Looking in, looking out-increasing awareness of intentional self-harm in community populations.

INTENTIONAL SELF-HARM without intent to die involves complex health, psychological, and social behaviors. Over many years, an attempt to explain these behaviors has ranged from the supernatural with demonic possession to multiple explanations through psychiatry and psychology (Favazza, 1996). At one time, self-harm was believed to exist primarily in patients with mental illness. In modern society, self-harm without intent to die has come into the main stream through the Internet, music, and movies and is now reported in various community populations. Approximately 1% to 4% of adults and 13% to 23% of adolescents report a history of self-harm without intent to die (Jacobson & Gould, 2007). Other community populations where self-harming behavior has been reported is 4% among military recruits (Klonsky, Oltmanns, & Turkheimer, 2003) to up to 38% among college students (Brown, Williams, & Collins, 2007; Favazza, DeRosear, & Conterio, 1989; Gratz, Conrad, & Roemer, 2002). People with a history of self-harm were found to have an elevated lifetime risk for suicide (deMoore & Robertson, 1998; Hawton, Zahl, & Weatherall, 2003; Zahl & Hawton, 2004). Self-harm is an international phenomenon as well with care being reported by researchers from England, India, and Norway (Klonsky, 2007). Advanced practice nurses (APNs), especially the psychiatric nurse practitioner and the pediatric nurse practitioner working with adolescents, are in key positions to screen for self-harming behavior. In a recently published study of Ohio APN's screening for self-harm (Tusaie, Acierto, Murray, Fitzgerald, & Chiu, 2009), psychiatric nurse practitioners reported to be the only group of APNs to screen 100% of their patients. However, APNs from other specialties did not respond to the survey question in such a uniform fashion. For instance, about 64% of pediatric nurse practitioners reported to screen for self-harm. Although there were only seven psychiatric nurse practitioners in this study who responded to the survey, this response makes one wonder, does this reflect the historical pattern of intentional self-harm being linked to mental illness? One can argue that the higher awareness seen in psychiatric nurse practitioners could be due to the fact that psychiatric nurses see patients with evidence of self-harm in their clinical practice. Importantly, the acute awareness by the psychiatric APN, that self harming behavior is a coping mechanism, may lead the psychiatric APN to pursue this behavior with their patients and why it may be occurring. The secretive nature and related shame of self-harm by Available online at www.sciencedirect.com