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Self-Harm - Science topic

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If I assist a patient with a case of self-poisoning in Brazil, do I need to report it on the exogenous intoxication form and on the self-harm form at the same time? Or maybe I should only report as a self-harm poisoning?
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The law requires the judgement of intent. It is self-inflicted harm is there was suicidal intent. Accidental poisoning would likely fit exogenous intoxication.
Does it give the definitions used on the forms?
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I'm looking for co-authors Are you a master's or doctoral student in psychology, behavioural sciences, social work, counseling psychology or a related discipline and would like to co-author a study on the depth of emotional pain? If so, let's examine this together.
Have you ever wondered why people self-harm when they are in discomfort or emotional pain? Some curse injury by cutting or burning their flesh, punching or hitting oneself. They do this to divert attention away from the pain or to distract the brain. Can you fathom burning your skin in order to relieve emotional pain? We won't be able to grasp why individuals do what they do or how to help them unless we understand the depth of emotional agony. It is simple to discuss bodily pains caused by injury or illness. Non-physical pain, on the other hand, is difficult to discuss, and instant treatment is impossible.
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Before we start an article or research on emotional pain, I think we should look closely about the main components or dimensions that make up emotional pain, and through which we can find a treatment that enables us to overcome or alleviate it in the individual who suffers from it.
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I am investigating the efficacy of Gestalt therapy with adolescents engaging in self-harm, using a single case experimental design. I have administered some tools to measure the level of self-harm, anxiety and depression at baseline, after 15 sessions and after 30 sessions. What statistical measures would you suggest I use to show the effect of the treatment besides visual analysis?
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Paired sample t-tests could be a simple approach to look at differences in a single variable from pre treatment to post treatment.
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People may experience: Behavioural: aggression, antisocial behaviour, compulsive behaviour, fidgeting, hyperactivity, impulsivity, repetitive movements, screaming, self-harm, social isolation, or persistent repetition of words or actions Muscular: inability to combine muscle movements, poor coordination, tic, or clumsiness Mood: anger, anxiety, apprehension, or loneliness Also common: depression, learning disability, nightmares, restricted behavior, sensitivity to sound, or stuttering
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Asperger's Syndrome, as such, has been "discontinued" as such, by the DSM-V (5) of the APA, and without "specific traits or own indicators" has been introduced within the "Autism Spectrum Disorders ( ASD) "... now well -and that said- if you are interested in the" proper indicators "that appeared in the DSM-IV and DSM-IV-TR (included within General Developmental Disorders), these were:
A) Alteration of social interaction, manifested by at least two of these characteristics: 1- Important alteration of the use of multiple non-verbal behaviors such as eye contact, facial expression, body postures and regulatory gestures of said social interaction. 2- Inability to develop relationships with peers appropriate to the level of development of the subject. 3- Absence of the spontaneous tendency to share enjoyment, interests and objectives with other people. 4- Lack of social or emotional reciprocity.
B)Restrictive, repetitive and stereotyped patterns of behavior, interests and activities, manifested by at least one of these characteristics: 1- Absorbing concern for one or more stereotyped and restrictive patterns of interest that are abnormal, either due to their intensity or their objective or by both. 2- Apparently inflexible adherence to specific non-functional or adaptive routines or rituals. 3- Stereotyped and repetitive motor mannerisms. 4- Persistent preoccupation with parts of objects.
C)The disorder causes a clinically significant impairment of the individual's social, occupational and other important areas of activity.
D) There is no clinically significant general language delay.
E) There is no clinically significant delay in cognitive development or in the development of self-help skills typical of age, adaptive behavior -except for social interaction- and curiosity about the environment during childhood.
F) Does not meet criteria for another pervasive developmental disorder or schizophrenia.
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According to WHO reports In public mental health terms, the main psychological impact to date is elevated rates of stress or anxiety. But as new measures and impacts are introduced – especially quarantine and its effects on many people’s usual activities, routines or livelihoods – levels of loneliness, depression, harmful alcohol and drug use, and self-harm or suicidal behaviour are also expected to rise. ( http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/novel-coronavirus-2019-ncov-technical-guidance-OLD/coronavirus-disease-covid-19-outbreak-technical-guidance-europe-OLD/mental )
Many of people suffering a lot due to be victims and witnesses who were not physically harmed receive psychological help and are checked for signs of needing further post-traumatic treatment or for losing hopes/ economic problems; .......the statistics now be announced that : With some 2.6 billion people around the world in some kind of lockdown, we are conducting arguably the largest psychological experiment ever; .....
