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The book looks daunting in size however in my opinion it has been one of the most interesting books I have read thus far.

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In my book the effects of self harm cut deep into the emotions of the charecters.

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Self-harm

Other names

Deliberate self-harm (DSH), self-injury (SI), self-poisoning, nonsuicidal self-injury (NSSI), cutting

Healed scars on the forearm from prior self harm

Specialty
Psychiatry

Self-harm, also known as self-injury, is defined as the intentional, direct injuring of body tissue, done without the intent to commit suicide. Other terms such as cutting and self-mutilation have been used for any self-harming behavior regardless of suicidal intent. The most common form of self-harm is using a sharp object to cut one's skin. Other forms include behaviour such as burning, scratching, or hitting body parts. While older definitions included behaviour such as interfering with wound healing, excessive skin picking ( dermatillomania), hair pulling ( trichotillomania) and the ingestion of toxic substances or objects as self-harm, in current terminology those are differentiated from the term self-harm.

Behaviours associated with substance abuse and eating disorders are not considered self-harm because the resulting tissue damage is ordinarily an unintentional side effect. Although suicide is not the intention of self-harm, the relationship between self-harm and suicide is complex, as self-harming behaviour may be potentially life-threatening. There is also an increased risk of suicide in individuals who self-harm and self-harm is found in 40-60% of suicides. However, generalizing individuals who self-harm to be suicidal is, in the majority of cases, inaccurate.

The desire to self-harm is a common symptom of some personality disorders. People with other mental disorders may also self-harm, including those with depression, anxiety disorders, substance abuse, eating disorders, post-traumatic stress disorder, schizophrenia, and dissociative disorders. Studies also provide strong support for a self-punishment function, and modest evidence for anti-dissociation, interpersonal-influence, anti-suicide, sensation-seeking, and interpersonal boundaries functions. Self-harm can also occur in high-functioning individuals who have no underlying mental health diagnosis. The motivations for self-harm vary. Some use it as a coping mechanism to provide temporary relief of intense feelings such as anxiety, depression, stress, emotional numbness, or a sense of failure. Self-harm is often associated with a history of trauma, including emotional and sexual abuse. There are a number of different methods that can be used to treat self-harm and which concentrate on either treating the underlying causes or on treating the behaviour itself. Other approaches involve avoidance techniques, which focus on keeping the individual occupied with other activities, or replacing the act of self-harm with safer methods that do not lead to permanent damage.

Self-harm is most common between the ages of 12 and 24. Self-harm is more common in females than males with this risk being five times greater in the 12-15 age group. Self-harm in childhood is relatively rare but the rate has been increasing since the 1980s. Self-harm can also occur in the elderly population. The risk of serious injury and suicide is higher in older people who self-harm. Captive animals, such as birds and monkeys, are also known to participate in self-harming behaviour.

Self-harm (SH), also referred to as self-injury (SI), self-inflicted violence (SIV), nonsuicidal self injury (NSSI) or self-injurious behaviour (SIB), are different terms to ascribe behaviours where demonstrable injury is self-inflicted. The behaviour involves deliberate tissue damage that is usually performed without suicidal intent. The most common form of self-harm involves cutting of the skin using a sharp object, e. g. a knife or razor blade. The term self-mutilation is also sometimes used, although this phrase evokes connotations that some find worrisome, inaccurate, or offensive. Self-inflicted wounds is a specific term associated with soldiers to describe non-lethal injuries inflicted in order to obtain early dismissal from combat. This differs from the common definition of self-harm, as damage is inflicted for a specific secondary purpose. A broader definition of self-harm might also include those who inflict harm on their bodies by means of disordered eating.

The older literature has used several different terms. For this reason research in the past decades has inconsistently focused on self-harming behavior without and with suicidal intent (including suicide attempts) with varying definitions leading to inconsistent and unclear results.

