Intentional self-harm NSW Department Of Health

Data table

View data table

Note

Includes suicide (attempted) and purposedly self-inflicted poisoning or injury. Hospital separations were classified using ICD-9-CM up to 1997-98 and ICD-10-AM from 1998-99 onwards. Rates were age-adjusted using the Australian population as at 30 June 2001. Numbers for 2006-07 include an estimate of the small number of interstate hospitalisations, data for which were unavailable at the time of production.

Source

NSW Admitted Patient Data Collection and ABS population estimates (HOIST). Centre for Epidemiology and Research, NSW Department of Health.

Commentary

Completed suicide is only one outcome of intentionally self-harming behaviours.

One other outcome of these behaviours is hospitalisation. It is not accurate to regard hospitalised self-harm as equivalent to 'attempted suicide' for comparison with 'completed suicide'. There is some overlap between hospitalised self-harm and suicide, as some suicide deaths occur after admission to a hospital, however, hospitalised self-harm is more frequent than completed suicide. (Steenkamp et al, 2000).

Most people who contact health services after an episode of intentional self harm are seen by emergency departments. They may or may not be admitted as hospital inpatients, and the injury may or may not be recorded as intentional. In recent years, there have been more than 10,000 hospital separations per year following an episode of intentional self harm.

Hospitalisation rates for intentional self-harm are consistently higher in females than in males, while the death rates from suicide are about 3 - 4 times greater in males than in females. This is thought to be mostly due to males using more lethal methods than females. The numbers of young females aged 15-24 hospitalised for self harm has begun to decrease after a peak in 2004-05 (483.0 per 100,000 in 2004-05), however the numbers remain significantly higher than among any other age group (435.6 per 100,000 population compared to 185.3 per 100,000 for females of all ages in 2006-07).

[back to top]

For more information

NSW Department of Health. Suicide prevention in NSW. Sydney: NSW Department of Health, 2003. Available at www.health.nsw.gov.au/pubs/s/pdf/well_suicide.pdf.

NSW Government New South Wales Interagency Action Plan for Better Mental Health Sydney: Available at http://www.dpc.nsw.gov.au/__data/assets/pdf_file/0015/11490/interagency.pdf

NSW Department of Health. Policy guidelines for the management of patients with possible suicidal behaviour for NSW Health staff and staff in private health facilities. Sydney: NSW Department of Health Circular 92/31, 1998.

Pirkis J, Burgess P, Dunt D. Suicidal ideation and suicide attempts among Australian adults. Crisis 2000; 21: 16-25.

Steenkamp M, Harrison J. Suicide and hospitalised self-harm in Australia. Injury Research and Statistics Series. AIHW Catalogue no. INJCAT 30. Adelaide: Australian Institute of Health and Welfare, 2000.

Steenkamp M, Harrison J. Suicide and hospitalised self-harm in Australia. Injury Research and Statistics Series. AIHW Catalogue no. INJCAT 30. Adelaide: Australian Institute of Health and Welfare, 2000.

Australian Government of Health and Aged Care's suicide prevention information available at Suicide prevention, national suicide prevention strategy www.health.gov.au/internet/wcms/publishing.nsf/Content/mental-suicide and at Healthinsite www.healthinsite.gov.au/topics/Suicide_Prevention.

Print version with data

Although this page can be printed directly from your Web browser, a higher quality version of this entire page (graph, table and text) is available as an Acrobat PDF file which can be printed or viewed on screen using free software.

Downloadable files

The data contained in the table on this page are available for download as a CSV file which can be imported into many software packages. The graph is available for download as an EPS (Encapsulated PostScript) file and as an EMF (Enhanced Metafile Format) file. Files in these formats can be imported into most word processing, presentation and graphics software packages.

Copyright notice

This work is copyright NSW Department of Health, 2006. It may be reproduced in whole or in part, subject to the inclusion of an acknowledgement of the source. Commercial usage or sale is prohibited.

Suggested citation

Population Health Division. The health of the people of New South Wales - Report of the Chief Health Officer. Sydney: NSW Department of Health. Available at: www.health.nsw.gov.au/publichealth/chorep/. Accessed (insert date of access).

