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Risk Factors

A number of social or psychological factors can be seen to have a high correlation with self-harm or its repetitions.

People experiencing various forms of mental ill-health can be considered to be at higher risk of self-harming Key issues are depression, ^[1], phobias , conduct disorders ^[2] Substance abuse is also considered a risk factor as are some personal characteristics such as poor probblem resolution skills, Impulsivity, hopelessness and agression.

Abuse during childhood is accepted as a primary social factor, ^[3], along with troubled parental or partner relationships. . Socio-econimic factors such as poverty and unemployment may also contribute

It must be noted, however that some people who self-harm have no experience of these factors ^[4]

Possible Motives

Motives for self-harm are often personal, often do not fit into medicalised models of behaviour, and may seem incomprehensible to others as demonstrated by this quote from a surviver:

"My motivations for self-harming were diverse, but included examining the interior of my arms for hydraulic lines. This may sound strange." however attempts to assess and quantify motives are often made by researchers and medical professionals.

Hawton and Van Heeringen present a compiled list of possible motives:

• To Die
• To escape from unbearable anguish
• To get relief
• To escape from a situation
• To show desparation to others
• To change the behaviour of others
• To get back at other people/make them feel guilty
• To get help

Assessement of motives in a medical setting is usually based on precursors to the incident, circumstances and information from the patient however the limited studies comparing professional and personal assesments show that these differ with professionals suggesting more manipulative or punitive motives. ^[5]

The UK ONS study reported only two motives: “to draw attention” and “because of anger”.

The above has been added

Many people who self-harm state that self-injury is a way to "go away" or dissociate, separating the mind from feelings that are causing anguish. This may be achcheived by tricking the mind into believing the pain felt at the time is caused by self-injury instead of the issues they were facing before: the physical pain therefore acts as a distraction from emotional pain,^[4]

To complement this theory, one can consider the need to 'stop' feeling emotional pain and mental agitation. "A person may be hyper-sensitive and overwhelmed; a great many thoughts may be revolving within their mind, and they may either become triggered or could make a decision to stop the overwhelming feelings." ^[6]

Alternatively self-injury may be a means of feeling something, even if the sensation is unpleasant and painful. Those who self-injure sometimes describe feelings of emptiness or numbness, and physical pain may be a relief from these feelings. "A person may be detached from himself or herself, detached from life, numb and unfeeling. They may then recognise the need to function more, or have a desire to feel real again, and a decision is made to create sensation and ‘wake up’." ^[6]

A flow diagram of these two theories is provided by LifeSIGNS.

Done to here

For some self-injurers this relief may primarily be psychological whilst for others this feeling of relief may be directly retalted to the release of beta endorphins in the brain (the same chemicals responsible for the "runner's high"). These act to reduce tension and emotional distress and may lead to a feeling of calm. A similar rush of endorphins is triggered when someone receives a tattoo. In this way, one can become addicted to getting tattoos. Similarly, those who self injure may also become addicted to the endorphin rush. ^{[citation needed]}

As a coping mechanism, self-injury can become psychologically addictive because, to the self-injurer, it works; it enables him/her to deal with intense stress in the current moment. The patterns sometimes created by it, such as specific time intervals between acts of self-injury, can also create a behavioral pattern that can result in a wanting or craving to fulfill thoughts of self-injury.^{[citation needed]}

It is also important to note that some self-injurers report feeling very little to no pain while self-harming. Marilie Strong's book A Bright Red Scream gives case reports that prove this several times.

Self-harm may also give a feeling of being in control of one's own body, which could be especially important for survivors of sexual abuse.

Self-injury may also be a means of communicating distress. This motivation is sometimes dismissed as "attention seeking" and has often been seen as the primary motivation. However, for many, the act of self-harm fulfils a purpose in itself and is not a means of communicating with or influencing others.

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similar to the way a hot water bottle reduces the pain of a stomachache.

Is this not just 'cos heat can sooth pain?

The sexual organs may be deliberately hurt as a way to deal with unwanted feelings of sexuality. ^{[citation needed]}

possibly, but needs citation

Self-harm is also a way for people to relieve the emotional pain of everyday life, especially in the case of teenagers, but not exclusively. People who self-harm may do so with a specific implement or with whatever is convenient to them. In experiencing physical pain, an inflicter of self-harm may seek control; for many, self-harm may be a way to experience a defined sensation rather than amorphous emotional stress. In some cases there may be a specific ritual associated with the activity, such as being in a certain location, listening to certain types of music, or following the activity with specific behaviors not directly related to the harming itself.

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A lesser form of this extreme act is, for example, hitting one's head on the table or pulling one's hair out. Although this is often used euphemistically, for those who do it serves the same purpose of deferring the stress experienced by the major cause by the pain from this secondary option.

Think this is superflous

Also, some people are soothed by the sight of their own blood, and it calms them in distressing situations. ^{[citation needed]}

needs referencing

Those who engage in self-harm face the contradictory reality of harming themselves whilst at the same time obtaining relief from this act.^[4]

Many who self-injure keep their injuries secret, while those who do disclose their injuries may be embarrassed and ashamed of their actions.

Repeats

Temp refs - these will automatically integrate with the rest I hope!