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It is so interesting question
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Can anyone advise me on which type of statistical analysis I should use? I want to look at the association between receiving a particular service (yes/no) and subsequent self-harm (yes/no) and whether the effect is mediated by social support (continuous), controlling for baseline SS. Thanks in advance!
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If you want to explore the mediating effect, a series of analyses are needed. ”Process“, a special program, performed by SAS or SPSS could be used.
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Hello everyone,
I'm studying the link between psychopathy and self-aggression/suicide. All variables are numeric.
IV is psychopathy: 4 levels.
DV is self-aggression.
I would like to test the contribution of gender, traumatic experiences and aggressiveness.
And control age and borderline personality disorder (BDP).
I'm considering these two options:
1. Multiple regression + post hoc: First I would do a multiple regression to test the 4 levels of the IV and then analyse the contribution (moderation / mediation) of gender, traumatic experiences and aggressiveness.
But using this method I can't control age and BDP, right?
2. Multiple hierarchical regression : First I would do a multiple regression to test the 4 levels of the IV. Then first model would include age and BDP, second one gender, third traumatic experiences and fourth aggressiveness. I would do 4 regressions, one for each level of the IV (psychopathy).
If the difference of R2 between model 1 and 2, 3, 4 is significant then I can report ΔR2 as the additional variance explained, hence knowing if any of the variables have an impact on self-aggression.
Thanks in advance!
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You do not need to do any post-hoc tests for multiple linear regression analysis.
From the part correlation column you see how much each IV contributes with (when you square the part correlation you get the %). The IV percentages do not add up to the R2 because the only tell how much each IV uniquely and significantly contribute to the total variance in your DV.
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College students seem under a lot of psychological pressure to boost their academic performance.
However, while some pressure can improve their overall grade, such stress can also trigger psychological disorders that can reach self harm or even suicide.
How can we help them?
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They should be helped to discover their unique meaning and gift in life: Our paper:
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Hi there
Can anyone recommend an assessment of risk for suicide and self harm for people with an intellectual disability? I have had a brief look at the evidence base and risk factors for this population are similar to the general population, so if there are no specific risk assessment for this group, which risk assessment would you recommend more generally for suicide and self harm risk?
Any advice would be gratefully received.
Best wishes
Bronwen
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Hi Bronwen,
I think this is a fascinating topic - I echo the sentiments of my colleagues who have previously responded in that there is very little information on this topic (Possibly because there was historically a widely held mistaken belief that people with ID did not die by suicide?).
These papers are not risk scales, but they seem relevant to what you are looking for:
* Mollison, E., Chaplin, E., Underwood, L., & McCarthy, J. (2014). A review of risk factors associated with suicide in adults with intellectual disability. Advances in Mental Health and Intellectual Disabilities, 8(5), 302-308.
* Ludi, E., Ballard, E. D., Greenbaum, R., Bridge, J., Reynolds, W., & Horowitz, L. (2012). Suicide risk in youth with intellectual disability: The challenges of screening. Journal of developmental and behavioral pediatrics: JDBP, 33(5), 431.
I am not sure that an ID-specific suicide risk measure does exist, but I suspect there is a clear need for one to be developed (I am unconvinced by the idea that a scale developed and intended for the general population but have the same value in people with ID).
Best wishes
Sam
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Looking for any research around child protection in Laos. GoL sensors everything so I'm looking for information that might not have been censored yet. Thank you!
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Self harm around the world in adolescent and children is on the increase, especially in Ireland.
The difference between the amount and methods between boy's and girls is vast.