Produced by

Centre for Epidemiology and Research, Population Health Division, NSW Department of Health.

Last updated on 15 December 2008

Wordless Wednesday

The Internet and Self-Injury: What Psychotherapists Should Know

Abstract

The Internet affords information gathering and sharing previously impossible. For individuals who practice self-injury, this capacity allows rapid identification of others with shared history, experience, and practices. For many of those who self-injure, the ability to find others like themselves reduces the isolation and loneliness which so often characterizes the behavior.

For others, however, active participation in on-line communities may effectively substitute for the real work required to develop positive coping and healthy relationships. Our experience suggests that regular assessment of self-injury Internet use is uncommon in therapeutic settings. Proliferation of self-injury message boards, informational websites, blogs, and YouTube posts is a clinical challenge. In this article, we review the research on self-injury and Internet use and then make a series of recommendations for clinicians.

Read entire report here

Professional Help

What problems may be encountered when getting professional help?

Self-injury brings out many uncomfortable feelings in people who don't do it: revulsion, anger, fear, and distaste, to name a few. If a medical professional is unable to cope with her own feelings about self-harm, then she has an obligation to herself and to her client to find a practitioner willing to do this work. In addition, she has the responsibility to be certain the client understands that the referral is due to her own inability to deal with self-injury and not to any inadequacies in the client.

People who self-injure do generally do so because of an internal dynamic, and not in order to annoy, anger or irritate others. Their self-injury is a behavioral response to an emotional state, and is usually not done in order to frustrate caretakers.

What problems may be encountered in the emergency room?

In emergency rooms, people with self-inflicted wounds are often told directly and indirectly, that they are not as deserving of care as someone who has an accidental injury. They are treated badly by the same doctors who would not hesitate to do everything possible to preserve the life of an overweight, sedentary heart-attack patient.

Doctors in emergency rooms and urgent-care clinics should be sensitive to the needs of patients who come in to have self-inflicted wounds treated. If the patient is calm, denies suicidal intent, and has a history of self-inflicted violence, the doctor should treat the wounds as they would treat non-self-inflicted injuries. Refusing to give anesthesia for stitches, making disparaging remarks, and treating the patient as an inconvenient nuisance simply further the feelings of invalidation and unworthiness the self-injurer already feels.

Although offering mental health follow-up services is appropriate, psychological evaluations with an eye toward hospitalization should be avoided in the emergency room unless the person is clearly a danger to his/her own life or to others. In places where people know that self-inflicted injuries are liable to lead to mistreatment and lengthy psychological evaluations, they are much less likely to seek medical attention for their wounds and thus are at a higher risk for wound infections and other complications.

taken from Focus Adolescent Services

Why Does Self-injury Make Some People Feel Better?

• It reduces physiological and psychological tension rapidly.
  Studies have suggested that when people who self-injure get emotionally overwhelmed, an act of self-harm brings their levels of psychological and physiological tension and arousal back to a bearable baseline level almost immediately. In other words, they feel a strong uncomfortable emotion, don't know how to handle it (indeed, often do not have a name for it), and know that hurting themselves will reduce the emotional discomfort extremely quickly. They may still feel bad (or not), but they don't have that panicky jittery trapped feeling; it's a calm bad feeling.

• Some people never get a chance to learn how to cope effectively.
  One factor common to most people who self-injure, whether they were abused or not, is invalidation. They were taught at any early age that their interpretations of and feelings about the things around them were bad and wrong. They learned that certain feelings weren't allowed. In abusive homes, they may have been severely punished for expressing certain thoughts and feelings. At the same time, they had no good role models for coping. You can't learn to cope effectively with distress unless you grow up around people who are coping effectively with distress. Although a history of abuse is common about self-injurers, not everyone who self-injures was abused. Sometimes invalidation and lack of role models for coping are enough, especially if the person's brain chemistry has already primed them for choosing this sort of coping.

