Understanding deliberate self harm: An enquiry into attempted suicide.

摘要

This study focused on the quantitative and qualitative aspects of suicidal behaviour of 90 people who had come to the attention of the Accident and Emergency Department of Westmead Hospital after an attempt to harm themselves. Their accounts of the events leading up to their action were explored in detail in order to gain an understanding of deliberate self harming behaviour. The data collected in this research was analysed using research methods taken from the quantitative as well as qualitative research traditions. A descriptive quantitative analysis was undertaken and known risk factors for deliberate self harm were explored. Secondly a qualitative analysis of the motives expressed at the time of the event undertaken. Lastly the risk factors identified in the study were combined with the circumstances and motive of attempt.;Participants were regrouped according to whether the problems the respondent described were chronic (longstanding) or acute (pivotal). The participants in the acute groups described difficulties dealing with issues they were currently presented with. The participants in the chronic groups described longstanding issues. In contrast the participants in the chronic groups described their lives as moving from crisis to crisis. Compared to the participants in the acute groups, the participants in the chronic groups were more likely (although not exclusively) to describe their family of origin as chaotic and to report a history of abuse, often occurring during their childhoods. Personality disorders were also more likely to occur in the in the chronic groups.;The participants were further classified according to the persistence of thoughts of self-harm (impulsive or non impulsive/deliberate) and the presence or absence of these feelings at the time of the interview (the resolution of the attempt) and the types of problems/situations and triggering events the person described as wanting to escape. Ten subgroups were identified in this manner. Those who belonged to the acute subgroups described their attempt as inability to cope with either: a psychiatric illness, social stressors or a loss of a relationship or employment. The issues that are described in the chronic subgroups are longstanding and multiple. The self harm attempt was made in the context of these multiple issues. These issues included depressed feelings brought to the foreground by drug or alcohol abuse, feelings of rejection, feelings of self hatred and underlying feelings of disconnectedness.;By developing strategies and treatments for the problems as they were identified in this study and by raising the awareness that there is help available for these different issues, we may be able to reduce the pain which results in an attempt to self harm.