Self-Harm in Adolescence

by Iva Buresová (Author)
©2016 Monographs VI, 125 Pages


The author discusses the subject of self-harm in adolescence, considering the historical context of the development of its classification system. She presents an overview of theoretical fundamentals as well as models of behavior derived from them. Within the context of current research studies, she describes its prevalence, etiology, and comorbidity. The author specifies the basic protective and risk factors as well as all important influences. She presents the diagnostic tools currently used in research and clinical practice including the description of key approaches to prevention, therapy and treatment. This book includes the results of a unique research study mapping the lexical trace of the term self-harm in adolescents and the differences in perception of this term among those without own practice, with mediation and with personal, often repeated experience.

Table Of Contents

  • Cover
  • Title
  • Copyright
  • About the author
  • About the book
  • This eBook can be cited
  • Table of Contents
  • Introduction
  • 1 Self-Harm Classification System Development
  • 1.1 Definition of Terms
  • 1.2 Differentiation from Suicidal Behaviour
  • 2 The Specifics of Self-Harm in Adolescence
  • 2.1 Prevalence
  • 2.2 Aetiology
  • 2.3 Comorbidity
  • 2.4 The Progress of Self-Harm
  • 2.5 Functions and Models of Motivation for Self-Harming Behaviour
  • 2.6 Forms of Self-Harm
  • 2.7 The Influence of Developmental Changes on Self-Harm
  • 3 Risk and Protective Factors of Self-Harm
  • 3.1 Biological Factors
  • 3.2 Personality Factors
  • 3.3 Family Influence
  • 3.4 The Influence of Peer Groups
  • 3.5 Socio-Economic Influences and the Impact of Mass Media and Social Networks
  • 4 Lexical Trace of the Term Self-Harm in Adolescents
  • 4.1 Gender Differences in the Perception of the Term Self-Harm by Adolescents
  • 4.2 Understanding of Self-Harm in Adolescents Based on their Experience with Self-Harm
  • 5 Diagnostic Tools Used in Research and Clinical Practice
  • 6 Preventive Strategy and Therapeutic Approaches
  • 6.1 Preventive Strategies Focused on Self-Harm in Adolescence
  • 6.2 Treatment and Therapeutic Approaches to Self-Harm in Adolescence
  • 6.3 The Specifics of Hospital Care for Self-Harming Adolescents
  • Summary
  • List of Abbreviations
  • References
  • List of Figures
  • List of Tables

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In the last decades there has been a visible increase in self-harming behaviour in the non-clinical population of adolescents on the European as well as the world scale. In the most comprehensive European research study published so far, Child & Adolescent Self-harm in Europe (CASE) Study, which was conducted in 2000–2001 (Madge et al., 2008), the 11.1% prevalence of self-harm was found in a sample of 30477 adolescents. Subsequent studies then state even a considerably higher occurrence of this phenomenon − up to one fifth (Brunner et al., 2007; Swahn et al., 2012). Although this fact could have been influenced by the increased interest of specialists in researching this phenomenon and the related development and specification of adequate diagnostic tools, it is certain that this specific behaviour, until recently considered highly pathological, is becoming a norm in this key developmental stage to such an extent that a significant number of adolescent individuals try it at least once in their life or even practice it for an extended period of time.

Currently, we therefore cannot consider the concept of self-harm only in the context of psychiatric diagnoses, or disharmonic personality development, but it is necessary to perceive it as one of the important risk factors, which are commonly a part of the process of becoming physically and emotionally mature in the contemporary generation of adolescents. However, the great majority of self-harming adolescents never seek the help of a psychologist, psychiatrist, doctor or another adult person (Hrubá, Klimusová & Burešová, 2012; Hawton, Saunders & O’Connor, 2012). The available research findings do not answer the question of why these things are happening, nevertheless this alarming discovery makes it important to raise awareness of the occurrence, progress, possible causes, ways of treatment, and other crucial matters related to self-harm in professional and non-professional public. One of the reasons why this phenomenon is marginalised by the society is also the lack of understanding of the causes which lead adolescents to voluntary experience of physical pain. ← 1 | 2 →

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1   Self-Harm Classification System Development