• Problems with neurotransmitters may play a role.
  Just as it's suspected that the way the brain uses serotonin may play a role in depression, so scientists think that problems in the serotonin system may predispose some people to self-injury by making them tend to be more aggressive and impulsive than most people. This tendency toward impulsive aggression, combined with a belief that their feelings are bad or wrong, can lead to the aggression being turned on the self. Of course, once this happens, the person harming himself learns that self-injury reduces his level of distress, and the cycle begins. Some researchers theorize that a desire to release endorphins, the body's natural painkillers, is involved.

• taken from: Focus Adolescent Services
  

Strength

How do you find strength when you have nothing left? I use quotes, things others have said I am honest and say 'I just cant do this'.

One of the signs that I am in 'trouble' is that I isolate, cut off friends, create petty arguments, wont answer phones etc I turn inward, I can go days without seeing people. At the time I most need people, I shut them out.

The Proverbial Wall...

Spiral

What happens when all your coping mechanisms are destructive . . .

Well not all (yes there is yoga, painting, blah blah blah), but the ones that work, that are instant gratification...

When your mind is screaming, or worse talking in dull monotone, repetitive suggestion . . .

When you just want to scream 'Shut the F*ck Up!'

When your first thought is 'No one will know' and the second is where is my kit . . .

Who does it harm?, nobody ... doh! that's why its called Self Harm


If you give someone 50 reasons why they shouldn't, they could give you 50 why they should.

But the main ones are

"I cant deal with this pain"

and 'It keeps me alive'

So before you judge, think about that

Stereotypes

I had a client once, beautiful, vibrant. Her father (perfectionist, career man) sounded proud of her recovery, her determination to not cut. After our session was finished he confided 'Im not really concerned about the self harm business. I read that its a teen thing and I'm sure she will grow out of it'

Wrong Mr W. , its not a teen thing . . .

Hope

Most of the important things in the world have been accomplished by people who have kept on trying when there seemed to be no hope at all.

Dale Carnegie
American Author

No matter how many times I try and fail, how stupid I feel for daring, how many promises I make to myself that end broken, I will keep trying because deep in my soul, where no one treads but me, I know I am worth more than this, I know I deserve better and I will keep trying till I succeed . . . Love Abbey

About Self Injury

Self harm is when someone deliberately hurts or injures themselves. Self injury can take a number of forms including:

• cutting or burning - the most common forms of self-harm

• taking overdoses of tablets or medicines
• punching themselves
• throwing their bodies against something
• pulling out their hair or eyelashes
• scratching, picking or tearing at their skin causing sores and scarring
• inhaling or sniffing harmful substances
• swallowing things that are not edible
• inserting objects into their bodies

Why Do People Self Injure?

Psychological motivations: What self-injurers say SI does for them.

Many papers on self-harm (Miller, 1994; Favazza 1986, 1996; Connors, 1996a, 2000; Solomon & Farrand, 1996; Ousch et al., 1999; Suyemoto, 1998; and others), have uncovered possible motivations for self-injurious behaviours:

• Escape from emptiness, depression, and feelings of unreality.
• Easing tension.
• Providing relief: when intense feelings build, self-injurers are overwhelmed and unable to cope. By causing pain, they reduce the level of emotional and physiological arousal to a bearable one.
• Relieving anger: many self-injurers have enormous amounts of rage within. Afraid to express it outwardly, they injure themselves as a way of venting these feelings.
• Escaping numbness: many of those who self-injure say they do it in order to feel something, to know that they're still alive.
• Grounding in reality, as a way of dealing with feelings of depersonalisation and dissociation
• Maintaining a sense of security or feeling of uniqueness
• Obtaining a feeling of euphoria
• Preventing suicide
• Expressing emotional pain they feel they cannot bear
• Obtaining or maintaining influence over the behaviours of others
• Communicating to others the extent of their inner turmoil
• Communicating a need for support
• Expressing or repressing sexuality
• Expressing or coping with feelings of alienation
• Validating their emotional pain -- the wounds can serve as evidence that those feelings are real
• Continuing abusive patterns: self-injurers tend to have been abused as children.
• Punishing oneself for being "bad"
• Obtaining biochemical relief: there is some thought that adults who were repeatedly traumatized as children have a hard time returning to a "normal" baseline level of arousal and are, in some sense, addicted to crisis behaviour. Self-harm can perpetuate this kind of crisis state
• Diverting attention (inner or outer) from issues that are too painful to examine
• Exerting a sense of control over one's body
• Preventing something worse from happening

The assumption is that the alternative to self injury is acting normal but on the contrary…the alternative to self injury is total loss of control and possibly suicide.