A common belief regarding self-harm is that it is an attention-seeking behaviour; however, in many cases, this is inaccurate. Many self-harmers are very self-conscious of their wounds and scars and feel guilty about their behaviour, leading them to go to great lengths to conceal their behaviour from others. They may offer alternative explanations for their injuries, or conceal their scars with clothing. Self-harm in such individuals may not be associated with suicidal or para-suicidal behaviour. People who self-harm are not usually seeking to end their own life; it has been suggested instead that they are using self-harm as a coping mechanism to relieve emotional pain or discomfort or as an attempt to communicate distress. Alternatively, interpretations based on the supposed lethality of a self-harm may not give clear indications as to its intent: seemingly superficial cuts may have been a suicide attempt, whereas life-threatening damage may have been done without the intent to die.[citation needed ]

Studies of individuals with developmental disabilities (such as intellectual disability) have shown self-harm being dependent on environmental factors such as obtaining attention or escape from demands. Some individuals may have dissociation harboring a desire to feel real or to fit into society's rules.

Eighty percent of self-harm involves stabbing or cutting the skin with a sharp object. However, the number of self-harm methods are only limited by an individual's inventiveness and their determination to harm themselves; this includes burning, self-poisoning, alcohol abuse, self-embedding of objects, hair pulling, bruising/hitting one's self, scratching to hurt one's self, knowingly abusing over the counter or prescription drugs, and forms of self-harm related to anorexia and bulimia. The locations of self-harm are often areas of the body that are easily hidden and concealed from the detection of others. As well as defining self-harm in terms of the act of damaging the body, it may be more accurate to define self-harm in terms of the intent, and the emotional distress that the person is attempting to deal with. Neither the DSM-IV-TR nor the ICD-10 provide diagnostic criteria for self-harm. It is often seen as only a symptom of an underlying disorder, though many people who self-harm would like this to be addressed. Common signs that a person may be engaging in self-harm include the following: they ensure that there are always harmful objects close by, they are experiencing difficulties in their personal relationships, their behaviour becomes unpredictable, they question their worth and identity, they make statements that display helplessness and hopelessness.

Although some people who self-harm do not have any form of recognised mental disorder, many people experiencing various forms of mental illnesses do have a higher risk of self-harm. The key areas of disorder which exhibit an increased risk include autism spectrum disorders, borderline personality disorder, dissociative disorders, bipolar disorder, depression, phobias, and conduct disorders. Schizophrenia may also be a contributing factor for self-harm. Those diagnosed with schizophrenia have a high risk of suicide, which is particularly greater in younger patients as they may not have an insight into the serious effects that the disorder can have on their lives. Substance abuse is also considered a risk factor as are some personal characteristics such as poor problem-solving skills and impulsivity. There are parallels between self-harm and Münchausen syndrome, a psychiatric disorder in which individuals feign illness or trauma. There may be a common ground of inner distress culminating in self-directed harm in a Münchausen patient. However, a desire to deceive medical personnel in order to gain treatment and attention is more important in Münchausen's than in self-harm.

Abuse during childhood is accepted as a primary social factor increasing the incidence of self-harm, as is bereavement, and troubled parental or partner relationships. Factors such as war, poverty, and unemployment may also contribute. Other predictors of self-harm and suicidal behavior include feelings of entrapment, defeat, lack of belonging, and perceiving oneself as a burden along with less effective social problem-solving skills. Self-harm is frequently described as an experience of depersonalisation or a dissociative state. As many as 70% of individuals with borderline personality disorder engage in self-harm. An estimated 30% of individuals with autism spectrum disorders engage in self-harm at some point, including eye-poking, skin-picking, hand-biting, and head-banging. The onset of puberty has also been shown to be the onset of self-harm including the onset of sexual activity; this is because the pubertal period is a period of neurodevelopmental vulnerability and comes with an increased risk of emotional disorders and risk-taking behaviors.

The most distinctive characteristic of the rare genetic condition, Lesch-Nyhan syndrome, is self-harm and may include biting and head-banging. Genetics may contribute to the risk of developing other psychological conditions, such as anxiety or depression, which could in turn lead to self-harming behaviour. However, the link between genetics and self-harm in otherwise healthy patients is largely inconclusive.

Substance misuse, dependence and withdrawal are associated with self-harm. Benzodiazepine dependence as well as benzodiazepine withdrawal is associated with self-harming behaviour in young people. Alcohol is a major risk factor for self-harm. A study which analysed self-harm presentations to emergency rooms in Northern Ireland found that alcohol was a major contributing factor and involved in 63.8% of self-harm presentations. A recent study in the relation between cannabis use and deliberate self-harm (DSH) in Norway and England found that, in general, cannabis use may not be a specific risk factor for DSH in young adolescents. Smoking has also been associated with self-harm in adolescents; one study found that suicide attempts were four times higher for adolescents that smoke than for those that do not.

