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Mental illness Although some people who self-harm do not suffer from any forms of recognised mental illness,[25] many people experiencing various forms of mental ill-health do have a higher risk of self-harm. The key areas of illness which exhibit an increased risk include autism spectrum disorders,[33][34] borderline personality disorder, bipolar disorder,[35] depression,[14][36] phobias,[14] and conduct disorders.[37] Schizophrenia may also be a contributing factor for self-harm. Those diagnosed with schizophrenia have a high risk of suicide, which is particularly greater in younger patients as they may not have an insight into the serious effects that the illness can have on their lives.[38] Substance abuse is also considered a risk factor[10] as are some personal characteristics such as poor problem-solving skills and impulsivity.[10] There are parallels between self-harm and Münchausen syndrome, a psychiatric disorder in which individuals feign illness or trauma.[39] There may be a common ground of inner distress culminating in self-directed harm in a Münchausen patient. However, a desire to deceive medical personnel in order to gain treatment and attention is more important in Münchausen's than in self-harm.[39] Psychological factors Abuse during childhood is accepted as a primary social factor increasing the incidence of self-harm,[40] as is bereavement,[41] and troubled parental or partner relationships.[10][15] Factors such as war, poverty, and unemployment may also contribute.[14][42][43] Self-harm is frequently described as an experience of depersonalisation or a dissociative state.[44] As many as 70% of individuals with borderline personality disorder engage in self-harm.[45] An estimated 30% of individuals with autism spectrum disorders engage in self-harm at some point, including eye-poking, skin-picking, hand-biting, and head-banging.[33][34] Genetics The most distinctive characteristic of the rare genetic condition Lesch-Nyhan syndrome is self-harm and may include biting and head-banging.[46] Genetics may contribute to the risk of developing other psychological conditions, such as anxiety or depression, which could in turn lead to self-harming behaviour. However, the link between genetics and self-harm in otherwise healthy patients is largely inconclusive.[4] Drugs and alcohol Substance misuse, dependence and withdrawal are associated with self-harm. Benzodiazepine dependence as well as benzodiazepine withdrawal is associated with self-harming behaviour in young people.[47] Alcohol is a major risk factor for self-harm.[29] A study which analysed self-harm presentations to emergency rooms in Northern Ireland found that alcohol was a major contributing factor and involved in 63.8% of self-harm presentations.[48] A recent study in the relation between cannabis use and deliberate self-harm (DSH) in Norway and England, found that, in general, cannabis use may not be a specific risk factor for DSH in young adolescents.[49] |
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