Self-harm seemingly appears to be a rather new phenomenon of the current age. However, the truth is that similarly to, for example, mental anorexia, its manifestations can be traced to the distant past1, portrayed in a number of works of art and bibliographical references. The term self-harm itself was first used in the case study by L. E. Emerson The Case of Miss A: a Preliminary Report of a Psychoanalytic Study and Treatment of a Case of Self-Mutilation (Emerson, 1913). Emerson refers here to this behaviour as “self-mutilation”, building his study on psychoanalytical basis and recognising self-cutting as a symbolic substitution of masturbation. Menninger (1935; 1938) is another important author in this context. He uses the same term in his studies and further distinguishes between suicidal and self-harming behaviour. However, he considers self-harm a partial suicide. In his view, this behaviour has a specific purpose and occurs under various circumstances and conditions. He defines it as a certain “weakened” wish to die and therefore introduces the term “partial suicide” into specialised literature (Menninger, 1935, p. 460). Menninger states 6 types of self-mutilation: 1) neurotic (biting nails, picking off scabs, excessive hair pulling out, unnecessary cosmetic procedures), 2) religious (self-whipping, etc.), 3) maturity ceremonies (circumcision, hymen removal), 4) psychotic (eyes, ears, genitals removal, extreme amputation), 5) based on organic damage (where repeated head banging and biting and breaking fingers occur, etc.) and 6) conventional (cutting nails and hair and shaving). Despite these first efforts to define and classify self-mutilation, relatively little attention has been paid to this behaviour by specialists until the late 70s of the 20th century (Yates, 2004). Specialised literature on this topic appeared very sporadically and to a great extent focused on self-harm only as on a symptom of some of the clinical diagnoses (e.g. personality disorder, ← 3 | 4 → mental retardation, etc.).2 However, in spite of this fact, we can still trace several important milestones, which formed the understanding of self-harm as a unique phenomenon throughout history.

In 1967, Graff & Mallin carried out a research study focused on self-harm, especially on wrist cutting, aiming to trace the causes of this behaviour. At that time, the impact of psychoanalytical theories had already decreased (Dominique & Roe-Sepowitz, 2005) and the influence of behaviourism was on the rise. Due to this influence, we can encounter new classifications of self-harm based on the description of the given behaviour. The above-mentioned authors described self-mutilation as follows: “In the past several years wrist slashers have become the new chronic patients in mental hospitals, replacing the schizophrenics” (Graff & Mallin, 1967, p. 74). In most respondents, the research found difficulties in communication and behaviour resulting from early deprivation. Self-harm was also the subject of the study titled The Syndrome of Delicate Self-Cutting by Pao in 1969, where he distinguished between self-harming individuals who harm themselves in a delicate way (delicate) and those who harm themselves in a rather coarse way (coarse). In his opinion, in the first group of individuals one cannot assume a suicidal aim. However, he noted this behaviour as relatively repetitive. In the second group of individuals, he observed the usual suicidal aim, which can even result in death. The author finds that the “delicate cutters” were usually young people who suffered from multiple attacks of self-harming surface cutting and were often diagnosed as suffering from a borderline personality disorder. In contrast, “coarse cutters” were usually older and often psychotic.

At the turn of the 70s and 80s, Ross & McKay (1979) introduced their classification of self-harm and highlighted the necessity to distinguish between direct self-harm (cutting, biting, excessive rubbing, cutting off parts, inserting objects, burning, swallowing or inhaling, hitting oneself and strangling) and indirect self-harm (overeating, drug abuse, etc.). Subsequently, Pattison & Kahan (1983) described in their work the typical characteristics of intentional self-harm – repetition, long-term nature, low mortality, and the intention to harm oneself – and suggested that intentional self-harm should be distinguished as a unique diagnostic syndrome. The authors also distinguished three basic elements of self-harm – the so called “self-harming acts” – which are: directness or indirectness of self-harming behaviour (referring to whether the behaviour is caused by a direct or indirect intention to mutilate oneself – some of the indirect acts are e.g. smoking, alcoholism, or not following medical treatment), frequency of repeating (the act can be one-time or repeated) ← 4 | 5 → and high or low mortality (among the acts with high mortality is a suicidal attempt, or a suicide). By combining these elements, eight additional groups were created, which the authors used to classify all forms of self-harming behaviour from smoking to premature ending of treatment of serious illnesses or even to suicide.

In 1987, the ground-breaking monograph Bodies under Siege: Self-Mutilation in Culture and Psychiatry by Armando Favazza is published. Favazza, in his work, uses the term “self-mutilation” and distinguishes between culturally accepted self-mutilation (e.g. piercing) and deviant self-mutilation, which he further classifies. Despite various gradual changes in his original conception that the author made throughout his lifetime research, he always strictly separated self-harm from suicidal behaviour and highlighted different motivation behind both acts. He was drawing on an assumption proven by practice that an individual who attempts suicide wants to end his or her life, while a person who intentionally harms oneself has the opposite aim – to feel better. In his study from 1990, he proposes a new taxonomy system of self-harm (Favazza & Rosenthal, 1990), which is used and respected to this day.


VI, 125
ISBN (Softcover)
Publication date
2016 (May)
diagnostic tools prevention strategies development risk factors risk behavior key developmental stage
Frankfurt am Main, Berlin, Bern, Bruxelles, New York, Oxford, Wien, 2016. VI, 125 pp., 3 coloured fig., 8 b/w fig., 7 tables

Biographical notes

Iva Buresová (Author)

Iva Burešová graduated in psychology at Masaryk University in Brno. As researcher at the Institute of Psychology, Faculty of Arts at Masaryk University she teaches psychological assessment, counseling psychology and developmental psychology. Prior she worked as counseling psychologist at the Center for Balanced Diagnostics in Brno as well as clinical psychologist at the Diagnostic Institute for Youth in Brno.


Title: Self-Harm in Adolescence