People who engage in self-harm deliberately hurt their bodies.
The term 'self-harm' (also referred to as 'deliberate self-harm' or
DSH) refers to a range of behaviours, not a mental disorder or
illness (1). At the milder end of the
spectrum, these behaviours include mild to moderate self-injury as
a response to emotional pain and, at the more extreme end,
attempted suicide (1, 2). The
most common methods of self-harm among young people are cutting and
deliberately overdosing on medication. Other methods include
burning or scalding the body, pinching and scratching oneself,
self-hitting and hanging (2).
In many cases self-harm is not intended to be fatal (2). It is estimated that the number of young people
who have engaged in self-harm is 40-100 times greater than those
who have actually ended their lives (3). For many
young people self-harm is a coping strategy, however maladaptive
and damaging, that allows them to continue to live rather than an
attempt to end their life (4).
There is now a general consensus among clinicians and
researchers that there is a distinct type of self-harming
behaviour, termed non-suicidal self-injury (NSSI) in which the
motivation is not intention to die, and that these behaviours
should be distinguished from those that are suicidal in nature (5). However research studies typically fail to make
this distinction and there is continued debate about terminology
and definitions (6). Other terms used to refer to
different forms of self-harm include self-injury, cutting,
parasuicide and attempted suicide.
Although many young people might try to hide their self-harming
behaviour, there are some obvious and less obvious signs that
someone might be self-harming (1). These
- Obvious changes in mood
- Changes in sleeping and eating patterns
- Losing interest and pleasure in activities that were once
- Decreased participation and poor communication with friends and
- Hiding or washing their own clothes and avoiding situations
were exposure of arm and legs is required (eg, swimming)
- Problems in social or intimate relationships
- Strange excuses provided for injuries
- Problems with work, school, social or family life
- Unexplained injuries, such as scratches, cuts or burn
- Unexplained physical complaints such as headaches or stomach
- Wearing clothes that cover up arms and legs, even in hot
Burden of youth suicide and self-harm in young
The most recent 'causes of death' publication from the
Australian Bureau of Statistics (ABS) indicates that in 2011,
suicide was the leading cause of death for young people aged 15-24,
followed closely by road traffic accidents (7). In 2011, 80 males aged 15-19 years and 151
males aged 20-24 years died by suicide (7).
For young females, 35 aged 15-19 years and 55 aged 20-24 years died
by suicide (7). (These figures should be
interpreted with caution as they are subject to an ABS revision
process which could see them change, see (8) for
The number of young people who die by suicide in Australia each
year is relatively low compared with the number who self-harm. It
is difficult to estimate the rate of self harm as evidence suggests
that only 10% of young people who self-harm will present for
hospital treatment (9). Evidence from Australian
studies suggest that 6-7% of Australian youth aged 15-24 years
engage in self-harm in any 12-month period (9).
Lifetime prevalence rates are higher, with 24% of females and 18%
of males aged 20-24 and 17% of females and 12% of males aged 15-19
reporting self-harming at some point in their life (10). While suicide is more common among young men,
self-harm is more common among young women.
Taken together, suicide and self-harm account for a considerable
portion of the burden of disability and mortality among young
Australians. It is estimated that 21% of "years life lost" due to
premature death among Australian youth in 2004 was due to suicide
and self-inflicted injury (11). In addition,
non-fatal suicidal behaviour and self-harm are associated with
substantial disability and loss of years of healthy life (11).
Common risk factors or characteristics for those self-harm are
similar to those who complete suicide (12). These
- History of self-harm and/or previous suicide attempt
- Mental or substance use disorders, especially depression
- Physical illness: terminal, painful or debilitating
- Family history of suicide, substance abuse and/or other
- History of sexual, physical or emotional abuse
- Socially isolated and/or living alone
- Bereavement in childhood
- Family disturbances
- Unemployment, change in occupational or financial status
- Rejection by a significant person eg, relationship breakup
- Recent discharge from a psychiatric hospital
Experiencing a mental health problem is a risk factor for both
self-harm and suicide. Evidence suggests that more than 90% of
people who present to hospital with self-harm have a mental
disorder, the most common being depression (2). A history of mental illness, in particular
depression, as well as the presence of more than one mental
disorder are also strong predictors of suicide (14-16).
While not all young people who self-harm or contemplate suicide
have a mental health problem, these behaviours do suggest the
experience of psychological distress.
1. Self-harm: Australian treatment guide for
consumers and carers. 2009 Royal Australian and New Zealand
College of Psychiatrists.
2. Skegg K. Self-harm. Lancet. 2005 Oct 22-28;366(9495):
3. Fox C, Hawton K. Deliberate self-harm in adolescence. 2004.
Jessica Kingsley Publishers: London.
4. Nock MK, Prinstein MJ, et al. Revealing the form and function of self-injurious
thoughts and behaviours: A real-time ecological assessment study
among adolescents and young adults. J Abnormal Psychol. 2009
5. Kelly CM, Jorm AF, et al. Development of mental health first aid guidelines
for deliberate non-suicidal self-injury: a Delphi study. BMC
Psychiatry. 2008 Jul 23;8: 62.
6. Jacobson CM, Gould M. The epidemiology and phenomenology of non-suicidal
self-injurious behaviours among adolescents: a critical review of
the literature. Arch Suicide Res. 2007;11(2): 129-147.
7. Australian Bureau of Statistics
(2013). Causes of death, 2011 Cat. no. 3303.0. ABS:
8. Australian Bureau of Statistics.
Technical note 2: causes of death revisions 2008
and 2009. 2012, ABS: Canberra.
9. De Leo D, Heller TS. Who are the kids who self-harm? An Australian
self-report school survey. Med J Aust. 2004 Aug 2;181(3):
10. Martin G, Swannell SV, et al. Self-injury in Australia: a community survey.
Med J Aust. 2010 Nov 1;193(9): 506-510.
11. Australian Institute of Health
and Welfare. Youth Australians: their health and wellbeing.
2007 Cat. no. PHE 87. Canberra: AIHW.
12. Hawton K, James A. Suicide and deliberate self harm in young
people. BMJ. 2005 Apr 16;330(7496): 891-894.
13. World Health Organisation. Preventing suicide: a resource for general
physicians. 2000. WHO: Geneva.
14. Beautrais AL. Risk factors for suicide and attempted suicide amongst
young people. Aust NZ J Psychiatry. 2000 Jun;34(3): 420-36.
15. Rey JM, Dudley MJ. Depressed youth, suicidality and
antidepressants. Med J Aust. 2005 182(8): 378-9.
16. Schmidt P, Muller R, et al. Suicide in children, adolescents and young
adults. Forensic Sci Int. 2002 Jul 17;127(3): 161-7.