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Autism and self harm, by caroline hattersley

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Autism and self harm, by Caroline Hattersley.

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Autism and self harm, by caroline hattersley

  1. 1. Self-harm in women and girls with autism Caroline Hattersley MEd MIoD Head of Information, Advice and Advocacy
  2. 2. Content <ul><li>Defining self-harm </li></ul><ul><li>Classification of self-harm and self-injury </li></ul><ul><li>Forms of self-harm </li></ul><ul><li>Prevalence and theories </li></ul><ul><li>Reasons people self-harm </li></ul><ul><li>Personal characteristics and risk of self-harming </li></ul><ul><li>Self harm and autism </li></ul><ul><li>Anya’s story </li></ul><ul><li>A nurse’s perspective </li></ul><ul><li>Conclusions </li></ul><ul><li>Comments and questions </li></ul>
  3. 3. Defining self-harm <ul><li>Self-harm is a broad term. “People may injure or poison themselves by scratching, cutting or burning their skin, by hitting themselves against objects, taking a drug overdose, or swallowing or putting other things inside themselves”. (Mind 2010) </li></ul>
  4. 4. Classifying self-harm and self-injury <ul><li>Four categories of self-harm/self-injury </li></ul><ul><li>Stereotypic </li></ul><ul><li>Major </li></ul><ul><li>Compulsive </li></ul><ul><li>Impulsive </li></ul><ul><li>(Simeon and Favazza 2001) </li></ul>
  5. 5. Forms of self-harm <ul><li>Cutting </li></ul><ul><li>Stabbing </li></ul><ul><li>Scratching the skin </li></ul><ul><li>Placement of sharp objects under the skin </li></ul><ul><li>Biting the inside of the mouth </li></ul><ul><li>Picking at sores and reopening wounds </li></ul><ul><li>Burning the skin with heat or chemicals </li></ul><ul><li>Pulling hair out </li></ul><ul><li>Bruising or breaking bones by hitting </li></ul><ul><li>Using ligatures to restrict blood flow </li></ul><ul><li>Ingesting toxins or objects </li></ul>
  6. 6. Forms of self-harm <ul><li>Arms and wrists - 74% </li></ul><ul><li>Legs – 44% </li></ul><ul><li>Abdomen - 25% </li></ul><ul><li>Head - 23% </li></ul><ul><li>Chest and breasts - 18% </li></ul><ul><li>Genitals - 8% </li></ul><ul><li>(Favazza and Conterio 1989) </li></ul>
  7. 7. Prevalence <ul><li>10% of 15-16 year olds have self-harmed (normally by cutting) (Mind 2010). </li></ul><ul><li>As many incidences of self-harm are kept secret and do not come to the attention of health professionals- figures are likely to be an under estimate (Hawton et al 2002a - cited NICE 2004 ); Meltzer et al 2002b - Cited NICE 2004 ). </li></ul><ul><li>National survey suggested between 4.6 - 6.6% have self-harmed. </li></ul><ul><li>(Meltzer et al 200b - Cited NICE 2004 ). </li></ul><ul><li>In a school survey 13% of 15-16 year olds stated that they had self-harmed. (Hawton et al 2002b - Cited NICE 2004 ). </li></ul><ul><li>Girls are more likely to self-harm than boys (Mind 2010) </li></ul>
  8. 8. Theories <ul><li>“ There is an unhelpful circularity in that self-harm is considered to be one of the defining features of both borderline and histrionic personality disorder”. (NICE 2004). </li></ul><ul><li>Self-harm is not usually an attempt at committing suicide, but a way of expressing deep emotional feelings, such as low self-esteem. It is also a way to cope with traumatic events or situations, such as the death of a loved one, or an abusive relationship. Self-harm is not an illness, it is an expression of personal distress. (Department of Health 2009). </li></ul><ul><li>The pain theory - when self injurious behaviour occurs the body produces chemical substances called opioids which act as an analgesia. (Ghaziuddin 2005). </li></ul><ul><li>The addiction theory – when the brain becomes addicted the endorphins that the body releases during episodes of self harm (Ghaziuddin 2005). </li></ul>
  9. 9. Possible reasons <ul><li>To demonstrate self hatred or self-loathing </li></ul><ul><li>To punish oneself. This can be specific or non-specific </li></ul><ul><li>To release emotions that can not be expressed in any other way </li></ul><ul><li>To prevent/stop/control intrusive thoughts or distressing flashbacks </li></ul><ul><li>To prevent suicide attempts </li></ul><ul><li>To see blood </li></ul><ul><li>To feel pain </li></ul><ul><li>To stop or calm ones thoughts </li></ul><ul><li>Reasons and methods for self-harming may differ (NICE 2004). </li></ul>
  10. 10. Personal characteristics that increase risk of self-harm <ul><li>Impairment in the ability to problem solve (Sadowski and Kelly 1993) </li></ul><ul><li>Reduced focus on the future (Orbach, Bar-Joseph and Dror (1990) </li></ul><ul><li>Effectiveness of problem solving (Hawthorn et al. 1999) </li></ul><ul><li>Lack of concern for danger (Shaffer et al 1988) </li></ul><ul><li>Presence of depressive symptoms and disorders (Kovacs, Goldston and Gatsonis 1993) </li></ul>
  11. 11. Self-harm and autism <ul><li>“Children with ‘higher-functioning’ ASD may deliberately self-harm, </li></ul><ul><li>for example by cutting, as a way of coping with anxiety and feelings </li></ul><ul><li>of being ‘different’”. </li></ul><ul><li>(NAS 2011) </li></ul>
  12. 13. A nurse's experience
  13. 14. Conclusions <ul><li>More research on autism and self-harm </li></ul><ul><li>Advice on self-harming to be accessible to people with autism </li></ul><ul><li>Better training and support for professionals </li></ul><ul><li>Joint working across services </li></ul>
  14. 15. <ul><li>“The myth that self mutilation is an attention-seeking device is purely that - a myth. In fact it is a very personal and private affair.”  </li></ul><ul><li>Jackson (2002) </li></ul>

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