Social Psychiatry and Psychiatric Epidemiology

, Volume 44, Issue 8, pp 601–607 | Cite as

Reasons for adolescent deliberate self-harm: a cry of pain and/or a cry for help?

Findings from the child and adolescent self-harm in Europe (CASE) study
  • Gerrit Scoliers
  • Gwendolyn Portzky
  • Nicola Madge
  • Anthea Hewitt
  • Keith Hawton
  • Erik Jan de Wilde
  • Mette Ystgaard
  • Ella Arensman
  • Diego De Leo
  • Sandor Fekete
  • Kees van Heeringen
ORIGINAL PAPER

Abstract

The present study examines reasons for adolescent deliberate self-harm. A cross-sectional survey using an anonymous self-report questionnaire was carried out in seven countries (Australia, Belgium, England, Hungary, Ireland, the Netherlands and Norway). Data on 30,477 school pupils between the ages of 14–17 were analysed. Past year and lifetime deliberate self-harm were assessed, along with the self-reported reasons for deliberate self-harm. The results showed that ‘wanted to get relief from a terrible state of mind’ and ‘wanted to die’ were most commonly reported. Principal component analysis indicated two underlying dimensions in the reasons for deliberate self-harm, i.e. a cry of pain motive and/or a cry for help motive. The majority of self-harmers reported at least one cry of pain motive (‘to die’, ‘to punish myself’, and ‘to get relief from a terrible state of mind’) and an additional cry for help motive (‘to show how desperate I was feeling’, to frighten someone’, ‘to get my own back on someone’, ‘to find out whether someone really loved me’, and ‘to get some attention’). Females reported more reasons than males. Only females showed an age difference, with girls aged 16–17 more frequently reporting a cry for help motive. There was considerable consistency in choice of motives across countries and genders. Systematic assessment of the reasons for deliberate self-harm can help clinicians to better understand the meaning of self harming behaviour, select appropriate treatment, suggest alternative coping strategies, and hopefully prevent future suicidal behaviour.

