Deliberate Self-Harm in Adolescents
Occurrences of deliberate self-harm (DSH) are commonly encountered when caring for adolescents, especially in mental healthcare settings. Defined as the intentional damage of body tissues without suicidal intent, DSH is officially included as a symptom of borderline personality disorder. However, DSH also occurs along with many other mental health conditions and also in nonclinical populations. The lifetime prevalence of DSH in adolescents and young adults varies greatly depending on the population studied, and is noted to be up to 80 % in some psychiatric inpatient populations. Because DSH is a marker for increased risk of future suicide attempts and can cause distress and injury, clinicians need to be able to provide thorough assessment of the behavior, monitor for suicidality, and refer for or provide proper treatment. This chapter covers how self-harm is defined and reviews the epidemiology of this behavior. Theories of the psychological function and the currently understood pathophysiology, along with recommended clinical approaches, assessment, and treatment strategies, are discussed.
KeywordsSuicide Attempt Borderline Personality Disorder Childhood Sexual Abuse Cerebral Spinal Fluid Dialectical Behavioral Therapy
- Claes, L., Houben, A., Vadereycken, W., Bijttebier, P., & Muehlenkamp, J. (2010). Brief report: The association between non-suicidal self-injury self-concept and acquaintance with self- injurious peers in a sample of adolescents. Journal of Adolescent Health, 33(5), 775–778.Google Scholar
- Clarkin, J. F., Foelsch, P. A., Levy, K. N., Hull, J. W., Delaney, J. C., & Kernberg, O. F. (2001). The development of a psychodynamic treatment for patients with borderline personality disorder: A preliminary study of behavioral change. Journal of Personality Disorders, 15(6), 487–495. doi: 10.1521/pedi.15.6.487.19190.PubMedCrossRefGoogle Scholar
- DSM-III-R. (2000). American Psychiatric Association’s diagnostic and statistical manual of mental disorders (3rd ed.). PsycCRITIQUES, 35(3), doi: 10.1037/028425.
- DSM-III-R. (1990). American Psychiatric Association’s diagnostic and statistical manual of mental disorders (4th ed.). PsycCRITIQUES, 35(3), doi: 10.1037/028425.
- Evans, K., Tyrer, P., Catalan, J., Schmidt, U., Davidson, K., Dent, J., et al. (1999). Manual-assisted cognitive-behavior therapy (MACT): A randomized controlled trial of a brief intervention with bibliotherapy in the treatment of recurrent deliberate self-harm. Psychological Medicine, 29(1), 19–25.PubMedCrossRefGoogle Scholar
- Hawton, K., Townsen, E., Arensman, E., Gunnell, D., Hazell, P., House, A., et al. (1999). Psychosocial and pharmacological treatments for deliberate self harm. Cochrane Database of Systematic Reviews, 3. Retrieved April 20, 2011.Google Scholar
- Linehan, M. M., Comtois, K., Brown, M. Z., Heard, H. L., & Wagner, A. (2006). Suicide attempt self-injury interview (SASII): Development, reliability, and validity of a scale to assess suicide attempts and intentional self-injury. Psychological Assessment, 18(3), 303–312. doi: 10.1037/1040-35188.8.131.523.PubMedCrossRefGoogle Scholar
- Linehan, M. M., Comtois, K., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., et al. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs. therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63(7), 757–766. doi: 10.1001/archpsyc.63.7.757.PubMedCrossRefGoogle Scholar
- Lloyd-Richardson, E. E., Perrine, N., Dierker, L., & Kelley, M. L. (2007). Characteristic and functions on non-suicidal self-injury in a community sample of adolescents. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 37(8), 1183–1192. doi: 10.1017/S003329170700027X.CrossRefGoogle Scholar
- Tyrer, P., Thompson, S., Schmidt, U., Jones, V., Knapp, M., Davidson, K., et al. (2003). Randomized controlled trial of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: The POPMACT study. Psychological Medicine, 33(6), 977–986. ISSN 0033-2917.PubMedCrossRefGoogle Scholar
- Whitlock, J., Muehlenkamp, J., & Eckenrode, J. (2008). Variation in nonsuicidal self-injury: Identification and features of latent classes in a college population of emerging adults. Journal of Clinical Child and Adolescent Psychology, 37(4), 725–735. doi: 10.1080/15374410802359734.PubMedGoogle Scholar