Self-harm is not typically suicidal behaviour, although there is the possibility that a self-inflicted injury may result in life-threatening damage. Although the person may not recognise the connection, self-harm often becomes a response to profound and overwhelming emotional pain that cannot be resolved in a more functional way.

The motivations for self-harm vary, as it may be used to fulfill a number of different functions. These functions include self-harm being used as a coping mechanism which provides temporary relief of intense feelings such as anxiety, depression, stress, emotional numbness and a sense of failure or self-loathing. There is also a positive statistical correlation between self-harm and emotional abuse. Self-harm may become a means of managing and controlling pain, in contrast to the pain experienced earlier in the person's life of which they had no control over (e.g., through abuse).

Other motives for self-harm do not fit into medicalised models of behaviour and may seem incomprehensible to others, as demonstrated by this quotation: "My motivations for self-harming were diverse, but included examining the interior of my arms for hydraulic lines. This may sound strange."

Assessment of motives in a medical setting is usually based on precursors to the incident, circumstances, and information from the patient. However, limited studies show that professional assessments tend to suggest more manipulative or punitive motives than personal assessments.

The UK ONS study reported only two motives: "to draw attention" and "because of anger". For some people, harming themselves can be a means of drawing attention to the need for help and to ask for assistance in an indirect way. It may also be an attempt to affect others and to manipulate them in some way emotionally. However, those with chronic, repetitive self-harm often do not want attention and hide their scars carefully.

Many people who self-harm state that it allows them to "go away" or dissociate, separating the mind from feelings that are causing anguish. This may be achieved by tricking the mind into believing that the present suffering being felt is caused by the self-harm instead of the issues they were facing previously: the physical pain therefore acts as a distraction from the original emotional pain. 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."

Alternatively, self-harm may be a means of feeling something, even if the sensation is unpleasant and painful. Those who self-harm sometimes describe feelings of emptiness or numbness ( anhedonia), and physical pain may be a relief from these feelings. "A person may be detached from themselves, 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'."

Those who engage in self-harm face the contradictory reality of harming themselves while at the same time obtaining relief from this act. It may even be hard for some to actually initiate cutting, but they often do because they know the relief that will follow. For some self-harmers this relief is primarily psychological while for others this feeling of relief comes from the beta endorphins released in the brain. Endorphins are endogenous opioids that are released in response to physical injury, acting as natural painkillers and inducing pleasant feelings, and in response to self-harm would act to reduce tension and emotional distress. Many self-harmers report feeling very little to no pain while self-harming and, for some, deliberate self-harm may become a means of seeking pleasure.

As a coping mechanism, self-harm can become psychologically addictive because, to the self-harmer, it works; it enables them to deal with intense stress in the current moment. The patterns sometimes created by it, such as specific time intervals between acts of self-harm, can also create a behavioural pattern that can result in a wanting or craving to fulfill thoughts of self-harm.

Emotional pain activates the same regions of the brain as physical pain, so emotional stress can be a significantly intolerable state for some people. Some of this is environmental and some of this is due to physiological differences in responding. The autonomic nervous system is composed of two components: the sympathetic nervous system controls arousal and physical activation (e.g., the fight-or-flight response) and the parasympathetic nervous system controls physical processes that are automatic (e.g., saliva production). The sympathetic nervous system innervates (e.g., is physically connected to and regulates) many parts of the body involved in stress responses. Studies of adolescents have shown that adolescents who self-injure have greater physiological reactivity (e.g., skin conductance) to stress than adolescents who do not self-injure. This stress response persists over time, staying constant or even increasing in self-injuring adolescents, but gradually decreases in adolescents who do not self-injure.

Several forms of psychosocial treatments can be used in self-harm including DBT. Psychiatric and personality disorders are common in individuals who self-harm and as a result self-harm may be an indicator of depression and/or other psychological problems.[citation needed ] Many people who self-harm have moderate or severe depression and therefore treatment with antidepressant medications may often be used. There is tentative evidence for the medication flupentixol; however, greater study is required before it can be recommended.

