自我傷害
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自我傷害(英語:Self-harm),又稱自傷或自殘(self-injury),是指有意且直接地傷害身體組織的行為,當事人一般沒有自殺的意圖[1][2][3]。无论是否有自杀意图, “自残”经常被滥用于任何有自我伤害的情况。[2][4] 較近期的文獻多會使用“自我傷害”和“自傷”去取代較不中立的「自殘」,特別是《精神疾病診斷與統計手冊第五版》出版以後。
最常見的自傷方法是使用尖銳的物體割破當事人自身的皮膚,但自傷也包括各式各樣的行為,包括自焚、划伤身體部位、把身體撞向硬物、用拳頭或其他會造成傷害的物件打向自己、干擾傷口癒合(摳皮症)、拔毛(拔毛癖),以及攝入有毒物質[2][5][6]。
物質濫用和进食障碍一般不會視作自傷,因為所造成的組織損傷通常都是無意的附加後果[7]。以及纹身和穿孔等社会可接受的身体修饰一也不被认为是自我伤害。[8]然而,相關定義的界線並不總是明確的:如果當事人故意以一些通常不視作自傷的行為傷害自己,那麼亦可界定為自傷[7]。
雖然自殺並不是自傷者的意圖,但自傷與自殺之間存在著一段複雜的關係,因自傷行為具有致命的潛在風險[9]。自傷者擁有相對較高的自殺風險[5][10];40–60%的自殺者亦曾出現過一定程度的自傷行為[11]。儘管如此,只有少数自残者有自杀倾向。仍不能归纳性地認定大多數自傷者最終都會自殺[12][13]。
有很多种疾病会导致「對自我伤害的渴求」。自我伤害是一些人格障碍的普遍症状。除此之外,有研究表明很多心理疾患的患者也会有该症状,包括抑郁症、焦虑症、自閉症譜系障礙、創傷後壓力症候群、精神分裂症、物质滥用、情绪障碍、进食障碍、創傷後壓力症候群、精神分裂症、解离障碍的人,以及经历性别焦虑症的人[2]。同时该研究证明自我伤害是自我惩罚功能的一种表现形式,根据研究自我伤害的动机可能是阶段性的反分离、反自杀、寻求感觉和人际关系影响, 根据个例不同, 自我伤害的动机各不相同[2]。在没有潜在心理健康诊断的高功能个体中也会发生自我伤害[14]。有些人将自我伤害用作因应,暂时缓解焦虑、抑郁、压力、情绪麻木或失败感等强烈情绪。自我伤害通常与创伤史有关,包括情感和性虐待。[15] 有许多不同的手段可用于治疗自我伤害,这些手段有些是专注于治疗根本原因, 有些是治疗自我伤害行为本身。其他方法包括回避治疗,重点是让个人忙于其他活动,或用不会导致永久损害的更安全的方法取代自我伤害的行为。[16]
自我伤害往往始于青春期。在童年的自我伤害相对罕见,但自20世纪80年代以来,比例有所上升。[17]老年人也有可能有自我伤害的行为。[18]自残的老年人严重受伤和自杀的风险更高。[19]被人类的圈养动物中, 鸟类和猴子也被观察到有自我伤害行为。[20]关于自我伤害的一个常见观念是,这是一种寻求注意力的行为;在许多情况下,这个观念是错误的。许多自我伤害者对暴露自己伤口和疤痕非常在意,对自己的行为感到内疚,导致他们不遗余力地向他人隐瞒自己的行为。[21]他们可能会为自己的伤害找一些借口,或用衣服隐藏他们的伤疤。[22][23]
參考文獻
- ^ Laye-Gindhu, A.; Schonert-Reichl, Kimberly A., Nonsuicidal Self-Harm Among Community Adolescents: Understanding the "Whats" and "Whys" of Self-Harm, Journal of Youth and Adolescence, 2005, 34 (5): 447–457, doi:10.1007/s10964-005-7262-z
- ^ 2.0 2.1 2.2 2.3 2.4 Klonsky, D., The functions of deliberate self-injury: A review of the evidence, Clinical Psychological Review, 2007, 27 (2): 226–239, PMID 17014942, doi:10.1016/j.cpr.2006.08.002
- ^ Muehlenkamp, J. J., Self-Injurious Behavior as a Separate Clinical Syndrome, American Journal of Orthopsychiatry, 2005, 75 (2): 324–333, PMID 15839768, doi:10.1037/0002-9432.75.2.324
- ^ Groschwitz RC, Plener P. The Neurobiology of Non-suicidal Self-injury (NSSI) : A review (PDF). Suicidology Online: 24–32. [2018-03-07]. (原始内容存档 (PDF)于2021-01-20).