Hence the need to carefully manage a young person’s self harm is crucial to enable them to remain safe. Ensuring that they are empowered to minimise the harm that they do to themselves and maximise their potential to gain positive control over their lives.

[taken from Newcombe House UK]

Dissociation World

Dissociation exists on a continuum with these everyday symptoms at one end and at the other more severe symptoms such as amnesia and identity alteration. At this end dissociation is often described as ‘going away’ as the sufferer voluntarily leaves their own body. These severe symptoms usually indicate a dissociative disorder especially if they are persistent, difficult to control and affect the sufferer’s everyday life.

There are five dissociative disorders:

1. Dissociative Amnesia – this is indicated when there is an inability to recall important personal information

2. Dissociative Fugue – this refers to the situation where a sufferer finds themselves in a place with no memory of getting there and sometimes with no knowledge of who they are.

3. Depersonalisation Disorder – this is a recurrent feeling of being detached from yourself or your feelings.

4. Dissociative Identity Disorder (DID) – previously known as multiple personality disorder this is characterised by the existence of two or more separate identities within one person who are able to take control.

5. Dissociative Disorder Not Otherwise Specified (DDNOS) – this often precedes a diagnosis of DID and is used until a definitive diagnosis of DID is able to be made.

Causes

Although dissociation is a common experience those with an actual dissociative disorder almost universally have a background of childhood trauma especially sexual and physical abuse. Over 99% of those diagnosed with DID have a history of prolonged and severe childhood sexual abuse usually with an early age of onset (before the age of eight) and the abuser being one or more of the child’s caregivers. There has been no genetic link indicated. This is probably because everybody is capable of dissociation as a young child but few people are in the situation of having to use it on a regular basis. This regular usage as a defence leads to the ability to dissociate being retained into adulthood and therefore leads directly to dissociative disorders.

There are a few cases where dissociative disorders have developed after a single trauma and they have been observed in those kept in captivity for long periods of time. Little is currently known about the phenomenon of dissociation itself. It is currently considered to be a highly creative and intelligent defence and a ‘trick of the imagination’. However newer studies have shown that dissociation is a biological phenomenon – brain imaging has shown that associative pathways in the brain are shut down during the dissociative experience. This suggests that the dissociative experiences may well be ‘real’ as opposed to imaginative.

Link to the excellent site is in the banner...

The Mind

" Each thought has power of its own.
Positive thought has a power and negative thought also has a power.
With positive power we build; with negative power we break.
Each positive thought is creation and each negative thought is destruction."

" When a negative thought comes, we have to feel that it is a thief.
A negative thought comes in the form of doubt, fear, jealousy, hypocrisy or meanness.
We have to feel that each negative thought has come to commit a theft,
to take something away from our inner life and inner wealth."

*"Negative Thoughts" - Excerpt from The Soul's Evolution by Sri Chinmoy."

The Black Dog

Since Churchill, people have related to the term of depression being a black dog, in fact in Australia the depression institute is named that. Its not like that for me.

Depression is more of a person, a shadow self. This friend is familiar to me, no surprises. Even at his worst and most destructive this friend is there. He envelopes me in negativity, talks to me in sense, 'You cant do that, dont try that, dont believe others, you know your not good at that' He is like the life coach, holding my hand, drawing me deeper.

With a deep slow voice, he entices me to stay with him, 'you know your not good enough, stay here with me where you belong' I fall into his arms as easy as too a lover & a blackness envelopes me, even the air is thick. There is no need for me to eat, to bathe, to dress or go outside. I slow my breathing, my thoughts and movements to his pace. Everything is slow, everything is meaningless.

Even living seems meaningless, his seductive voice whispers on, it all makes sense when you hear it from him & you fail to hear your own voice or the voice of others but give in to his as fighting is just too hard.

Cutting and Self-Injury

By John M. Grohol, Psy.D.

January 5, 2009

This entry may be triggering or difficult to read for some people.

