Negative Intrusive Thoughts and dissociation as Risk Factors for Self‐Harm

Relationships between self‐harm and vulnerability factors were studied in a general population of 432 participants, of whom 30% reported some experience of self‐harm. This group scored higher on dissociation and childhood trauma, had lower self‐worth, and reported more negative intrusive thoughts. Among the non‐harming group, 10% scored similarly to the self‐harmers on the dissociation and self‐worth scales, and engaged in potentially maladaptive behaviors that are not defined as indicating clinical self‐harm, but experienced fewer negative intrusive thoughts. This group may be at risk of future self‐harm if they begin to experience negative intrusive thoughts. If negative intrusive thoughts are playing a causal role, then therapeutic approaches tackling them may help those who are currently self‐harming.     

Self‐Harm in Young Offenders

The prevalence and correlates of self‐harm and suicidal behavior in 515 young offenders (mean age 17.3 years, SD = 1.7) serving community‐based orders (CBOs; n = 242) or custodial sentences (n = 273) in Victoria, Australia, are described. Results from structured interviews showed that 83 (16.1%) participants reported self‐harming in the previous 6 months, and this was more common among those serving custodial sentences than those serving CBOs (19.4% vs. 12.4%; OR 3.10, 95% CI: 1.74–5.55). Multiple incidents were more common in females and 24% (95% CI: 19–39) of participants who had self‐harmed reported having done so with suicidal intent. Self‐harm was associated with recent bullying victimization, expulsion from school, past year violent victimization, cannabis dependence, and risk‐taking behavior in the preceding year. The epidemiological profile of self‐harm in this population appears to be distinct from that seen in the general population. Young offenders who self‐harm are a vulnerable group with high rates of psychiatric morbidity, substance misuse problems, and social risk factors. They may benefit from targeted psychological interventions designed specifically to address impulsivity, delivered both within–and during the transition from–the youth justice system.     

Identifying Risk for Self‐Harm: Rumination and Negative Affectivity in the Prospective Prediction of Nonsuicidal Self‐Injury

Research suggests nonsuicidal self‐injury (NSSI) may function as a maladaptive strategy to regulate negative emotions, and individuals high in trait negative affectivity (NA) may be particularly at risk. Rumination, a cognitive emotion regulation strategy, may amplify negative affect, increasing the likelihood of NSSI. The current study found that high NA and high rumination interacted to predict both likelihood of engagement in NSSI and frequency of NSSI. This study provides support for the joint contribution of cognitive and temperamental factors impacting the relationship between NA and NSSI and suggests that interventions targeted at maladaptive emotion regulation strategies may help inform individualized treatment.     

Self‐Harm and Conventional Gender Roles in Women

A total of thirty‐two women admitted to a general hospital for medical treatment after self‐harming completed measures of conventional positive and negative masculinity and femininity. Comparisons were made with two control groups with no self‐harm history; 33 women receiving psychiatric outpatient treatment and a nonclinical sample of 206 women. Multinomial logistic regression analyses showed that those with lower scores on Instrumentality and Unmitigated Agency (positive and negative masculinity) and higher scores on Insecurity (negative femininity) had greater odds of self‐harming. Relationships were weaker after accounting for generalized self‐efficacy. Results are discussed in relation to previous findings and suggestions for prevention are made.     

Suicidal Intent and Method of Self‐Harm: A Large‐scale Study of Self‐Harm Patients Presenting to a General Hospital

Data from the Oxford Monitoring System for Attempted Suicide (2004–2011) were used to study hospital presentations for self‐harm in which Suicidal Intent Scale (SIS) scores were obtained (N = 4,840). Regression of medians was used to control for the confounding effect of age and gender. Higher estimated median SIS scores were associated with increasing age, male gender, self‐poisoning versus self‐injury, multiple methods of self‐harm versus self‐injury alone, use of gas (mainly carbon monoxide), dangerous methods of self‐injury (including hanging, gunshot), and use of alcohol as part of the act. For self‐poisoning patients, there was a correlation between the number of tablets taken and the total SIS score. Compared with self‐poisoning with paracetamol and paracetamol‐containing compounds, self‐poisoning with antipsychotics was associated with a lower median SIS score while antidepressants had the same estimated median as paracetamol. Use of alcohol within 6 hours of self‐harm was associated with lower SIS scores. In conclusion, certain methods of self‐harm, particularly dangerous methods of self‐injury and self‐poisoning with gas, were associated with high intent and should alert clinicians to potential higher risk of suicide. However, apart from use of gas, suicidal intent cannot be inferred from type of drugs used for self‐poisoning.     

