SCIE Research briefing 16: Deliberate self-harm (DSH) among children and adolescents: who is at risk and how is it recognised?
Published August 2005
Introduction - What is the issue?
The topic of this briefing is deliberate self-harm (DSH) and self-injurious behaviour (SIB) among children and adolescents up to the age of 19, who live in the community. Self-harm is defined as "a non fatal act in which an individual deliberately causes self injury or ingests a substance more than the therapeutic dose". The National Inquiry describes self-harm as "a wide range of things that people do to themselves in a deliberate and usually hidden way, which are damaging". It includes overdoses (self poisoning) and self-mutilation (e.g. cutting behaviours, burning, scalding, banging heads and other body parts against walls, hair-pulling, biting, and swallowing or inserting objects). Some of these actions result in no visible harm, and others require no medical assistance. This briefing does not cover eating disorders, drug and alcohol misuse, risk taking behaviours such as unsafe sex or dangerous driving. Nor does it cover children or young people with severe intellectual or developmental disabilities.
Children and young people who self-harm often do not necessarily restrict themselves to one form of self-harm only, but may choose others when they are unable to self-harm as usual because they are being observed or monitored, or need the relief self-harm provides quickly. Self-harm may indicate a temporary period of emotional pain or distress, or deeper mental health issues which may result in suicide. A great deal of the research and policy literature does not distinguish between self-harm with the intention of committing suicide or self-harm without that intention, sometimes called self injury or self mutilation. Although this briefing recognises that self-harm, specifically self-injury or mutilation, and attempted suicide have very different motivations, the term "self-harm" is used throughout the briefing to denote all of the behaviours described above, including attempted suicide, unless the piece of research being cited explicitly relates to a single type of self injury or mutilation alone. The focus of this briefing therefore is the act of self-harming rather than whether or not the intention was unequivocally to commit suicide.
- Self-harm by children and adolescents most often involves overdoses (self poisoning) and self-mutilation (e.g. cutting behaviours, burning, scalding, banging heads and other body parts against walls, hair-pulling and biting).
- Repeated self-harm is associated with risk of suicide.
- Four times as many girls as boys self-harm up to age 16, although this ratio reduces to twice as many among 18 to 19 year-olds.
- The following are the principal factors associated with increased risk of self-harm among children and adolescents: mental health or behavioural issues, such as depression, severe anxiety and impulsivity; a history of self-harm; experience of an abusive home life; poor communication with parents; living in care or secure institutions.
- Common triggers for self-harm include experience or memories of stressful life events, such as being abused, witnessing domestic violence, disruptive or abusive relationships with parents, problems with boy or girlfriends, going into care, unwanted pregnancy, or problems at home or school.
- No one factor has been shown to predict self-harm. However, a combination of external pressures from home and school life, emotions such as anger, guilt or frustration, and mental or behavioural issues such as depression, conduct disorders or impulsivity, may lead to self-harm.
- Many children and adolescents who repeatedly self-harm consider it to have a positive purpose, a way to relieve unbearable pressure or pain. Some young people view it as a suicide prevention strategy, a means of protecting themselves. It is also seen as a coping strategy over which they have control.
- Self-harm can also be a means of communicating pain and distress to others.