A presentation about how and why people from different age groups harm themselves, the disorders that self farm is related and code of ethics.

1. CP 510: Professional Ethics and Law
Chatzistavraki Vania
Giannikakis Dimitris
Gkioka Maria
14/10/2013

2. What is Deliberate Self Harm (DSH)?
 DSH an intentional act of self poisoning or self
injury regardless of the type of motivation or
degree of suicidal attempt (Whitlock et al., 2006).
 It is considered to be an indication that something
is wrong and a primary disorder.
 Whatever the type of DSH is used, it is an
unhealthy and dangerous act, and can leave
deep scars. Both physically and emotionally.

3. Types-Expression of DSH
 Cutting the skin
o Sharp objects:
 Razors
 Knives
 Needles/pins
 Sharp stones
 Broken glass
 Deep Scratching
 Burning
 Hitting or brushing
 Biting
 Head banging
 Pulling hair
 Overdose/neglect of
medication-drugs
 Alcohol abuse
 Self mutilation
 Hanging
 Asphyxiation
Royal College of Psychiatrists (2010)

4. Adolescents
 Ross & Heath (2002) the 13 % of the general
adolescent population
 13%-25% of adolescents and young adults
(Rodham & Hawton, 2009)
 Often is repetitive
 Age 14-16 onset
 Begin in childhood continue adulthood
 All marks are hidden even in the summer periods
(e.g. long sleeves)

5. Adolescents (Demographics)
 Prevalent among adolescent girls.
 Population in middle school is in higher risk
because this is the rate they initiate in self-injury
(Gollust, et al., 2008).
 No socioeconomic status give significant
differences (Jacobson & Gould, 2007).
 High risk appear to be in bisexual individuals
compared to heterosexual or homosexual
teenagers.

6. Adolescents Intentionally …
 Harm themselves and usually are documented to
have the following characteristics-disorders:
•
•
•
•
•
•
•
•
•
Depression
Schizophrenic
Abused
Childhood trauma
Poor family communication
Low family warmth
Cope with painful emotions
Feel good of chemical release
Influence by peers
(Ross & Heath, 2002)

7. Adolescents Intentionally …
 Adolescents are not able to handle their emotions
(negative or sensitive) and experience an intense
shame or they cannot control their selves
(Chapman et al., 2006)
 During the self-injury the brain releases
chemicals, the endorphins. They produce a “high”
feeling that causes an addiction to the teenagers
(Sher & Stanley, 2009).

8. Adults
 There is a stereotype that only teenagers and
young girls commit self-harm. However, it is also
common during the adulthood for both genders.
 The rate of self-harm is higher in females, but
fatal self-harm which concluded into suicide is
more prevalent among men (Royal College of
Psychiatrics, 1994).
 Adults are more prevalent into suicide in
comparison to adolescents (Hepple &
Quinton, 1997).

9. Adults
 Adults from all social and cultural backgrounds




commit self-harm, but some individuals are more
vulnerable because of:
Life experiences
Personal or social circumstances
Socioeconomic deprivation (Mitchell &
Dennis, 2006)
Physical factors or a combination of the above

10. Reasons for self-harm in adults
 Bipolar disorder
 Mood disorders
 Alcohol abuse
 Drugs abuse
 Traumatic events
 Coping mechanism (for some individuals self-
harm can be a coping mechanism)
 Illness
(Royal College of Psychiatrist, 1994)

11. Further Research in self-harm in
adults
 Self harm is one of the commonest reasons for
emergency hospital attendance in England and
Wales with an estimated 140-150,000 hospital
presentations every year (Gunnell et al., 2004).
 4026 (99.8%) episodes
o 3198 (79,4%) Overdose
o 457 (11,4%) Self-laceration
o 193(4,8%) combination of laceration and overdose
o 178(4,4%) Other methods
o Bleach/ weed killer (n=30),
o Self strangulation/Hanging (n=27)
o Jumping (n=22)
o Carbon monoxide poisoning (n=19)

12. Mitchell & Dennis (2006) review table
This figure illustrates the difference between the above age groups concerning
the two genders in Deliberate self harm attendances (DSH).

13. Older people who self harm are in
high risk for committing suicide.
 It is more likely to be
MEN over 75 years old.
 Evidence suggest that
fatal and non-fatal self
harm are more closely
related in elderly than in
younger adults.
 Elderly who self harm
are more likely to live
alone or to be single
(Murphy, 2011)
 Elderly
who self-harm
present
67
times
greater
risk
to
committee suicide than
elderly who don’t.
 There is 3 times greater
risk of suicide than
younger adults who self
harm (Murphy, 2011).
 Approximately 90% of
older people who are
both depressed and
self-harmed, committee
suicide
(Merrill
&
Owens, 1990).

14. How they self harm
 34% are Paracetamol
overdose
 30% Benzodiazepine
overdose
 12%
Antidepressant
overdose
 11%
Psychotropic
overdose
 9% Aspirin overdose
From those who self harm:
 40% were sorry they self
harmed.
 40% were ambivalent
and
 20% regretted the fact
they were alive.
(Dennis, Wakefield, Molloy
, Andrews, &

15. What are their motives
1.
2.
3.
4.
5.
6.
61% to gain relief from an intolerable state of
mind.
53% to escape from an intolerable situation.
22% to make other people understand how
desperate the person was feeling.
18% to influence others.
18% to seek help.
12% to make other people feel sorry
(Hawton, Cole, O’Grady, & Osborn, 1982). percentages
 1,3,5 higher
were noticed in depressed
elderly.
 2,4,6 higher percentages
were noticed in non-

16. Diseases elderly suffer when selfharm:
 Most common:
(43%) Depression, (24%)Recurrent
Depression, (1%)Bipolar affective disorder
(currently depressed)
 Less Common: Alcohol abusers, Alzheimer
sufferers.
 19% has no psychiatric disorder (Dennis, et.
al, 2006).