- ^ 5.0 5.1 Skegg, K., Self-harm, Lancet, 2005, 366: 1471–1483, doi:10.1016/s0140-6736(05)67600-3
- ^ Truth Hurts Report, Mental Health Foundation, 2006 [2008-06-11], ISBN 978-1-903645-81-9, (原始内容存档于2019-11-02)
- ^ 7.0 7.1 Klonsky, E. D., Non-Suicidal Self-Injury: An Introduction, Journal of Clinical Psychology, 2007, 63 (11): 1039–43, PMID 17932979, doi:10.1002/jclp.20411
- ^ Klonsky 2007b,第1040頁 harvnb error: no target: CITEREFKlonsky2007b (help): "[B]ehaviors associated with substance and eating disorders—such as alcohol abuse, binging, and purging—are usually not considered self-injury because the resulting tissue damage is ordinarily an unintentional sideeffect. In addition, body piercings and tattoos are typically not considered self-injury because they are socially sanctioned forms of cultural or artistic expression. However, the boundaries are not always clear-cut. In some cases behaviors that usually fall outside the boundaries of self-injury may indeed represent self-injury if performed with explicit intent to cause tissue damage."
- ^ Farber, S.; et al, Death and annihilation anxieties in anorexia nervosa, bulimia, and self-mutilation, Psychoanalytic Psychology, 2007, 24 (2): 289–305, doi:10.1037/0736-9735.24.2.289
- ^ Haw, C.; et al, Psychiatric and personality disorders in deliberate self-harm patients, British Journal of Psychiatry, 2001, 178 (1): 48–54, PMID 11136210, doi:10.1192/bjp.178.1.48
- ^ Hawton K., Zahl D. and Weatherall, R., Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital, British Journal of Psychiatry, 2003, 182: 537–542, PMID 12777346, doi:10.1192/bjp.182.6.537
- ^ Fox, C; Hawton, K, Deliberate Self-Harm in Adolescence, London: Jessica Kingsley, 2004, ISBN 978-1-84310-237-3
- ^ Suyemoto, K. L., The functions of self-mutilation, Clinical Psychology Review, 1998, 18 (5): 531–554, PMID 9740977, doi:10.1016/S0272-7358(97)00105-0
- ^ Meltzer H, Lader D, Corbin T, Singleton N, Jenkins R, Brugha T. Non Fatal Suicidal Behaviour Among Adults aged 16 to 74 (PDF). Great Britain: The Stationery office. 2000 [2023-11-16]. ISBN 978-0-11-621548-2. (原始内容存档 (PDF)于2024-03-15).
- ^ Rea K, Aiken F, Borastero C. Building therapeutic staff: client relationships with women who self-harm. Women's Health Issues. 1997, 7 (2): 121–125. PMID 9071885. doi:10.1016/S1049-3867(96)00112-0.
- ^ Klonsky ED, Glenn CR. Resisting Urges to Self-Injure. Behavioural and Cognitive Psychotherapy. March 2008, 36 (2): 211–220. PMC 5841247
. PMID 29527120. doi:10.1017/S1352465808004128.
- ^ Thomas B, Hardy S, Cutting P. Stuart and Sundeen's mental health nursing: principles and practice. Elsevier Health Sciences. 1997: 343. ISBN 978-0-7234-2590-8.
- ^ Pierce D. Deliberate self-harm in the elderly. International Journal of Geriatric Psychiatry. 1987, 2 (2): 105–110. S2CID 145408278. doi:10.1002/gps.930020208.
- ^ National Institute for Clinical Excellence. National Clinical Practice Guideline Number 16: Self-harm (PDF). The British Psychological Society. 2004 [2009-12-13]. (原始内容存档 (PDF)于2012-09-05).
- ^ Jones IH, Barraclough BM. Auto-mutilation in animals and its relevance to self-injury in man. Acta Psychiatrica Scandinavica. July 1978, 58 (1): 40–47. PMID 99981. S2CID 24737213. doi:10.1111/j.1600-0447.1978.tb06918.x.
- ^ Truth Hurts Report. Mental Health Foundation. 2006 [2008-06-11]. ISBN 978-1-903645-81-9. (原始内容存档于2019-11-02).
- ^ Spandler H. Who's Hurting Who? Young people, self-harm and suicide. Manchester: 42nd Street. 1996. ISBN 978-1-900782-00-5.
- ^ Pembroke LR (编). Self-harm – Perspectives from personal experience
. Chipmunka/Survivors Speak Out. 1994. ISBN 978-1-904697-04-6.
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