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Define self-harm

The act of self-poisoning or self-injury, irrespective of the actual purpose of the act


Define non-suicidal self-injury (Nock, 2009)

Deliberate damage to the body in the absence of conscious intent to die


Which mental illness has traditionally been associated with non-suicidal self injury?

Borderline personality disorder


What percentage of 16-24 year olds report having self-harmed? (2014 UK Adult Psychiatric Morbidity Survey)

Women: 25.7%
Men: 9.7%


Why might there be a gender difference in self-harm reporting?

Society tends to associate self-harm with women so it may be easier for them to talk about, and men are more likely to use violent methods (e.g. punching a wall) which they may not recognise as self-harming


How many individuals continue to self harm? (Moran et al, 2012)

1 in 4 are still self-harming after 4 years, with severity typically increasing


State some predictors of non-suicidal self-injury (Wilkinson et al, 2011)

History of NSSI, hopelessness, anxiety disorder, younger age, female gender


State some predictors of suicide after psychological therapy (Wilkinson et al, 2011)

Suicidal ideation before therapy, NSSI, poor family function


State some risk factors for self-harm (Fox et al, 2015)

Disadvantaged socio-economic background, social isolation, negative life events, prior history, cluster B personality disorder, hopelessness


Is self-harm always associated with a mental illness?

No - but it is more prevalent in those with mental illness, especially depression, anxiety, personality disorder, and substance abuse


State some psychological factors associated with self-harm (O-Connor et al, 2012)

Sense of entrapment, lack of belonging, seeing oneself as a burden, low self-esteem, impulsivity, hopelessness, lack of emotion regulation, difficulties in problem-solving


What is the biggest risk factor for suicide? (Whitlock et al, 2013)



State some reasons for self-harm

Suicidal ideation, wanting to punish oneself, to stop feeling emotional pain, to feel in control, to feel anything, expressing distress, habit


What proportion of individuals who self-harm present to hospital? (Hawton et al, 2002)

1 in 8


Describe how reasons for self-harm can change over time (Towsend et al, 2016)

The most common reason to initiate self-harm is wanting to feel better, but the reason tends to shift to helplessness and wanting to die, or just out of habit. It initially tends to make the person feel better, but later becomes associated with guilt


Name some emotion regulation models for self-harm

Gross emotion regulation model, difficulties in emotion regulation model, experimental avoidance model, emotional cascade model


Describe the gross emotion regulation model of self-harm

Emotion regualtion involves antecedent-focused regulation strategies and response-focused strategies - the latter are aberrant in self-harm, with increased levels of emotion suppression and less cognitive reappraisal.


Give a piece of evidence supporting the gross emotion regulation model of self-harm

Voon et al: Encouraging congnitive reappraisal reduces the frequency and medical severity of self-harm


Describe the difficulties in emotion regulation model proposed by Gratz & Roemer in 2004

Self-harm features 4 main difficulties: alxeithymia (awareness & understanding of emotions), accepting emotion, controlling impulses and behaviour, and being flexible in situational strategies


Give a piece of evidence against the difficulties in emotion regulation model proposed by Gratz & Roemer in 2004

Most studies have found no evidence of increased impulsivity in individuals who self-harm (Hamza et al, 2015)


Describe Chapman's experimental avoidance model of self-harm

It suggests that self-harm is the result of emotional suppression - a mixture of high emotion intensity, difficulty in regulation, and poor distress tolerance leads to emotion avoidance through deliberate self-harm. This produces temporary relief, trapping individuals in a negative cycle


Give a piece of evidence supporting Chapman's experimental avoidance model of self-harm

Self-harm commonly co-occurs with other avoidant emotion regulation behaviours such as binge-eating and substance abuse (Buckholdt et al, 2015)


Describe Selby & Joiner's 2013 emotional cascade model of self-harm

Minimal negative emotional stimuli are amplified by rumination, leading to self-harm


Give a piece of evidence supporting Selby & Joiner's 2013 emotional cascade model of self-harm

Self-harm is associated with increased levels of rumination and negative emotion, and increased reflection with no solution (Hoff & Muehlenkamp, 2009)


Describe the differences in attention allocation seen in individuals who self-harm (Allen & Hooley, 2015)

Those who self-harm exhibit preferential automatic attention allocation to negative stimuli


Describe the effect of imagery on self-harm (Wesslau et al, 2015; Hasking et al, 2017)

Distressing images of self-harm or its impact on others are not associated with self-harm, but images with a positive appraisal (e.g. escape) are associated with increased self-harm


State some interpersonal hypotheses for self-harm

Social learning hypothesis, self-punishment hypothesis, social signalling hypothesis


Describe the social learning hypothesis of self-harm (Whitlock et al, 2009)

Self-harm is increasing due to greater recognition of it and its prevalence in the media


Describe the self-punishment hypothesis of self-harm (Glassman et al, 2017)

Self-harm is self-directed abuse learned via repeated abuse or criticism by others


Describe the social signalling hypothesis of self-harm (Wedig & Nock, 2007)

When other communication strategies have failed, self-harm is the only method individuals have left