The Relationship Between Nonsuicidal Self‐Injury Age of Onset and Severity of Self‐Harm

This study examined how age of nonsuicidal self‐injury (NSSI ) onset relates to NSSI severity and suicidality using decision tree analyses (nonparametric regression models that recursively partition predictor variables to create groupings). Those with an earlier age of NSSI onset reported greater NSSI frequency, NSSI methods, and NSSI ‐related hospital visits. No significant splits were found for suicide ideation or attempts, although those with an earlier onset were more likely to have a suicide plan. Overall, findings suggest that onset of NSSI before age 12 is associated with more severe NSSI and may be a crucial age for prevention efforts.     

Distinguishing Between Subgroups of Adolescents Who Self‐Harm

The differences in factors associated with subgroups of adolescents in the continuum of deliberate self‐harm (DSH) phenomena were investigated. In an anonymous self‐report survey of 6,020 adolescents aged 15 and 16 years, 3.2% of adolescents (5.3% females, 1.3% males) reported DSH with intent to die, 2.8% (4.3% females; 1.5% males) reported DSH without intent to die, and 15% (22.4% females; 8.5% males) reported thoughts of DSH without acts. Regression analysis indicated considerable overlap in vulnerability factors along the spectrum of DSH thoughts and acts. A uniquely distinct relationship was found between DSH of a friend and DSH without intent to die on one hand and DSH of a family member with DSH with intent to die on the other. Results indicate that familial and nonfamilial social influences on DSH behavior may be important in designing prevention programs and that educational programs for the promotion of psychological well‐being may be helpful for adolescents at any point along the spectrum of DSH that was examined.     

Predictors of Unintentionally Severe Harm During Nonsuicidal Self‐Injury

This study aimed to identify predictors of unintentionally severe injury during nonsuicidal self‐injury (NSSI). The authors examined 3 potential predictors in a sample of 102 college students: addictive qualities of NSSI, impulsivity, and dissociation. Both impulsivity and addictive qualities of NSSI were associated with unintentionally severe injury during NSSI. In a logistic regression, only addictive qualities of NSSI emerged as a significant predictor of unintentionally severe injury during NSSI. Implications for counseling and research are discussed.     

Exploring Causes of the Self‐serving Bias

The self‐serving bias refers to a tendency for people to take personal responsibility for their desirable outcomes yet externalize responsibility for their undesirable outcomes. We review a variety of explanations for this attribution bias. Although researchers have historically pitted cognitive and motivational explanations for the self‐serving bias against one another, cognitive and motivation processes often work in tandem to lead people to conclude that they are responsible for the desirable but not the undesirable outcomes.     

Thoughts of Self‐Harm and Help‐Seeking Behavior among Youth in the Community

The association between thoughts of self‐harm and help‐seeking among youth with symptoms of depression was examined. Data were drawn from the Health Behavior of School‐aged Children Study (n = 15, 686), a nationally representative sample of youth in the United States. Analyses focused on comparing help‐seeking behaviors among youth with and without thoughts of deliberate self‐harm (DSH) when depressed. Depressed youth with thoughts of DSH exhibited different patterns of help‐seeking than those without. Both groups most frequently sought help from friends and parents. However, adolescents with thoughts of DSH were statistically more likely than youth without to seek help from friends (DSH: 69.9%; no DSH: 57.8%; AOR = 1.46), but less likely to seek help from parents (DSH: 53.7%; no DSH: 73.1%; AOR = 0.47). Youth with DSH were more likely to seek help from school officials (AOR = 1.05), health professionals (AOR: 1.83), or a counselor (AOR = 1.93) compared with those without thoughts of DSH who were more likely to seek help from a sibling (AOR: 0.77) or other relatives (AOR: 0.78). Results may help inform programs to improve identification of youth at risk of self‐harm in community and school settings.     

Key Considerations for Using No‐Harm Contracts With Clients Who Self‐Injure

One of the more controversial issues in working with people who self‐injure is whether counselors should use no‐harm contracts. Important therapeutic considerations include the efficacy of such contracts or agreements in preventing self‐injury, the emotional and behavioral responses of clients, and the perceived protection these contracts or agreements may offer counselors. The authors weigh potential benefits and pitfalls and make recommendations for working collaboratively with clients to meet their individual needs.     

Exploring Self‐Injury Through a Relational Cultural Lens

In this article, self‐injurious behaviors are examined through the conceptual framework of relational cultural theory (RCT). As an emerging theoretical approach that takes into account the importance of relationships and relational goals, it is suggested that RCT be used in conjunction with mainstream approaches to treat self‐injury.     

Definitions of Suicide and Self‐Harm Behavior in an Australian Aboriginal Community

In this small qualitative grounded theory study (21 interviews and focus groups with a total of 26 participants) investigating the understandings of and attitudes toward suicide and self‐harm of Aboriginal peoples in a coastal region of New South Wales, Australia, we found that cultural factors particular to these communities influence the way such behavior is defined in an Aboriginal context. A continuation of certain “traditional” cultural forms of self‐harm behavior was evident in participant definitions, notably the practice of female hair cutting, also described as a mourning ritual, which appears to serve as a marker both to the individual and others.     

