Talk:Self-harm/Archive 3

I would like to change/ add some information to the Definition of Self Injury

I would like to take out body piercing and tattooing from the definition of self-injury because those are forms of expression.

I also would like to add that many self-injurers don't take shame in their scars. They may show their cuts to people as a cry for help or for attention because they may not get the attention and love from their home (will change wording to be less offensive).. Also that some self-injurers take pride in their scars because it reminds them of the past and how far they have come or that they tell a story.

This is just a rough description of what I would like to add, please tell me what you think and if you would want me to add anymore.

--Alexshelley (talk) 03:05, 11 June 2008 (UTC)

I agree about body mods, I've removed "as well as tattooing or body piercing that goes beyond the limits of culturally accepted body modification". I agree that not all self-harmers are ashamed of their scars - we must be careful with the wording, as it's in the context of attention seeking, and we don't want to imply that those who aren't ashamed are attention seeking (it's possible to not be attention seeking, without also having to be ashamed of them). Also it's not synonymous with concealing behaviour (it's possible that a self-harmer might conceal their behaviour from others, but this doesn't mean they are ashamed of their scars). Perhaps we should just drop the bit about being self-conscious (it doesn't have a source, so we don't know how many self-harmers do feel this), and leave it with the bit about concealing behaviour?

If you want to add that self-harmers show their cuts to get attention, I think that needs a source. Mdwh (talk) 09:21, 11 June 2008 (UTC)

Yes, by all means if you can improve the article then feel free and be bold, however, I concur that any information that you add should be cited. I do feel that some people do feel ashamed / self-concious of their inhuries and scars. The point that Mdwh makes is valid, that self-harmers may conceal their behaviour for other reasons but if the self-harmer conceals their behaviour from others so as not to draw attention to themself, then is not the same thing as being self-concious about their behaviour? Polyamorph (talk) 10:29, 11 June 2008 (UTC)

I have also added a source about being self-concious. The actual source states that many people feel guilty about their behaviour and so conceal their injuries, this is I feel, the same as being self-concious. Polyamorph (talk) 10:48, 11 June 2008 (UTC)

I mean that someone might conceal their scars because they don't want negative comments or people forming prejudice opinions about them (especially in a particular situation, e.g., at work), but this is not out of any shame they feel about what they do, or the scars. (Perhaps an analogy might be gay people who sometimes conceal their status - whether that's not coming out, or not doing public displays of affection with their partner - because of the prejudice they face, and not out of being ashamed of their sexuality.) Mdwh (talk) 21:15, 11 June 2008 (UTC)

I see, and its a good point you make. I think it's a bit of both and could be made clearer in the text. Thanks, Polyamorph (talk) 06:02, 12 June 2008 (UTC)

AlexShelley, I see that you made an edit about snapping rubber bands on a wrist as reinforcing self-injury. It is actually used as a method of treatment, i.e. "weaning" heavy cutters off of self-injury, as it does not cause permanent damage. It is discussed/used in a therapeutic setting, helps a lot of people not turn to the blade, and eventually quit completely. - Magsxemail (talk) 03:52, 20 June 2008 (UTC)

That is all very well but without reliable sources to back up these claims, this information cannot be incorporated into the article. If you do have a source that backs up this information then by all means post it here. Polyamorph (talk) 06:28, 20 June 2008 (UTC)

I will post updates/edit when I can; for now, this is one site that talks about using the rubber band technique as a way to alter thoughts. [1] I'll find more relevant sources before editing the article. -Magsxemail (talk) 06:21, 22 June 2008 (UTC)

I don't want to discourage your efforts but blog sites are not generally accepted as reliable sources, please see Wikipedia:Referencing for beginners. Polyamorph (talk) 11:29, 28 June 2008 (UTC)

A problem is that most 'reliable' sources aren't people who have experienced it themselves, and since it is known that many self-injurers hide their situation, it is also not unlikely that they hide their motivations. I believe it is indeed not personal shame that motivates the concealment, but rather the knowledge that society does not accept it, even the fear of the usual incorrect reactions. Self injurers usually do so to relieve pain, and the usual reactions tend to bring more pain to them. Also it's something personal, and the underlying motivations often even more personal. --217.122.225.60 (talk) 10:03, 4 September 2008 (UTC)

self injury in the developing world

If "Self-injury (SI) or self-harm (SH) is deliberate injury inflicted by a person upon their own body without suicidal intent", why do you talk about suicide attempts in Sri Lanka, since these are obviously done _with_ suicidal attempt? Helenetoile (talk) 04:26, 13 August 2008 (UTC)Helene