I am interested in looking at the reasons for this. Especially from a psychological perspective
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Hi,
I could list thousands of real world examples in which a cultural belief (e.g. Religion or political ideology ) in any particular area is attributing towards some form of social ill. However, I will only list one real world example for this case study, due in part, because cultural belief can cause some of the worst social pathological behavior to manifest and I,for one, wouldn't want to stir a psychological hornets nest. And that's why I've been very hesitant to get involved on a political level in the context of this case study. The reason I'm referring this case study to you ( the scientific community) is due to the fact that the more logical minds think about any particular problem the more probable a solution can be found to mitigate that problem.
Case Study:
A community is seriously contaminating the air they breath with toxic smoke (there isn't a "healthy" smoke). Whilst they do have the choice to not emit toxic smoke in there local environment.e.g. By using more cleaner technologies to heat there homes. They "choose" not to. The reasons why this form of social self harm exists (other than when there is no choice.e.g. Burn Coal or freeze) is only because of ignorance in most cases.
This ignorance is based on a central cultural presumption. A belief that blinds them from the facts, thus they act without due care and attention.
Fact 1.
The community (a significant percentage of the people in the community that contribute towards a negative health difference to the overall air quality) are choosing to behave in a way that, evidence has shown, seriously harms health ( e.g. Coal/wood smoke is far more toxic than cigarette smoke).
Fact 2.
They don't (are not cognitively indoctrinated too) accept the facts due to a habitual cognitive bias ( driven in part by a religious upbringing in which they are indoctrinated in such away that they avoid certain facts that contradicts their central premise (belief/opinion) and or ideological/financial incentive).
Fact 3.
local industry actively promotes ( and part takes) in the ritual of burning stuff in the local environment and is financially motivated to promote the burning of wood and coal.
Fact 4.
The culture is comparably wealthy in so that most (if not all) do not even consider the alternative cleaner options. New homes are built and coal fire places and or wood burners are installed.
Fact 5. The local governing bodies are part of the coal/wood burning culture thus are not interested in mitigating the problem (e.g. Smoke control regulations).
Fact 6. Some of the narratives promoted by local business ( financially associated within the tree to burning wood economy) suggest that burning wood for heating is a sustainable method to mitigate climate change.i.e. Tree's fix Carbon from the air and burning wood releases the carbon back into the Air ( and in local peoples lungs). Whilst this narrative is correct, they then go on to add the "carbon neutral" narrative, which is completely incorrect. For example, it takes a lot of industry (predominantly a diesel driven industry) to grow tree plantations and get those tree's processed and into houses as logs. Furthermore, the conifer tree plantations take up most of the forested areas of the local landscape and being of a monoculture design, are not self sustaining in the long term.e.g. Loss of fertile soils and loss of the carbon ( carbon capture cycle. Thus on a large scale disruptive to the ecosystem ).
So given the particulates (sorry, pun intended), the particulars of this case, does anyone have any suggestions what methods could be used in order to reduce smoke emissions thus improve the general health of the area. Other than replacing the entire culture with more intelligent thoughtful people, I'm at a loss in how to help these poor "souls" out.
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Gary;
Start casting about for your credible voice now. That voice can use all of the background information, literature research, and legwork that you can provide as a "good lieutenant". By providing that kind of quiet support the public face of your effort is less likely to burn out and will also gain confidence in the validity of the effort.
I, and others, started working on the preservation of a tract of land in this community and were pitted against entrenched real estate development interests. The strategy that I've suggested to you is the one we used. Progress was glacially slow with plenty of setbacks and some crucial "victories". The faces have mostly changed but the goal remained. Now, 40 years later that tract of land, and an area that doubled the total area, is about to be placed in permanent conservancy. This old war-horse is mostly out to pasture but still feels the warm joy of seeing a good thing through to a happy conclusion. As you pointed out, it took far longer than it should have. But in hindsight that's OK.
Best, Jim Des Lauriers
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I have looked around, but need help locating a dataset about self-harm, injury among adolescents.
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Hi Jane
I am back at work from hols.  I don't know any sorry!  Look forward to talking soon.  I see yr article just came out!  Suuuuuper!!!!  Congrats.  Georgia
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In the US, we must document a face-to-face assessment within one hour of restraint application when the restraints are used to prevent patient from self-harm or harming others. I've not been able to locate a  validated tool to do this reassessment. Many folks reference an article by Nadler-Moodie from 2009 but the standards have changed since then. Any help would be appreciated.