Dialectical behavior therapy for adolescents (DBT-A) is a well-established treatment for self-injurious behaviour in youth and probably useful for decreasing the risk of non suicidal self injury. Several other treatments including integrated CBT (I-CBT), attachment-based family therapy (ABFT), resourceful adolescent parent program (RAP-P), intensive interpersonal psychotherapy for adolescents (IPT-A-IN), mentalization-based treatment for adolescents (MBT-A), and integrated family therapy are probably efficacious. Cognitive behavioural therapy may also be used to assist those with Axis I diagnoses, such as depression, schizophrenia, and bipolar disorder. Dialectical behaviour therapy (DBT) can be successful for those individuals exhibiting a personality disorder, and could potentially be used for those with other mental disorders who exhibit self-harming behaviour. Diagnosis and treatment of the causes of self-harm is thought by many to be the best approach to treating self-harm. But in some cases, particularly in people with a personality disorder, this is not very effective, so more clinicians are starting to take a DBT approach in order to reduce the behaviour itself. People who rely on habitual self-harm are sometimes hospitalised, based on their stability, their ability and especially their willingness to get help. In adolescents multisystem therapy shows promise. Pharmacotherapy has not been tested as a treatment for adolescents who self-harmed.

A meta-analysis found that psychological therapy is effective in reducing self-harm. The proportion of the adolescents who self-harmed over the follow-up period was lower in the intervention groups (28%) than in controls (33%). Psychological therapies with the largest effect sizes were dialectical behaviour therapy (DBT), cognitive-behavioural therapy (CBT), and mentalization-based therapy (MBT).

Generating alternative behaviours that the person can engage in instead of self-harm is one successful behavioural method that is employed to avoid self-harm. Techniques, aimed at keeping busy, may include journaling, taking a walk, participating in sports or exercise or being around friends when the person has the urge to harm themselves. The removal of objects used for self-harm from easy reach is also helpful for resisting self-harming urges. The provision of a card that allows the person to make emergency contact with counselling services should the urge to self-harm arise may also help prevent the act of self-harm. Alternative and safer methods of self-harm that do not lead to permanent damage, for example the snapping of a rubber band on the wrist, may also help calm the urge to self-harm.[failed verification ] Using biofeedback may help raise self-awareness of certain pre-occupations or particular mental state or mood that precede bouts of self-harming behaviour, and help identify techniques to avoid those pre-occupations before they lead to self-harm. Any avoidance or coping strategy must be appropriate to the individual's motivation and reason for harming.

It is difficult to gain an accurate picture of incidence and prevalence of self-harm. This is due in a part to a lack of sufficient numbers of dedicated research centres to provide a continuous monitoring system. However, even with sufficient resources, statistical estimates are crude since most incidences of self-harm are undisclosed to the medical profession as acts of self-harm are frequently carried out in secret, and wounds may be superficial and easily treated by the individual. Recorded figures can be based on three sources: psychiatric samples, hospital admissions and general population surveys.

The World Health Organization estimates that, as of 2010, 880,000 deaths occur as a result of self-harm. About 10% of admissions to medical wards in the UK are as a result of self-harm, the majority of which are drug overdoses. However, studies based only on hospital admissions may hide the larger group of self-harmers who do not need or seek hospital treatment for their injuries, instead treating themselves. Many adolescents who present to general hospitals with deliberate self-harm report previous episodes for which they did not receive medical attention. In the United States up to 4% of adults self-harm with approximately 1% of the population engaging in chronic or severe self-harm.

Current research suggests that the rates of self-harm are much higher among young people with the average age of onset between 14 and 24. The earliest reported incidents of self-harm are in children between 5 and 7 years old. In the UK in 2008 rates of self-harm in young people could be as high as 33%. In addition there appears to be an increased risk of self-harm in college students than among the general population. In a study of undergraduate students in the US, 9.8% of the students surveyed indicated that they had purposefully cut or burned themselves on at least one occasion in the past. When the definition of self-harm was expanded to include head-banging, scratching oneself, and hitting oneself along with cutting and burning, 32% of the sample said they had done this. In Ireland, a study found that instances of hospital-treated self-harm were much higher in city and urban districts, than in rural settings. The CASE (Child & Adolescent Self-harm in Europe) study suggests that the life-time risk of self-injury is ~1:7 for women and ~1:25 for men.

