When Feeling Better Hurts

For an estimated one to three million Americans, self-harm is a serious problem. The behaviors are usually done secretly and privately. However, one in five self-injurers have accidentally made life threatening injuries.

The call comes out as an attempted suicide. Dad, screaming at the dispatcher, reports that his 22-year-old daughter has slit her wrists. The fire department is staging; it is a two officer call. On scene, the victim has numerous lacerations to both wrists with what appears to be a significant amount of blood loss. Paramedics cleanse the wounds and apply bandages, they advise you that the injuries are superficial and that the subject does not need transport to the hospital. The subject denies suicidal ideation or previous suicide attempts, explaining, "I'm a cutter, I don't want to kill myself, I do this all the time, it makes me feel better." If you are a school resource officer, the subject is 15, maybe even younger. There appears to be an epidemic of self-cutting at the high school. What exactly is deliberate self-harm? Why would someone intentionally hurt themselves? As an officer, what do you do at these calls?

By definition, deliberate self-harm refers (DSH) to the direct destruction of body tissue by an individual with resulting physical damage. Also, by definition, it is intentional injury to one's body without conscious suicidal intention. DSH is also referred to as self-mutilation, self-injury, self-abuse, self-inflicted violence and parasuicide. The behaviors are usually done secretly and privately. Self-harm may be planned and ritualistically performed, or it may occur impulsively and without forethought.

Types of Deliberate Self-Harm

There are three major classifications of self-harm.

  1. Major self-harm, such as castration and amputation of limbs, is usually associated with psychosis.
  2. Stereotypic self-harm, such as repeated head banging, is most frequently associated with mental retardation, autism or psychosis.
  3. The most common form of deliberate self-harm is referred to as moderate or superficial; it is the subject of this article. This type of self-harm includes
    • Cutting (72%)--the most targeted body parts are the upper limbs
    • Burning (35%)
    • Self-hitting (30%)
    • Interference with wound healing (22%)
    • Hair-pulling (10%)
    • Bone-breaking (8%)

Other methods of self-harm include scratching, skin-picking, deliberate overuse injuries, interference with wound healing, scraping, biting, and ingestion of sharp objects or toxic substances. While some individuals may self-harm only a few times, others have great difficulty stopping the behavior. Self-harm does not include behaviors where the primary purpose is sexual gratification (autoasphyxiation) body decoration (piercing or tattoos), religious ritualistic behaviors, or attempts to "fit in" or "be cool."

Epidemiology of Deliberate Self-Harm

For an estimated one to three million Americans, self-harm is a serious problem. Research has demonstrated that approximately one percent of the general population engages in deliberate self-harm. This statistic is likely to be grossly underestimated due to the secrecy and the stigma of the behavior. DSH tends to begin in childhood or adolescence; the typical age of onset is between ages 10 and 16. While the majority of people who harm themselves are females between the ages of 13 and 30, there are self-injurers of every age, gender, and economic group. DSH tends to peak between the ages of 18 and 24, and decreases as an individual enters his or her 30s and 40s. Princess Diana was a self-cutter; she also threw herself down a flight of stairs. The most common professions of self-injurers are teachers, nurses and managers.

Reasons People Self-Harm

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