2. What is `Deliberate Self-Harm/Injury'?

Deliberate self-harm is really a broad term for several distinct types of behaviour which cause personal harm or injury and incorporate a wide spectrum of self-abusive patterns. The most prolific forms of this type of behaviour include: Deliberate Self-Harm

e.g. Suicide Parasuicide Overdosing Deliberate Self-Injury e.g. Cutting Burning Hitting Self-Destructive Behaviour e.g. Eating Distress Substance Misuse Deliberate Self-Harm: Currently the most prolific form of self-harm is by ingestion of tablets, often the individual has consumed alcohol and in many instancesto the point where intoxication is apparent. The tablets that are usually ingested are analgesics in the form of Paracetamol, although prescribed medication, most typically antidepressants and Benzodiazipines are also chosen. Historically deliberate self-harm seems to have been more common among women however; increasing numbers of men now appear to be harming themselves. Unfortunately men also tend to choose more violent and aggressive forms of self-harm which in some cases can lead to accidental death especially when ligatures or offensive weapons are used. It has been estimated that 40% of those who kill themselves have a history of self-harm/suicide attempts. People who self-harm may die as a consequence of their behaviour, whether deliberately or accidentally.

Deliberate Self-Injury: Is the deliberate and direct damaging of body tissue without conscious intent to commit suicide and is sometimes also known as 'self-mutilation'. People who deliberately injure themselves are not automatically suicidal. Self-injury is not intended to cause death; nevertheless, it is not about attention-seeking or game-playing. Like suicidal feelings self-injury may express a powerful sense of despair and should be taken seriously. There has been a trend to classify types of this behaviour.

Major self-injury: This is an extreme and fairly uncommon form and consists of sporadic acts in which a great deal of tissue is destroyed and often results in permanent disfigurement and is associated with psychotic or acute intoxicated states.

Stereotypic self-injury: This form of injury consists of fixed, often rhythmic patterns such as head banging, eyeball pressing and finger or arm biting and can be exhibited by people who are psychotic or autistic. Individuals who have been institutionalized (in secure psychiatric institutions and prisons) sometimes exhibit this extreme behaviour.

Superficial or moderate self-injury: This is described as 'common behaviour' and is a significant indicator of emotional distress. This kind of injury is not highly lethal and results in relatively little tissue damage. It occurs sporadically and repetitively and sometimes develops an 'addictive' quality and becomes an overwhelming preoccupation for some people. Cutting the skin with razor blades or broken glass is the most commonly seen method, although self-punching and scratching are among other examples. This type of self-injury in particular is primarily about helping oneself cope with great emotional pain. For some it is a desperate attempt to show that something is really wrong, and attention should be paid to their distress.

Self-Destructive Behaviour: This type of behaviour has the primary purpose of absenting oneself from pain rather than directly 'doing something to oneself'. In some ways self-destructive behaviour is a form of indirect self-injury where the link between the behaviour and the consequence is not always apparent

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