17. Why they self harm?
 79% face difficulties with their own health.
 19% face relationship difficulties.
 17% are affected by other’s health problem.
 6% face financial difficulties.
(Dennis, et. al, 2006)

18. Possible treatments of DSH
 Antidepressants
 Problem solving therapy
 Individual therapy
 Group therapy
 Family therapy
 In-patient hospitalization
 Stress reduction and management skills
 Attention to possible indicators after the therapy for
repeated episodes of DSH
(Mitchell & Dennis, 2005)

19. Ethical Codes for DSH
 AMHCA (2010), in Confidentiality section, the
counselor has to break off the confidentiality in cases
of self harm, suicidality or other extreme occasion
(abuse, murder, neglect) that threat the client or
others.
 BPS (2009), in Confidentiality section 4.3 the
psychologist disclosures when there is adequate
indication about the safety of the client. Has to
inform appropriate third parties without prior consent.

20. Ethical Codes for DSH
 Counselors also have responsibilities to parents
and the school (ASCA, 2004).
 In Standard D.1b, p. 2 ( ASCA) informs the
appropriate officials in accordance with school
policy and the parents..
 ACA (2005) B.1.b, Respect for Confidentiality, the
therapist do not share confidential information only in
a few serious situations, harm to him/herself or
others.
 All of the Codes of Ethics state that all of the above occur
especially in minority groups (children, teenagers and elder).
Especially, when the individuals are not able to decide for
themselves (e.g. mental illness).

22. Additional guidance for self harm
According to National Institute for Health and Care
Excellence (2004):
 Self harmed individuals deserve equal
treatment, respect and confidentiality, as any other
patient.
 Health care professionals should also take under
consideration the possible distress and the emotional
damage these people have experienced, and they
should provide them emotional support and
supervision.
 Furthermore, they should sympathize with the clients
and encourage them to express their feelings about
their self harm experience.
 Psychologists should have a risk assessment for all
age groups in order to avoid suicidal attempts.
 A psychiatric diagnosis is also recommended for
individuals with DSH.

24. References
American Counseling Association (1995).Code of ethics
and standards of practice. Alexandria, VA: Author.
American Mental Health Counselors Association (2010).
Code of Ethics. Alexandria, VA: Author
American School Counselor Association (2004). ASCA
ethical standards. Alexandria, VA: Author
British Psychological Society (2009). Code of Ethics and
Conduct. Ethics Committee of the British Psychological
Society.
Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006).
Solving the puzzle of deliberate self-harm: The
experiential avoidance model. Behavior Research and
Therapy, 44(3), 371-394.
Dennis, M., S., Wakefield, P., Molloy, C., Andrews, H. &
Friedman, T. (2006). A study of self-harm in older people:
Mental disorder, social factors and motives. Aging &
Mental Health.

25. References
Gollust, S. E., Eisenberg, D., & Golberstein, E. (2008).
Prevalence and correlates of self-injury among university
students. Journal of American College Health, 56, 491498.
Gunnell, D., Bennewith, O., Peters, J., House, A., Hawton, K.
(2004). The epidemiology and management of self-harm
amongst adults in England. Journal of public health. Vol
27, no 1, 67-73.
Hawton, K., Cole, D., O’Grady, J., & Osborn, M. (1982).
Motivational aspects of Deliberate self- poisoning in
adolescents. British Journal of Psychiatry, 141, 286-291.
Hepple, J., & Quinton, C. (1997). One hundred cases of
attempted suicide in the elderly. British Journal of
Psychiatry, 171: 42-46
Jacobson, C. M., & Gould, M. (2007). The epidemiology and
phenomenology of non-suicidal self-injurious behavior
among adolescents: A critical review of the literature.
Archives of Suicide Research, 11(2), 129-147.

26. References
Mitchell, A., & Dennis, M. (2006). Self harm and attempted
suicide in adults: 10 practical questions and answers for
emergency department stuff. Emergency Medicine
Journal.
Murphy, E., (2011). Risk factors for repetition and suicide
following self-harm in older adults: multicentre cohort
study.
National Institute for Health and Care Excellence (2004).
Self-harm: The short-term physical and psychological
management and secondary prevention of self-harm in
primary and secondary care. Retrieved from
http://publications.nice.org.uk/self-harm-cg16/guidance
Rodham, K., & Hawton, K. (2009). Epidemiology and
phenomenology of nonsuicidal self-injury. In M. K. Nock
(Ed.), Understanding nonsuicidal self-injury:

27. References
Ross, S. and Heath, N. (2002). A study of the frequency
of self-mutilation in a community sample of
adolescents. Journal of Youth and Adolescents, 31
(1): 67-78
Royal College of Psychiatrists (2010). Selfharm, suicide and risk: helping people who self-harm.
College Report CR158, Royal College of
Psychiatrists.
Sher, L., & Stanley, B. (2009). Biological models of
nonsuicidal self-injury. In M. K. Nock
(Ed.), Understanding nonsuicidal self-injury:
Origins, assessment, and treatment (pp. 99-116).
Washington, DC: American Psychological Association.
Whitlock, J., Eckenrode, J., & Silverman, D. (2006).
Self-injurious behaviors in a college population.
Pediatrics, 117, 1939-1948.