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Laske and Stephens discuss the assessment tools for delirium and restraints in this article. While not exactly restraints, perhaps this will get you started on your research.
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A suicide threat has been defined as "a verbal statement or behavioral act that may indicate serious intent to kill oneself" (see link to Wedig et al., 2013). In the case of borderline personality disorder suicide threats may also be made without any intent to take one's life (see J. Paris, Half in Love with Death, 2006). Suicide threats may be contingent ("If I'm not admitted I will...") or non-contingent ("I'm going to shoot myself!") (See Lambert, M., Seven-Year Outcome of Patients Evaluated for Suicidality, Psychiatric Services, 2002, 55,1, 92-94). Threats may or may not reference a plan. Suicide threats, of any type, would seem to be the second most common forms of suicidal behavior after suicidal ideation. The overwhelming majority of threats heard daily by emergency responders, crisis centers, hot lines, rehabs, and ERs, are conditional with more intent of personal gain or manipulation than personal demise. Nonetheless, many excellent discussions of "suicidal behavior" do not address suicide threats (e.g., Nock et al., Suicide and Suicidal Behavior, Epidemiology Rev., 30,1, 133-154). There appears to be relatively little research explicitly focusing on threats as suicidal behavior
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Hi Keith and others...
The definition of suicidal:
"deeply unhappy or depressed and likely to commit suicide.
relating to or likely to lead to suicide."
What does likely to commit suicide imply?
90%?    50%?      10%    .04% ?
The most at risk are bipolar men who have self harmed (Nordentoft et al 2011). They had a risk of about .04% per month.
Therefore no matter what a patient says or does they are unlikely to commit suicide. We need better terminology for patients who feel "suicidal" or self harm.
We need to assess the problems patients present with and regard all patients as at risk as most patients who commit suicide were assessed as not high risk. If we focus on hige risk we are ignoring most of those who will kill themselves.
What do you think?
For a fuller account of my delusions about suicide risk  see: http://bjpo.rcpsych.org/content/2/1/e1
Declan
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non-suicidal self-harm 
a way to relieve stress 
in adolescents
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Every symptom and disorder can be considered as available way to deal with conflicts. Not the best way but available. They all have has it's function and the meaning based on available capacities of the person. Without revealing that function and meaning it is difficult to develop other ways to deal with conflicts. Here is a short video: http://www.youtube.com/watch?v=qxRMuQ0h_fw
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Instruments such as the Beck Hopelessness Scale or the Coping Response Inventory were not designed to be administered to a suicide decedent's  collateral contacts. However, in some psychological autopsy research this is how they are sometimes used. I think that this "off label" use may raise methodological issues that may affect the validity of data so gathered. I would appreciate feedback, one way or the other, on this question. Thanks!
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Dear Tony, 
Here is a paper on the issue:
Suicide and Life-Threatening Behavior
Volume 35, Issue 5, pages 536–546, October 2005
Utah Youth Suicide Study: Psychological Autopsy
Michelle Moskos et al. 
"While traditional psychological autopsy studies primarily focus on the administration of psychometric measures to identify any underlying diagnosis of mental illness for the suicide decedent, we focused our interviews to identify which contacts in the decedent's life recognized risk factors for suicidal behavior, symptoms of mental illness, as well as barriers to mental health treatment for the decedent. Parents and friends recognized most symptoms universally, although friends better recognized symptoms of substance abuse than any other contact."
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We need to compare the self report of the family functioning of tw groups of adolescents. Those who have report life prevalence of self injury and those who don´t. Since we are having problems recruiting them, we'll end working with a small sample.
The assessment instrument is the MacMaster's FAD.
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one more thong i want to add here if your data is not normalized so we can use non-parametric tests. have u checked it?
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By acute services I am referring to home treatment, crisis, respite and acute inpatients services.
By co-production, I am referring to services that have been co-designed and/or delivered with service users and/or people who have a lived experience of using this type of service.
Examples of co-production in mental health services tend to focus on primary and secondary care, so we have examples of Therapeutic Communities or third sector services that use the co-production model.
I am interested in any case studies, examples of services (I am based in the UK but am open to whatever is going on elsewhere), evaluations, research or other papers on this subject.