I quote from the article: "Many people admitted for deliberate self-poisoning during a study by Eddleston et al.[33] were young and few expressed a desire to die". This is taken from the reference: Eddleston, M. et al. (1998), "Deliberate self-harm in Sri Lanka: an overlooked tragedy in the developing world", British Medical Journal 317: 133–135. This suggests that self poisoning in Sri Lanka is not obviously done with suicidal attempt but is a common form of self harm in this country. I hope this clarifies things. It's like saying that the cutting of wrists is not self harm because it is obviously done with suicidal intent, however it is in fact one of the commonest forms of self-injury that has no suicidal intent. Polyamorph (talk) 09:37, 13 August 2008 (UTC)

Quoting from the Eddleston et al: "Deliberate self harm or attempted suicide?: Many people admitted for deliberate self poisoning were young: about two thirds were aged under 30. Few expressed a desire to die but, unfortunately, deaths are relatively common among the young. Sixty per cent of deaths in female patients occurred in those aged less than 25 years. For most of the youngsters, self poison­ing seems to be the preferred method of dealing with difficult situations. Examples include a 16 year old girl who died after eating oleander seeds because her mother said she could not watch television; a 13 year old boy who drank organophosphates after his mother scolded him, and who spent three weeks in intensive care being ventilated; and a 14 year old boy who presented in complete heart block after eating oleander seeds because his pet mynah bird had died ..."

"Conclusions: Deliberate self poisoning is a major problem in the developing world, where it is the cause of many deaths, particularly among young people. In suggesting ways of preventing deliberate self harm in the developing world we must be realistic, particularly since its incidence is still increasing in the West—2700 people are referred to hospital for self poisoning each week in the United Kingdom alone (Hawton 1997). It is likely to be even more difficult for the developing world, with its limited resources, to address this problem effectively. However, we think that the time has come to acknowledge the seriousness of the situation as a first step towards pre­venting this massive unnecessary loss of life."

where (Hawton 1997) : Hawton K, Fagg J, Simkin S, Bale E, Bond A. Trends in deliberate self harm in Oxford, 1985­1995: implications for clinical services and the prevention of suicide. Br J Psychiatry 1997;171:556­60.

Should the Gender Differences section should be revamped?

This extensive quote is from an April 2008 journal article, primarily a literature review.

Another notable finding in reviewing the literature on prevalence of NSSI is that there is more likely to be a gender difference when examining clinical samples than community samples (e.g., Jacobsen, Muehlenkamp, & Miller, 2006; Nixon, Cloutier, & Aggarwal, 2002). This may be because women are more prone to seek help than men, or due to the inclusion of overdose or inappropriate ingestion of medication without suicidal intent in many of the studies conducted in clinical settings, which have been found to be largely female behaviors (e.g., Briere & Gil, 1998; Rodham, Hawton, & Evans, 2004). In examining the prevalence of NSSI for male and female participants within community samples, it appears that the inclusion of overdose and ingestion of substances may be at the root of the observed gender differences. Specifically, studies of self-injury in community samples that have revealed gender differences (e.g., Laye-Gindhu & Schonert-Reichl, 2005; Nixon, Cloutier, & Jansson, 2007; Patton et al., 1997) have included overdose or abuse of pills/medication without suicide intent. Studies that have limited their definition to behaviors such as cutting, burning, self-hitting, and other forms of direct tissue damage have failed to find gender differences (e.g., Izutsu et al., 2006; Lloyd-Richardson et al., 2007; Muehlenkamp & Gutierrez, 2004; 2007; Ross & Heath, 2002; Zoroglu et al., 2003). This pattern holds true in studies exploring NSSI among young adults; with the exception of Whitlock, Eckenrode, and Silverman (2006), who reported a very small gender difference. Thus, NSSI may not necessarily be a predominately female behavior, although in clinical samples there are significantly more women who engage in NSSI than men.

Heath, N.L., Toste, J.R., Nedecheva, T., & Charlebois, A. (2008). An examination of nonsuicidal self-injury among college students. Journal of Mental Health Counseling, 130 (2), 137-156.

