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Abstract
Deliberate self-harm (DSH) is a common and typically secret phenomenon in adolescents, especially females that involves two main features-self-derogation and negative emotionality. Causes of non-suicidal self-injury include attempts to get help from professionals, express disgust or self-anger, resist suicidal thoughts, and correct episodes of dissociation. DSH is associated with eating disorders and alcohol abuse, as well as other illicit drug abuse. Fortunately, most self-cutters are not at high risk for eventual suicide; however, all those with DSH histories should be carefully assessed for suicide as well as offered comprehensive management. Programs for prevention of suicide should be implemented for adolescents at risk for suicide and this includes those with histories of DSH.
Keywords: Pediatrics, adolescence, self-cutting, pain, public health
Introduction
Deliberate self-harm (DSM) is not an illness, but a behavior defined "as an act by an individual with the intent of harming himself/herself physically (1)." Methods of self-harm are noted in Table 1 (2,3) with the most common methods being poisoning and selfcutting in non-fatal injuries (4) and females usually outnumbering males (5). In Western countries, 5-8% of adolescents report self-harm each year because of such issues as depression, drug abuse, anxiety, and poverty (6-9). High risk factors for overt suicide in DSH include a strong suicidal intent, concomitant psychiatric disorders, using a method of high lethality (e.g., gun), and taking measures against being discovered (6,8). Thus, the phenomenon of self-injury is an important issue and will be considered in more detail in this review.
Etiology
Youth who engage in self-cutting and other features of deliberate self-harm are reflecting underlying emotional conflicts and dysfunction. Each youth is a complex individual and a variety of underlying factors may be found that differ in various people in terms of intensity and number of underlying factors. A major factor often found in many self-cutting youth is severe family dysfunction that induces different states of depersonalization and an altered state of mind (dissociation) (10, 11).
Thus, self-cutting may be noted in youth who suffer from sexual or physical abuse (12-14), severe family neglect (15), early separation from parents, being homeless, and running away from home (16). Research also shows the importance of parental alienation that includes intense criticism by parents of their adolescents that induces non-suicidal self-injury...