In general, the latest aggregated research has found no difference in the prevalence of self-harm between men and women. This is in contrast to past research which indicated that up to four times as many females as males have direct experience of self-harm. However, caution is needed in seeing self-harm as a greater problem for females, since males may engage in different forms of self-harm (e.g., hitting themselves) which could be easier to hide or explained as the result of different circumstances. Hence, there remain widely opposing views as to whether the gender paradox is a real phenomenon, or merely the artifact of bias in data collection.

The WHO/EURO Multicentre Study of Suicide, established in 1989, demonstrated that, for each age group, the female rate of self-harm exceeded that of the males, with the highest rate among females in the 13-24 age group and the highest rate among males in the 12-34 age group. However, this discrepancy has been known to vary significantly depending upon population and methodological criteria, consistent with wide-ranging uncertainties in gathering and interpreting data regarding rates of self-harm in general. Such problems have sometimes been the focus of criticism in the context of broader psychosocial interpretation. For example, feminist author Barbara Brickman has speculated that reported gender differences in rates of self-harm are due to deliberate socially biased methodological and sampling errors, directly blaming medical discourse for pathologising the female.

Only recently have attempts to improve health in the developing world concentrated on not only physical illness but also mental health. Deliberate self-harm is common in the developing world. Research into self-harm in the developing world is however still very limited although an important case study is that of Sri Lanka, which is a country exhibiting a high incidence of suicide and self-poisoning with agricultural pesticides or natural poisons. Many people admitted for deliberate self-poisoning during a study by Eddleston et al. were young and few expressed a desire to die, but death was relatively common in the young in these cases. The improvement of medical management of acute poisoning in the developing world is poor and improvements are required in order to reduce mortality.

Some of the causes of deliberate self-poisoning in Sri Lankan adolescents included bereavement and harsh discipline by parents. The coping mechanisms are being spread in local communities as people are surrounded by others who have previously deliberately harmed themselves or attempted suicide. One way of reducing self-harm would be to limit access to poisons; however many cases involve pesticides or yellow oleander seeds, and the reduction of access to these agents would be difficult. Great potential for the reduction of self-harm lies in education and prevention, but limited resources in the developing world make these methods challenging.

Deliberate self-harm is especially prevalent in prison populations. A proposed explanation for this is that prisons are often violent places, and prisoners who wish to avoid physical confrontations may resort to self-harm as a ruse, either to convince other prisoners that they are dangerously insane and resilient to pain or to obtain protection from the prison authorities. Self-harm also occurs frequently in inmates who are placed in solitary confinement.

Self-harm was, and in some cases continues to be, a ritual practice in many cultures and religions.

The Maya priesthood performed auto- sacrifice by cutting and piercing their bodies in order to draw blood. A reference to the priests of Baal "cutting themselves with blades until blood flowed" can be found in the Hebrew Bible. However, in Judaism, such self-harm is forbidden under Mosaic law. It occurred in ancient Canaanite mourning rituals, as described in the Ras Shamra tablets.

Self-harm is practised in Hinduism by the ascetics known as s. In Catholicism it is known as mortification of the flesh. Some branches of Islam mark the Day of Ashura, the commemoration of the martyrdom of Imam Hussein, with a ritual of self-flagellation, using chains and swords.

Dueling scars such as those acquired through academic fencing at certain traditional German universities are an early example of scarification in European society. Sometimes, students who did not fence would scar themselves with razors in imitation.

Constance Lytton, a prominent suffragette, used a stint in Holloway Prison during March 1909 to mutilate her body. Her plan was to carve 'Votes for Women' from her breast to her cheek, so that it would always be visible. But after completing the "V" on her breast and ribs she requested sterile dressings to avoid blood poisoning, and her plan was aborted by the authorities. She wrote of this in her memoir Prisons and Prisoners.

Kikuyu girls cut each other's vulvas in the 1950s as a symbol of defiance, in the context of the campaign against female genital mutilation in colonial Kenya. The movement came to be known as Ngaitana ("I will circumcise myself"), because to avoid naming their friends the girls said they had cut themselves. Historian Lynn Thomas described the episode as significant in the history of FGM because it made clear that its victims were also its perpetrators.