Keywords

deliberate self-harm adolescence reasons cry of pain cry for help 

References

  1. 1.
    Bancroft J, Hawton K, Simkin S, Kingston B, Cumming C, Whitwell D (1979) The reasons people give for taking overdoses: a further inquiry. Br J Med Psychol 52:353–365PubMedGoogle Scholar
  2. 2.
    Bancroft J, Skrimshire A, Simkin S (1976) The reasons people give for taking overdoses. Br J Psychiatry 128:538–548PubMedCrossRefGoogle Scholar
  3. 3.
    Boergers J, Spirito A, Donaldson D (1998) Reasons for adolescent suicide attempts: associations with psychological functioning. J Am Acad Child Adolesc Psychiatry 37:1287–1293PubMedCrossRefGoogle Scholar
  4. 4.
    Choquet M, Ledoux, S (1994) Adolescents—Enquête Nationale. Analyses et Perspectives. Paris: Inserm, 346 pGoogle Scholar
  5. 5.
    Hawton K, James A (2005) ABC of adolescence–suicide and deliberate self-harm in young people. Br Med J 330:891–894CrossRefGoogle Scholar
  6. 6.
    Hawton K, Rodham K (2006) By their own young hand–deliberate self-harm and suicidal ideas in adolescents. Jessica Kingsley Publishers, LondonGoogle Scholar
  7. 7.
    Hawton K, Fagg J, Simkin S (1996) Deliberate self-poisoning and self-injury in children and adolescents under 16 years of age in Oxford, 1976–1993. Br J Psychiatry 169:202–208PubMedCrossRefGoogle Scholar
  8. 8.
    Hawton K, Cole D, O’Grady J, Osborn M (1982) Motivational aspects of deliberate self poisoning in adolescents. Br J Psychiatry 141:286–291PubMedCrossRefGoogle Scholar
  9. 9.
    Hawton K, Rodham K, Evans E, Weatherall R (2002) Deliberate self harm in adolescents: self report survey in schools in England. Br Med J 325:1207–1211CrossRefGoogle Scholar
  10. 10.
    Hjelmeland H, Hawton K, Nordvik H, Bille-Brahe U, De Leo D, Fekete S, Grad O, Haring C, Kerkhof JF, Lonnqvist J, Michel K, Renberg ES, Schmidtke A, van Heeringen K, Wasserman D (2002) Why people engage in parasuicide: a cross-cultural study of intentions. Suicide Life Threat Behav 32:380–393PubMedCrossRefGoogle Scholar
  11. 11.
    Holden R, Delisle M (2006) Factor structure of the reasons for attempting suicide questionnaire (RASQ) with suicide attempters. J Psychopathol Behav Assess 28:1–8CrossRefGoogle Scholar
  12. 12.
    Holden R, Mcleod L (2000) The structure of the reasons for attempting suicide questionnaire (RASQ) in a nonclinical adult population. Personality Individ Differ 29:621–628CrossRefGoogle Scholar
  13. 13.
    Holden R, Kerr P, Mendonca J, Velamoor V (1998) Are some motives more linked to suicide proneness than others? J Clin Psychol 54:569–576PubMedCrossRefGoogle Scholar
  14. 14.
    Kalafat J, Elias M (1994) An evaluation of a school-based suicide awareness intervention. Suicide Life Threat Behav 24:224–233PubMedGoogle Scholar
  15. 15.
    Kerkhof A, Bernasco W, Bille-Brahe U, Platt S, Schmidtke A (1993) European parasuicide study interview schedule, initial interview. In: Bille-Brahe U (ed) WHO/EURO multicentre study on parasuicide. WHO Regional Office for Europe, CopenhagenGoogle Scholar
  16. 16.
    Kienhorst I, De Wilde E, Diekstra R, Wolters W (1995) Adolescents’ image of their suicide attempt. J Am Acad Child Adolesc Psychiatry 34:623–628PubMedCrossRefGoogle Scholar
  17. 17.
    Madge N, Hewitt A, Hawton K, De Wilde EJ, Corcoran P, Fekete S, Van Heeringen K, De Leo D, Ystgaard M (2008) Deliberate self-harm within an international community sample of young people: comparative findings from the child and adolescent self-harm in Europe (CASE) study. J Child Psychol Psychiatry 49:667–677PubMedCrossRefGoogle Scholar
  18. 18.
    Michel K, Valach L, Waeber V (1994) Understanding deliberate self-harm: the patients’ views. Crisis 15:172–178PubMedGoogle Scholar
  19. 19.
    Pagès F, Arvers P, Hassler C, Choquet M (2004) What are the characteristics of adolescent hospitalized suicide attempters? Eur Child Adolesc Psychiatry 13:151–158PubMedCrossRefGoogle Scholar
  20. 20.
    Pollock L, Williams J (2001) Effective problem solving in suicide attempters depends on specific autobiographical recall. Suicide Life Threat Behav 31(4):386–396PubMedCrossRefGoogle Scholar
  21. 21.
    Rodham K, Hawton K, Evans E (2004) Reasons for deliberate self-harm: comparison of self-poisoners and self-cutters in a community sample of adolescents. J Am Child Adolesc Psychiatry 43:1–8CrossRefGoogle Scholar
  22. 22.
    Schnyder U, Valach L, Bichsel K, Michel K (1999) Attempted suicide—do we understand the patients’ reasons? Gen Hosp Psychiatry 21:62–69PubMedCrossRefGoogle Scholar
  23. 23.
    Skögman K, öjehagen A (2003) Motives for suicide attempts—the views of the patients. Arch Suicide Res 7:193–206CrossRefGoogle Scholar
  24. 24.
    Varadaraj R, Mendonca J, Rauchenberg P (1986) Motives and intent: a comparison of views of overdose patients and their key relatives/friends. Canad J Psychiatry 31:621–624Google Scholar
  25. 25.
    Williams J (2001) Suicide and attempted suicide. Understanding the cry of pain, PenguinGoogle Scholar
  26. 26.
    Ystgaard M, Arensman E, Hawton K, Madge N, Van Heeringen K, De Wilde EJ, De Leo D, Fekete S(2008) Deliberate self harm in adolescents: comparison between those who attend health services following self-harm and those who do not. Accepted by the J AdolescGoogle Scholar

Copyright information

© Steinkopff Verlag Darmstadt 2008

Authors and Affiliations

  • Gerrit Scoliers
    • 1
  • Gwendolyn Portzky
    • 1
  • Nicola Madge
    • 2
  • Anthea Hewitt
    • 2
  • Keith Hawton
    • 3
  • Erik Jan de Wilde
    • 4
  • Mette Ystgaard
    • 5
  • Ella Arensman
    • 6
  • Diego De Leo
    • 7
  • Sandor Fekete
    • 8
  • Kees van Heeringen
    • 1
  1. 1.Unit for Suicide Research, Dept. of Psychiatry and Medical PsychologyUniversity of GhentGhentBelgium
  2. 2.School of Health Sciences and Social CareBrunel University UxbridgeLondonUK
  3. 3.Centre for Suicide ResearchUniversity of OxfordOxfordUK
  4. 4.Netherlands Youth InstituteUtrechtThe Netherlands
  5. 5.Centre for Child and Adolescent Mental HealthOsloNorway
  6. 6.National Suicide Research FoundationCorkIreland
  7. 7.Australian Institute for Suicide Research and PreventionGriffith University Gold CoastBrisbaneAustralia
  8. 8.Dept. of PsychiatryUniversity of PecsPecsHungary

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