I'm seeing this trend in every new journal article on self-injury. Gender differences are virtually nonexistent. I can provide more sources if necessary to get a re-written gender differences section. Anybody want to take on the task of including them? AncalagonTB (talk) 22:53, 13 August 2008 (UTC)

If you can provide reliable sources that the gender gap is closing (or at least the most up to date statistics take into account all genders and background instead of concentration on a minority of the population) then please please provide them. I'm sure if we collaborate we can incorporate the new information. The section already reads "Caution is however needed in seeing self-harm as a greater problem for females, since males may well engage in different forms of self-harm which may be easier to hide or explained as the result of different circumstances". However, there is a strong bias in the early literature towards prevalence in females, this is no fault of the authors and does not violate NPOV (hence I removed the tag), it is simply a representation of the methods used at that time to determine prevalence. E.G. females may be more likely to present themselves at hospitals or males may be more likely to make up different excuses for their injuries, hence the bias in the statistics. I do stongly believe that there is no real discrepency in the prevalence of self-injury between genders and the article really needs to extensively address this issue by citing reliable literature. Polyamorph (talk) 08:19, 14 August 2008 (UTC)

The majority of youths found to be self-harming are first identified within school systems, not clinical settings. In the U.S. a significant majority of these cases would be sent for psychological evaluations. Perhaps, the federal Department of Education has morbidity studies that would clarify this. The Center for Disease Control (especially the weekly reports of morbitity) would be of value here. My own experience, though, in a large urban school system, is that the over-representation of female adolescents is rather dramatic. 70.130.41.94 (talk) 15:55, 11 November 2008 (UTC)

On this subject, I recently wrote an email complaining to the bbc that their information on self harm presented a gender bias. Based on our article and the issues raised here on the talk page. Here is the transcript of the email

BBC's reply:

Thank you for your email, we are currently in the process of reviewing our mental health pages with the Royal College of Psychiatrists, and self harm will be one of the first to go live on the site. It's currently in the editing process but we hope for it to go live within the next month at the latest.

Kind regards

BBC Health team

Original Message

From: Sent: 25 November 2008 11:16 To: Health-Education Subject: Self harm

Comments: Dear Sir/Madam,

I wrote to you some time ago (I think it was in 2006) regarding the innaccurate content on your self harm webpages. It is common for the media to portray self-harm as a mostly female problem and the bbc seems to share this bias. Whether it is by the use of images of female teens or the blatant statement in your article that states "self harm is more common in females". This is not necessarily accurate, research does seem to suggest that statistically females are more likely to self harm but from my own personal experience and from other less biased studies, it is clear that many male subjects do self harm but are more likely to conceal their injuries or problems. Simply because more females present themselves at hospitals or doctors surgeries, does not mean the same problems are not being experienced by males. This sentiment is shared by the Mental Health Foundation in their "truth hurts" report (2006).

There is also a good review in:

Heath, N.L., Toste, J.R., Nedecheva, T., & Charlebois, A. (2008). An examination of nonsuicidal self-injury among college students. Journal of Mental Health Counseling, 130 (2), 137-156

This suggests that gender differences are virtually non-existent in community samples. It is only clinical samples that seem to suggest a gender difference which can be linked to the fact that women may be more prone to seek help. There are also many different methods of self harm and research seems to suggest that where self harm is limited to behaviours such as cutting, burning, self-hitting, and other forms of direct tissue damage, very little gender differences are observed.

I would really like the bbc to adress this issure once and for all. It is evident that both males and females engage in self-harm, the research is limited but I would like to believe that the bbc could produce a report and information based on the whole facts and the most recent research as opposed to biased speculation and clinical studies.

Yours Faithfully,

The bbc webpages have indeed been updated here: http://www.bbc.co.uk/health/conditions/mental_health/emotion_selfharm.shtml

I have also noticed the recent bbc news article here: http://news.bbc.co.uk/1/hi/health/7783347.stm which seems to parallel the sentiments expressed in my email and those expressed in the article and on this talk page. I don't think that is simply a coincidence, and maybe the tide is changing on how self harm and specifically the importance of gender is reported. Polyamorph (talk) 18:56, 17 December 2008 (UTC)

history of the condition?

the article should have a history section. What is the earliest known reference to this condition/practice? I know many ancient and indigenous cultures practice various forms of scarification etc, but what about self harm for emotional reasons as talked about here? It'd be interesting to know whether there is evidence for it from all over history and from many different cultures or if it is purely a modern western thing. --86.135.221.95 (talk) 02:12, 14 August 2008 (UTC)

This has been discussed previously, for example here and here. The article could probably do with a history section but requires research be done to ensure the information is reliable. In terms of other cultures, there is already the mention of the Sri Lankan case study which suggests self harm is not "purely a modern western thing": Self-injury#Self-harm_in_the_developing_world. Polyamorph (talk) 08:41, 14 August 2008 (UTC)