The term "self-mutilation" occurred in a study by L. E. Emerson in 1913 where he considered self-cutting a symbolic substitution for masturbation. The term reappeared in an article in 1935 and a book in 1938 when Karl Menninger refined his conceptual definitions of self-mutilation. His study on self-destructiveness differentiated between suicidal behaviours and self-mutilation. For Menninger, self-mutilation was a non-fatal expression of an attenuated death wish and thus coined the term partial suicide. He began a classification system of six types:

1. neurotic - nail-biters, pickers, extreme hair removal and unnecessary cosmetic surgery.

2. religious - self-flagellants and others.

3. puberty rites - hymen removal, circumcision or clitoral alteration.

4. psychotic - eye or ear removal, genital self-mutilation and extreme amputation

5. organic brain diseases - which allow repetitive head-banging, hand-biting, finger-fracturing or eye removal.

6. conventional - nail-clipping, trimming of hair and shaving beards.

Pao (1969) differentiated between delicate (low lethality) and coarse (high lethality) self-mutilators who cut. The "delicate" cutters were young, multiple episodic of superficial cuts and generally had borderline personality disorder diagnosis. The "coarse" cutters were older and generally psychotic. Ross and McKay (1979) categorized self-mutilators into 9 groups: cutting, biting, abrading, severing, inserting, burning, ingesting or inhaling, hitting, and constricting.

After the 1970s the focus of self-harm shifted from Freudian psycho-sexual drives of the patients.

Walsh and Rosen (1988) created four categories numbered by Roman numerals I-IV, defining Self-mutilation as rows II, III and IV.

Classification

Examples of Behaviour

Degree of Physical Damage

Psychological State

Social Acceptability

I

Ear-piercing, nail-biting, small tattoos, cosmetic surgery (not considered self-harm by the majority of the population)

Superficial to mild

Benign

Mostly accepted

II

Piercings, saber scars, ritualistic clan scarring, sailor and gang tattoos, minor wound-excoriation, trichotillomania

Mild to moderate

Benign to agitated

Subculture acceptance

III

Wrist- or body-cutting, self-inflicted cigarette burns and tattoos, major wound-excoriation

Mild to moderate

Psychic crisis

Accepted by some subgroups but not by the general population

IV

Auto-castration, self-enucleation, amputation

Severe

Psychotic decompensation

Unacceptable

Favazza and Rosenthal (1993) reviewed hundreds of studies and divided self-mutilation into two categories: culturally sanctioned self-mutilation and deviant self-mutilation. Favazza also created two subcategories of sanctioned self-mutilations; rituals and practices. The rituals are mutilations repeated generationally and "reflect the traditions, symbolism, and beliefs of a society" (p. 226). Practices are historically transient and cosmetic such as piercing of earlobes, nose, eyebrows as well as male circumcision (for non-Jews) while Deviant self-mutilation is equivalent to self-harm.

Digital self-harm, which according to Justin W. Patchin and Sameer Hinduja is "the anonymous online posting, sending, or otherwise sharing of hurtful content about oneself", is an increasingly prevalent form of self-harm in the modern day and age for adolescents. Self-hate is highly prevalent in the adolescent stages. Through recent years, social media has grown and most adolescents now confront their feelings, whether about themselves or about others, online. The Society for Adolescent Health and Medicine published a nationally representative survey of 5,593 middle and high school students (12 to 17 years old) obtained in 2016. The study was led by Justin W. Patchin, PhD and Sameer Hinduja, PhD. Their study, "Digital Self-Harm Among Adolescents" revealed that 6 percent of students say they have cyberbullied themselves. The study also found that males were significantly more likely to report digital self-harm than females, with 7.1 percent for males compared with 5.3 percent for females. The study found correlations between digital self-harm and factors such as sexual orientation, prior experience with bullying, drug use, and depressive symptoms.

There are many movements among the general self-harm community to make self-harm itself and treatment better known to mental health professionals, as well as the general public. For example, March 1 is designated as Self-injury Awareness Day (SIAD) around the world. On this day, some people choose to be more open about their own self-harm, and awareness organizations make special efforts to raise awareness about self-harm.

Self-harm in non-human mammals is a well-established but not widely known phenomenon. Its study under zoo or laboratory conditions could lead to a better understanding of self-harm in human patients.

