attempted suicide: new diagnosis or false dichotomy? |journal=British Journal of Psychiatry |date=May 2013 |volume=202 |issue=5 |pages=326–328 |type=Editorial |doi=10.1192/bjp.bp.112.116111 |doi-access=free |pmid=23637107}}
* <!--C-->{{cite journal |last1=Connors |first1=Robin |title=Self-injury in trauma survivors: 1. Functions and meanings. |journal=American Journal of Orthopsychiatry |date=1996 |volume=66 |issue=2 |pages=197–206 |doi=10.1037/h0080171 |pmid=9173798}}
* <!--D-->{{cite journal |last1=Doyle |first1=L. |last2=Sheridan |first2=A. |last3=Treacy |first3=M. P. |title=Motivations for adolescent self-harm and the implications for mental health nurses |journal=Journal of Psychiatric and Mental Health Nursing |publisher=Wiley |volume=24 |issue=2–3 |date=2017-01-25 |issn=1351-0126 |pages=134–142 |hdl=2262/92183 |s2cid=20406171 |hdl-access=free |doi=10.1111/jpm.12360 |pmid=28124465}}
* <!--G-->{{cite journal |last1=Gill |first1=James H. |title=Avian Skin Diseases |journal=Veterinary Clinics of North America: Exotic Animal Practice |date=May 2001 |volume=4 |issue=2 |pages=463–492 |doi=10.1016/S1094-9194(17)30040-3 |pmid=11480362}}
* {{cite book |last1=Gould |first1=GM |last2=Pyle |first2=WL |year=1896 |title=Anomalies and curiosities of medicine |location=New York |publisher=Bell Publishing Co.}}
* <!--H-->{{cite journal |last1=Haris |first1=Aishah Madinah |last2=Pitman |first2=Alexandra |last3=Mughal |first3=Faraz |last4=Bakanaite |first4=Evelina |last5=Morant |first5=Nicola |last6=Rowe |first6=Sarah L |title=Harm minimisation for self-harm: a cross-sectional survey of British clinicians' perspectives and practices |journal=BMJ Open |date=June 2022 |volume=12 |issue=6 |pages=e056199 |pmc=9171231 |doi=10.1136/bmjopen-2021-056199 |pmid=35980724}}
* <!--M-->{{cite journal |last1=Moran |first1=Paul |last2=Coffey |first2=Carolyn |last3=Romaniuk |first3=Helena |last4=Olsson |first4=Craig |last5=Borschmann |first5=Rohan |last6=Carlin |first6=John B |last7=Patton |first7=George C |title=The natural history of self-harm from adolescence to young adulthood: a population-based cohort study |journal=The Lancet |publisher=Elsevier BV |volume=379 |issue=9812 |year=2012 |issn=0140-6736 |pages=236–243 |s2cid=14680279 |doi=10.1016/s0140-6736(11)61141-0 |doi-access=free |pmid=22100201}}
* <!--P-->{{cite journal |last1=Patton |first1=George C. |last2=Viner |first2=Russell |title=Pubertal transitions in health |journal=The Lancet |date=March 2007 |volume=369 |issue=9567 |pages=1130–1139 |s2cid=12367153 |doi=10.1016/S0140-6736(07)60366-3 |pmid=17398312 |url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)60366-3/fulltext |url-access=registration}}{{cbignore}}
* <!--R-->{{cite journal |last1=Rasmussen |first1=Susan |last2=Hawton |first2=Keith |last3=Philpott-Morgan |first3=Sion |last4=O'Connor |first4=Rory C. |title=Why Do Adolescents Self-Harm? |journal=Crisis |publisher=Hogrefe Publishing Group |volume=37 |issue=3 |year=2016 |issn=0227-5910 |pages=176–183 |doi=10.1027/0227-5910/a000369 |pmid=26831210 |url=https://eprints.gla.ac.uk/128747/1/128747.pdf}}
* {{cite journal |last1=Roberts |first1=Elystan |last2=Joinson |first2=Carol |last3=Gunnell |first3=David |last4=Fraser |first4=Abigail |last5=Mars |first5=Becky |title=Pubertal timing and self-harm: a prospective cohort analysis of males and females |journal=Epidemiology and Psychiatric Sciences |date=2020 |volume=29 |pages=e170 |pmc=7576520 |doi=10.1017/S2045796020000839 |doi-access=free |pmid=33021194}}
* <!--Z-->{{cite journal |last1=Zahl |first1=Daniel Louis |last2=Hawton |first2=Keith |title=Repetition of deliberate self-harm and subsequent suicide risk: Long-term follow-up study of 11 583 patients |journal=British Journal of Psychiatry |publisher=Royal College of Psychiatrists |volume=185 |issue=1 |year=2004 |issn=0007-1250 |pages=70–75 |s2cid=16329045 |doi=10.1192/bjp.185.1.70 |doi-access=free |pmid=15231558}}
{{Refend}}
{{Div col end}}

==External links==
<!-- Please do not add links to self-help or support group sites to this list. Please discuss on the article talk page if you are considering adding new links to this list. -->
{{Commons category}}
* [https://www.rcpsych.ac.uk/mental-health/problems-disorders/self-harm Information about self-harm] from the [[Royal College of Psychiatrists]]

{{Medical resources
| DiseasesDB = 30605
| ICD10 = {{ICD10|X60-X84}}
| ICD9 =
| ICDO =
| OMIM =
| MedlinePlus =
| eMedicineSubj =
| eMedicineTopic =
| MeshID = D016728
| diseasesDB_mult = {{DiseasesDB2|29126}}
}}
{{Borderline personality disorder}}
{{Authority control}}

[[Category:Self-harm| ]]
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