Victimization and Exposure to Pro‐Self‐Harm and Pro‐Suicide Websites: A Cross‐National Study

The study of websites displaying methods of both physical self‐harm and suicide has become an important aspect of deliberate self‐injury and suicide research. However, little is known about contextual factors related to entering such sites. Using data from 3,567 respondents aged 15–30 in the US, UK, Germany, and Finland, we found that experiences of victimization are associated with entering pro‐self‐harm sites and pro‐suicide sites. Also, the victimization context had relevance, as online victimization was particularly related to pro‐self‐harm behavior. The findings suggest a need to organize more specific online support for the victims of violence and online aggression.     

Firearm Storage Practices and Risk Perceptions Among a Nationally Representative Sample of U.S. Veterans With and Without Self‐Harm Risk Factors

Despite the disproportionate use of firearms in Veteran suicides and the well‐established link between firearm access and suicide, little is known about how Veterans store their firearms or what they think about the relationship between firearm access and suicide risk. Using data from 2015 nationally representative online survey (response rate 60.9%), we compare characteristics of Veteran firearm owners with and without self‐harm risk factors with respect to how they store their firearms and their beliefs about suicide risk related to firearms. Overall, one in three U.S. Veteran firearm owners store household firearms loaded and unlocked, one in twenty believe that a firearm increases household suicide risk, and one in four consider their loaded and unlocked firearm to be inaccessible to suicidal household members. Storage practices and risk perceptions are similar among those with and without self‐reported suicide risk factors. Affecting risk perceptions may be a critical aspect of interventions addressing lethal means safety among U.S. Veterans.     

Help‐Seeking for Suicidal Thoughts and Self‐Harm in Young People: A Systematic Review

There is a growing body of evidence to suggest that only a minority of young people experiencing suicidal thoughts or self‐harm present to any health services. This is of concern given that young people with suicidal thoughts or self‐harm often require treatment for mental illness as well as to reduce their risk of completed suicide. We reviewed previously published international community epidemiological studies examining help‐seeking for suicidal thoughts or self‐harm in young people up to the age of 26. The studies confirm that the majority of these young people do not seek professional help, and this includes seeking medical help after an overdose. The majority of young people studied do, however, seek help from social networks that most commonly are peers. Factors influencing and barriers to help‐seeking are discussed and highlight a need for further research into the role that peers and family play in the help‐seeking process for young people with suicidal thoughts or self‐harm.     

Adolescents Exposed to Suicidal Behavior of Others: Prevalence of Self‐Harm and Associated Psychological,Lifestyle, and Life Event Factors

Exposure to suicidal behavior of others was examined among 3,881 Irish adolescents in the Child and Adolescent Self‐harm in Europe (CASE) study. One third of the sample had been exposed to suicidal behavior, and exposed adolescents were eight times more likely to also report own self‐harm. Exposed adolescents shared many risk factors with those reporting own self‐harm. Those reporting both exposure and own self‐harm presented the most maladaptive profile on psychological, life event, and lifestyle domains, but neither anxiety nor depression distinguished this group. Exposed adolescents are burdened by a wide range of risk factors and in need of support.     

Mirror Self‐Recognition and Self‐Identification

That great apes are the only primates to recognise their reflections is often taken to show that they are self‐aware—however, there has been much recent debate about whether the self‐awareness in question is psychological or bodily self‐awareness. This paper argues that whilst self‐recognition does not require psychological self‐awareness, to claim that it requires only bodily self‐awareness would leave something out. That is that self‐recognition requires ‘objective self‐awareness’—the capacity for first person thoughts like ‘that's me’, which involve self‐identification and so are vulnerable to error through misidentification. This objective self‐awareness is distinct from bodily or psychological self‐awareness, requires cognitive sophistication and provides the beginnings of a more conceptual self‐representation which might play a role in planning, mental time travel and theory of mind.     

Predicting Deliberate Self‐Harm in Adolescents: A Six Month Prospective Study

Few studies have investigated the extent to which psychosocial/psychological factors are associated with the prediction of deliberate self‐harm (DSH) among adolescents. In this study, 737 pupils aged 15–16 years completed a lifestyle and coping survey at time one and 500 were followed up six months later. Six point two percent of the respondents (n = 31) reported an act of DSH between Time 1 and Time 2. In multivariate analyses, worries about sexual orientation, history of sexual abuse, family DSH, anxiety, and self‐esteem were associated with repeat DSH during the course of the study, but history of sexual abuse was the only factor predictive of first‐time DSH. The findings suggest that school‐based programs focused on how young people cope with psychosocial stressors may offer promise.