Zoo or laboratory rearing and isolation are important factors leading to increased susceptibility to self-harm in higher mammals, e.g., macaque monkeys. Non-primate mammals are also known to mutilate themselves under laboratory conditions after administration of drugs. For example, pemoline, clonidine, amphetamine, and very high (toxic) doses of caffeine or theophylline are known to precipitate self-harm in lab animals.

In dogs, canine obsessive-compulsive disorder can lead to self-inflicted injuries, for example canine lick granuloma. Captive birds are sometimes known to engage in feather-plucking, causing damage to feathers that can range from feather shredding to the removal of most or all feathers within the bird's reach, or even the mutilation of skin or muscle tissue.

Breeders of show mice have noticed similar behaviours. One known as "barbering" involves a mouse obsessively grooming the whiskers and facial fur off of themselves and cage-mates.

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Self-harm Other names Deliberate self-harm (DSH), self-injury (SI), self-poisoning, nonsuicidal self-injury (NSSI), cutting Healed scars on the forearm from prior self harm Specialty Psychiatry Self-harm, also known as self-injury, is defined as the intentional, direct injuring of body tissue, done without the intent to commit suicide.

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Great books and great reads for anyone with a passion for books.

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Get physical! When your body works, your subconscious brain kicks into gear, and that's where creativity lives. Also, it's always good to step away frGet physical! When your body works, your subconscious brain kicks into gear, and that's where creativity lives. Also, it's always good to step away from your writing when you're blocked, and this makes you do that. Ellen Hopkins...more (less)

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Get physical! When your body works, your subconscious brain kicks into gear, and that's where creativity lives. Also, it's always good to step away frGet physical! When your body works, your subconscious brain kicks into gear, and that's where creativity lives.

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Mental issues are not something to look past
The truth is hidden in the lines

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¨New York times bestselling author of fourteen young adult novels, as well as the adult novels, as well as the adult novels Triangles,Collateral and love lies Beneath. She lives with her family in Carson City, Nevada.¨

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Ellen Hopkins has published many more good reads such as
-CRANK
-burned
-Traffick
-Tricks

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Welcome to my home (page, that is). If you're here, it probably means you want to know more about me, so where do we start? To go all the way back to my beginning requires rewinding-eek!-over six decades. If you're up for a little time travel, check out my bio page. If you just want to know more about my books, you'll find information on those here. (Did you know I published twenty nonfiction books for children before moving into young adult fiction?) You can also learn where I might be appearing, and discover the answers to frequently asked questions. Oh, and if you're a writer, there's a whole section with tips on writing and publishing on the Reference page.

Many of you may be researching for school projects. Please visit my For Students section, also on the Reference page. If you don't find the information you need here, feel free to contact me via email. But please understand I get many, many requests for interviews every day. Use other resources first, then target your email with five specific questions not answered anywhere else.

To you wonderful teachers out there, you will find links to some really great reading guides for all my young adult novels. If you are asking your students to write to their favorite author, please know that I vastly prefer email to snail mail! The post office is twenty miles away and I don't get there every day.

If you're a teacher, librarian or assorted "other" hoping to schedule an author appearance, my personal life has slowed down a little and I'm happy to consider invitations. Please check in with Roberta at author.appearances@simonandschuster.com

So go on. Take a good, long look around and come back often. I'm happy you've chosen to visit me here. The front door's open, water's on for tea, and there are cookies in the oven. Only problem is, it's likely my husband is baking them. Since my life turned crazy busy, he has moved into the role of family chef. And he's still learning. (And burning stuff.)

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Welcome to my home (page, that is). If you're here, it probably means you want to know more about me, so where do we start? To go all the way back to my beginning requires rewinding-eek!-over six decades. If you're up for a little time travel, check out my bio page.

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The location of my book

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Bipolar disorder, previously known as "manic depression," is a brain-based disorder. This condition is characterized by one or more occurrences of manic or "mixed" episodes, and in some cases, may include a major depressive episode.

While depression has commonly been associated with the disorder, we now know a bipolar diagnosis does not need to include depressive episodes, though it can.

Moreover, the disorder has the potential to affect virtually all other areas of your body, from your energy levels and appetite to your muscles and even libido.

Read on to find out how bipolar can affect different areas of your body.

