Nonfatal self-directed violence (SDV) is a broad term that can include self-harming behaviors such as cutting, burning, or mutilating, and can also encompass suicidal behavior and attempts that cause nonfatal injuries and suicidal attempts that are noninvasive, such as poisoning. In a recent study conducted by Natalya S. Weber of the Preventive Medicine Program at Walter Reed Army Institute of Research in Maryland, SDV is used to describe all self-harming behaviors. Weber wanted to determine the demographic and, more specifically, gender differences that exist in SDV, especially those causing injury. Although there is a vast amount of research suggesting that self-harm does not directly predict suicidal ideation or attempts, the type of SDV and other influential factors could increase the risk of suicidal behavior in some people who engage in self-harm.
Weber evaluated discharge data from a national survey that examined individuals who were admitted to psychiatric hospitals for SDV. Because those who incurred injuries could have a stronger intent to take their own lives, Weber focused on the difference between injurious and noninjurious SDV. She found that there were significant differences between those who injured themselves and those who used noninjurious methods of self-harm, like poisoning. Gender was one of the biggest variables, with men being nearly twice as likely to use injurious SDVs compared to women.
The findings also revealed a high saturation of comorbidity, with more than 86% of the SDV clients having a diagnosis of mood, substance abuse, or psychotic disorder. Problems with psychosis and personality issues were the strongest indicators of self-injury for both men and women in this study. Weber believes that perhaps the increased impulsivity and aggressiveness evident in many individuals with psychosis or schizophrenia could partly explain this finding. Weber also found that suicide attempts were much higher in the female participants than in the males, but males were at a significantly greater risk for suicide completion. “This gender difference in attempts versus suicides is one of the most widely supported findings in the epidemiology of suicidal behavior,” said Weber. She supports the notion that attention and intervention efforts should be focused equally on males in females with a history of SDV behavior.
Weber NS, Fisher JA, Cowan DN, Postolache TT, Larsen RA, et al. (2013). Descriptive epidemiology and underlying psychiatric disorders among hospitalizations with self-directed violence. PLoS ONE 8(3): e59818. doi:10.1371/journal.pone.0059818
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