Assuming that the Sri-Lankan cases really are self-injury and not attempted suicide (there are multiple reasons why someone in that position might lie about suicidal intent), then it's interesting that they use different methods of self injury than is usual in the west. Presumably they have access to sharp objects yet they prefer to use poison. In addition since writing the above I have looked into the historical angle myself and it seems that, looking at classical Greek sources and the like, one form of self-injury that crops up a lot seems to be poking out eyes which I assume is almost unheard of in modern cases. The methods, at least, do seem to be partly culture linked. Let alone the reasons behind doing it in the first place. --86.135.221.95 (talk) 19:56, 14 August 2008 (UTC)

I think it is more to do with the fact that only those cases serious enough to warrant hospitalisation are documented, generally even self-harm by cutting is not likely to be life-threatening and although someone might be treated in the West for a deep cut, other countries do not have such good health care. Self-poisoning is certainly not limited to the developing world, there are many overdoses in the West which are simply "cries for help", not suicide attempts (See my comments in the talk section Talk:Self-injury#self injury in the developing world). Polyamorph (talk) 22:57, 14 August 2008 (UTC)

There are mentions of non-suicidal self harm in the bible, in case anyone wants to make a history section. —Preceding unsigned comment added by 70.181.97.102 (talk) 10:01, 7 December 2008 (UTC)

There is mention of a cutter in the Bible. I'm not sure of the citation of the scripture, but one of the men that Jesus cast a demon(s) out of exhibited this behavior.

Jn motto (talk) 17:12, 23 January 2009 (UTC)

SI in autism & developmental disabilities

I feel this needs a larger section... Obviously those with autism & other types of cognitive disabilities usually have the same reasons for self-injury as anyone else; but the different sensory experiences involved (especially for autism) and cognitive abilities add extra complications.

The answer to the question, "Is it self-stimulation or self-harm?" is, "It depends on the person and the situation"--in fact, can vary within the same individual (different behaviors for different purposes)... Unfortunately I don't have any more testimony to this than a few blog posts & some message board discussions. References anybody? —Preceding unsigned comment added by 24.164.85.119 (talk) 01:26, 23 September 2008 (UTC)

Ritual Cutting

Well, let's talk about reorganising it. It seems odd to me to talk entirely about self-injury in one context, then have this paragraph at the top about a rather different context. Also consider how we keep body modification, Algolagnia and Self-inflicted wound as separate articles entirely - shouldn't these be mentioned here too, if we are covering over types of self-injury? Or should we put ritual cutting in its own article (which already exists for the Maya civilization), and link to it from here? Mdwh (talk) 11:31, 30 September 2008 (UTC)

I also think this should be mainly covered in a later section, rather than the lead paragraphs - the flow doesn't read write at the moment, talking about self-harmers, then ritual cutting, then it talks about them not being suicidal, which is supposed to refer to self-harmers in the original context, not ritual cutting. Mdwh (talk) 11:32, 30 September 2008 (UTC)

I think that most of these should be discussed in summary style. In my view body modification is essentially different as it is more about the long term result rather than immediate ones, Self-inflicted wounds are related, but is about external reactions rather than internal ones, and Algolagnia is a potenial cause rather than an occurrence of self-injury. --Nate1481 11:53, 30 September 2008 (UTC)

This article concentrates on the form a self-injury as a medical condition, not as some sort of ritual procedure. It is ok to mention and link to body modification, Algolagnia, Self-inflicted wound and the Mayan example but not to discuss these in any detail since this should be dealt with in those articles. I certainly don't think it is appropriate to have the paragraph in the lead about ritual cutting - the lead is supposed to be a summary of the key points of the article itself and this article does not deal with this issue at all. I agree that there should be a section that deals with other forms of self injury, possibly under the motivations heading, linking to the appropriate articles. Polyamorph (talk) 13:29, 30 September 2008 (UTC)

Ok, I put the paragraph on Mayan practices under "Motives...Cultural motives". Polyamorph (talk) 15:52, 1 October 2008 (UTC)

Dietary factors?

I just added a little section on "drugs and diet", weighted heavily toward drugs. I'd like to ask that those versed in the problem add any relevant dietary information. I found one anecdotal account of a woman treated successfully with dietary serotonin, but not enough to be worth including yet. Given the linkage of so many drugs to purine metabolism, I was curious whether people have tried using the foods that people with gout should never eat to try to stave off the condition (liver, sardines, red meat and so forth). Wnt (talk) 05:02, 18 October 2008 (UTC)