I am also interested in any work that has been done on improving the experience of service users who experience psychological distress and are admitted to acute services. In particular, presenting with self-harm, suicidal ideation, considered of danger to themselves or others - the types of presentations that are associated with personality disorders.  These types of presentations are often viewed as problematic in acute services as they are not purely biological and cannot be solely treated with medication.  Any work that has been done around improving services, treatment, staff confidence, reduction of stigma in this area would be very helpful.
As you can see, I'm quite open regarding ideas/papers that may inform this, as I am aware that work regarding co-production and improving the experience of service users who experience psychological distress in Acute services is not abundantly available at the moment!
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Hi Tamar,
I'm coming in a bit late here, but thought this might be useful:
The Maudsley hospital has a specialist day service for people with a diagnosis of personality disorder:
I also know there is a crisis house in South London and Maudsley Trust.
This is a co-produced piece of research into service user views of alternatives to inpatient care:
There is also the literature on the harm minimisation approach for self harm, which I know is being implemented in some inpatient services, e.g:
I am really interested self harm and crisis services, and also co-production, so would love to hear more about what you are up to!
With best wishes,
Karen
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We are trying to study the differences in causes of death due to suicide (ICD-10: X60.0 - X84.9) between illicit drug users in contact with drug treatment services and those without from national General Mortality Register (GMR), the underlying cause of death is encoded according to ICD-10, selected underlying cause of death linked to external causes of injury and poisonings. Data from GMR are regularly reported to the WHO.
As we are talking about illicit drug users, where suicide by overdose is relatively frequent we would like in our study to introduce concept of direct cause of death-suicide (by overdose, poisoning with psychoactive substances) and indirect (where death-suicide is not a direct consequences of drug) according to EMCDDA. Considering this and causes of death by ICD-10 (among poisonings e.g. X62 Intentional self-poisoning by and exposure to narcotics, while among self- harm e.g. X70 Intentional self-harm by hanging, strangulation and suffocation) in our opinion should be appropriate to divide suicides in direct by self-poisoning (overdose) and indirect those by self-harm. Unfortunately one of  experts (in the field of suicide) insists that group of suicide by self harm is not acceptable as per definition of WHO self harm could not finish in death.
Thank you in advance for comments and suggestions.
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I think the issue here is intent.  The World Health Organization has defined suicide as "the act of deliberately killing oneself."  (See first link.)  It is entirely possible for people to intentionally "self harm by hanging, strangulation, and suffocation" without intending to die from this.  An example is auto-erotic asphyxia, also known as breath play.  A person might die as a result of this even though they didn't intend to kill themself.  Similarly, a person might intentionally self-poison by exposure to narcotics in order to 'get high' without intending to kill themself.  Based upon some very quick research, I couldn't find any operational definition of "intentional self-harm" for ICD-10 and did find at least one researcher state that this phrase was not defined in ICD-10 (see second link).
I suspect the expert you spoke to might have understood this definitional issue between the WHO definition of suicide (which requires intent to die from the act) and the ICD-10 coding titles which state "intentional self-harm" without defining if the subject intended to die from the intentional self-harm.
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I am considering research in to Emergency staff responses to presentations with deliberate self harm and considering research questionnaires that may be suitable?
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J Psychiatr Ment Health Nurs. 2007 Aug;14(5):438-45.
Measuring nurse attitudes towards deliberate self-harm: the Self-Harm Antipathy Scale (SHAS).
Patterson P1, Whittington R, Bogg J.
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Abstract
Most mental health nurses engage at some point with clients who harm themselves and these nurses often experience strong negative emotional reactions. Prolonged engagement with relapsing clients can lead to antipathy, and 'malignant alienation'. The study reported here has the aim of developing a brief, robust instrument for assessing nurse attitudes in this area. The Self-Harm Antipathy Scale, developed here on a sample of 153 healthcare professionals, has 30 attitudinal items with six factors. It has acceptable face validity, good internal consistency and some evidence of good test-retest reliability. It discriminates effectively between criterion groups. Overall this is evidence for the complexity of nurses' responses to this client group but such complex attitudes can still be assessed using a relatively brief structured instrument.