Academic journal article New Zealand Journal of Psychology

Conceptualisations of Deliberate Self-Harm as It Occurs within the Context of Pacific Populations Living in New Zealand

Academic journal article New Zealand Journal of Psychology

Conceptualisations of Deliberate Self-Harm as It Occurs within the Context of Pacific Populations Living in New Zealand

Article excerpt

Introduction

Deliberate self-harm (DSH) is the strongest predictor for eventual death by suicide with recent figures indicating that associated costs to the health system are approximately $25 million (Ministry of Health, MOH: 2014). While the adverse impacts of DSH on Pacific populations are notable (MOH, 2014; Hatcher, Sharon, & Collins, 2009), clinical definitions of DSH do not consider Pacific perspectives. This reflects the wider gap in the existing body of knowledge around DSH in Pacific populations, pointing to the need to consider conceptualisations that more closely reflect their unique cultural perspectives. The inclusion of an official Pacific definition of DSH would better inform research, risk assessments, symptomatology documentation, clinical diagnosis and consistent communications between professionals, regarding Pacific clients (De Leo, Burgis, Bertolote, Kerkof, & Bille-Brahe, 2006; Muehrer, 1995). The aims of the present study were to a) explore Pacific mental health and addiction professionals' (working in New Zealand) understandings and perceptions of DSH, and b) to identify a Pacific- relevant definition of DSH based on these health professionals' perspectives and understandings.

Literature definition(s) of DSH

The literature presents differing views on whether DSH and suicide are different levels of the same behavior continuum or are separate behaviours entirely (Farrelly & Francis, 2009; De Leo et al., 2006). The two dominant DSH paradigms that are widely adopted by researchers and clinicians include:

a) DSH irrespective of intent (commonly referred to as 'self-harm')

b) DSH without suicidal intent (referred to as 'nonsuicidal self-injury' or NSSI) (Latimer, Meade & Tennant, 2013).

Both paradigms consider DSH as a subtype of self-destructive behaviour(s) that are self-initiated, intentional, and causes direct or immediate injuries to the self, with non-fatal outcomes (Associate MOH, 2006; Latimer, Meade, & Tennant, 2013; Lundh, Karim, & Quilisch, 2007; Fortune, 2006). Both paradigms exclude self-destructive behaviours considered indirect, that cause physical harm over time such as, substance abuse or eating disorders; those associated with cognitive disability, episodes of psychosis, and acts of self-harm that are considered culturally or religiously sanctioned (Gratz, 2006; Fortune, Seymour, & Lambie, 2005; Lundh et al., 2007; De Leo et al., 2006).

Diagnostic Statistical Manual of Mental Disorders and DSH

Efforts to promote more accurate comparisons across clinical diagnoses and between studies, had seen the inclusion of NSSI and suicidal behaviour in section III of the most recently released Diagnostic Statistical Manual of Mental Health Disorders-5 (DSM5) (Muehlenkamp et al., 2012). Previously, DSH (encompassing of NSSI and self-harm) was only considered as a symptom of Borderline Personality Disorder (BPD) in earlier versions of the DSM and in the International Statistical Classification of Diseases and Related Health Problems Manual (Fox, 2004). Subsequently, the inclusion of NSSI and suicidal behaviour as proposed distinctive disorders in the DSM-5, therefore reflects an attempt to classify DSH as being either with or without the intent to die (Muehlenkamp et al., 2012).

The merit for the inclusion of DSH, more specifically, NSSI and suicidal behaviour in the DSM-5 was also in part based on recent evidence that suggests that the methods of DSH most associated with NSSI may form a distinct grouping of behaviour on a DSH continuum (Ougrin & Zundel, 2009, Latimer et al., 2013). Findings have shown that multiple incidents of NSSI were reported more frequently than attempted suicide or completed suicides indicating a need for a 'new' category (Muehlenkamp, 2005; Jacobson & Gould, 2007). For these reasons, the DSM-5 now includes NSSI and Suicidal behaviour in section III, 'Emerging Measures and Models of the DSM-5' manual under the heading 'Condition for Further Studies' among other disorders including internet gaming disorder (APA, 2013). …

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