The effects of bipolar disorder

Bipolar disorder is identified by periods of manic episodes.

During a manic phase, you have above-average energy levels, and may not sleep much. You can also experience irritability, restlessness, and an increased sex drive.

If you develop depression, this phase can have the opposite effects on the body. You may feel a sudden lack of energy and require more sleep, along with feeling depressed and hopeless.

Appetite changes can also occur if the person develops depression. As with mania, depression can also cause irritability and restlessness.

It's also possible to experience a mixed-state of mania and depression. You might notice symptoms from both phases.

Central nervous system

Bipolar disorder primarily affects the brain, which is part of your central nervous system.

Composed of both the brain and the spine, your central nervous system is made up of a series of nerves that are in control of different body activities.

Some of the effects include:

irritability

aggressiveness

hopelessness

feelings of guilt

severe sadness

loss of interest in activities you normally enjoy

being in an excessively good mood

overactivity

feelings of hyperactivity

being easily distracted

forgetfulness

being overly defensive

having a provocative attitude

Bipolar disorder can also make it difficult to concentrate.

When you're in the midst of a manic phase, you might find your mind racing and have a hard time controlling your thoughts. You may even talk faster than usual.

A depressive episode can also cause concentration difficulties, but your mind may feel a lot slower than normal. You might feel restless and have a hard time making decisions. Your memory may also be low.

Bipolar disorder can affect your ability to fall and stay asleep.

Manic phases often mean that you need very little sleep, and depressive episodes can result in sleeping more or less than normal. It's not uncommon to have insomnia in both instances.

Insomnia can become especially dangerous in bipolar disorder, as you may be more tempted to take sleeping pills. Such risks are more associated with mania than depression.

Cardiovascular system

When you have anxiety in addition to bipolar disorder, this can affect your cardiovascular system, too.

This includes:

heart palpitations

rapid heart rate

an increased pulse

Higher-than-normal blood pressure may also occur.

People with bipolar disorder are at a higher risk of being diagnosed with anxiety or attention-deficit hyperactivity disorder (ADHD), according to the National Institute of Mental Health (NAMI).

Endocrine system

Your endocrine system consists of hormones that rely heavily on messaging signals from the brain. When these signals are disrupted, you can experience hormone fluctuations.

Bipolar disorder can cause changes to your libido. Mania may put your sex drive on overload, while depression can significantly decrease it.

Some people experience poor judgment with this disorder, which can also increase the risk for poor decision-making in terms of sexual health.

Bipolar disorder may also affect your weight, especially during depressive phases. With depression, you might experience a decrease in your appetite, resulting in weight loss.

It's also possible to have the opposite experience - your appetite might increase, thereby making you gain weight.

Skeletal and muscular systems

Bipolar disorder doesn't directly affect the bones and muscles, but if you experience depressive episodes, these can affect your skeletal and muscular systems.

Depression can lead to unexplained aches and pains, which can make everyday activities difficult to manage. You might also find it difficult to exercise due to your discomfort.

Moreover, if you do experience depression, weakness and fatigue are common and can be accompanied with sleeping too much or an inability to sleep.

Gastrointestinal system

Anxiety associated with bipolar disorder can make your feel tired and irritable. It can also affect your gastrointestinal system.

Some of these effects include:

Such symptoms are often accompanied with feelings of panic, or a sense of impending doom. You might also sweat and breathe rapidly.

Other effects

Bipolar disorder can affect your performance at work or school. It can also make it challenging to build and maintain relationships.

Other effects may include:

heavy alcohol use

drug misuse

spending sprees

unrealistic beliefs in your own abilities

Many people with bipolar disorder are still highly functioning individuals and can maintain a healthy professional and personal life. Untreated bipolar disorder is more likely to worsen and interfere with your daily life.

Suicidal thoughts and actions can occur in both manic and depressive episodes.

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13 Effects of Bipolar Disorder on the Body

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Bipolar disorder directly impacts the brain. With this condition, you have alternating phases of mania and depression. Though bipolar disorder can have a profound effect on your mood, this disorder affects virtually all other areas of your body as well. Here's how bipolar can affect different areas of your body.

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An entire community can be changed by a suicide. This is why it's essential that support is available for everyone impacted in the wake of a suicide loss, and that we continue to work towards prevention.

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