Self-injury behavior is something that is more common than many people realize. (In one study by researchers at Brown University of high school students, 46 percent had injured themselves in the past year on multiple occasions.) It is often misunderstood, not just by the lay public, but also by the mental health professionals who ostensibly should know what self-injury it is and how best to treat it.

Self-injury is used by people as over-drinking is used by others — to drown out emotional pain with something else. In the case of self-injury, that something else is physical pain. It focuses your attention and takes your mind off of your emotional pain, if only for a little while.

Cutting is the most common form of self-injury — making skin-deep cuts on one’s arms, wrists, or less noticeable areas on one’s body. The cuts are not meant to cause permanent damage or harm, nor are they meant as a suicidal gesture. The cuts are the means to an end themselves — they provide a source of immediate but non-serious physical pain (as long as they are allowed to heal cleanly). Other forms of self-injury include burning, or keeping old wounds open or inviting infection in them to keep them painful.

The people with the most severe self-injury behavior often can think of little else as they go through their day — it becomes something more than just a way to deal with emotional pain, it becomes its own obsession, as it did with Becki, a person who self-injured and is profiled in an article that appeared online in Newsweek last week:

Becki describes it as an obsessive battle, and one she often lost. At her worst, she says she spent every hour living and breathing self-injury. She dreamed about it. She’d think about it at school. She bought every book published on it. She searched for self-injury Websites, and compiled what she found into a 13-page Website of her own. “I was cutting 10-plus times a day, and still, if I didn’t do it, I would feel like I was missing something,” she says.

Newsweek’s article is a fairly good read on self-injury and self-harm, describing what self-injury is, using Becki as a case study, and brings us up-to-date on treatment options and the latest research into self-injury. If nothing else, it helps bring this behavior out into the open more, helping people understand that it is not something that one should be ashamed of and that it can be treated.

As the article notes, self-injury isn’t recognized as a mental disorder by itself. But that doesn’t mean it can’t be treated. Treatment usually is done through psychotherapy, and focuses on helping the person identify their own triggers for self-injurious behavior, and find alternative methods for helping them deal with the emotional pain in their life.

Read the full article: Why She Cuts (Potentially Triggering)

Dr. John Grohol is the CEO and founder of Psych Central and has been writing about mental health and psychology issues online since 1992.

What Depression Feels Like

The following is a description of how I feel when I'm going through a depressed period. It is not how I feel most of the time.

Useless: When I get depressed, I feel useless. I have this feeling that everything I've ever done is worthless, and that anything I'll ever do will be equally worthless. I feel like nothing I do matters. When I do try to accomplish something, I feel like it isn't good enough no matter how hard I work on it. Even worse, I feel like everybody is aware of my failure, and I feel incredibly guilty for being a failure. I look at my lazy housekeeping and feel like a failure as a homemaker. I mentally replay all of the mistakes I've made with my kids, and I feel like a failure as a mother. I look at my body and feel like a failure as a wife because I'm not as attractive as I'd like to be. My self-esteem plummets, and I feel like a burden on my poor husband.

Tired: When I get depressed, I'm too tired to do anything. Everything feels like an overwhelming task, even getting dressed or brushing my teeth. If somebody tries to convince me to do anything, I feel guilty for not wanting to comply and resentful at the idea that they would ask me to do anything when I'm feeling so tired. Along with my physical fatigue I feel mentally fatigued. I have to force myself to do everything I do.

Irrational: When I get depressed, I have a hard time thinking. Problem solving is difficult, even for little things like adding two numbers or figuring out which tool to use to complete a task. I react to situation emotionally rather than logically, so I end up making mistakes I regret. I lose my temper with my kids and pets when they don't follow the family rules, and I start yelling at them rather than logically disciplining them. In extreme cases of depression, I may even think about running away or suicide even though I don't plan on doing either.

Unsocial: When I get depressed, I don't want to socialize even though I realize that it probably would be good for me to get around other people and lift my spirits.

Stuck: When I get depressed, I feel like I'm trapped, stuck in this pit of worthlessness. While I'm trapped, I feel like life is passing me by. I sometimes think that things will never get better.

Source