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自傷
自傷
又称	蓄意自我傷害、自傷、非自杀性自我伤害
	自傷所造成的前臂傷疤
类型	創傷、autoaggression[]、有意行為[]
治療	心理治療
分类和外部资源
醫學專科	精神科
ICD-11	MB23.E
ICD-10	X84
DiseasesDB	30605、29126
	[编辑此条目的维基数据]

自傷（self-harm，self-injury）^[1]^[2]是有意且直接地傷害身體組織的行為，當事人一般沒有自殺的意圖^[3]^[4]^[5]。无论是否有自杀意图, “自残”经常被滥用于任何有自我伤害的情况。^[4]^[6] 較近期的文獻多會使用“自我傷害”和“自傷”去取代較不中立的「自殘」，特別是《精神疾病診斷與統計手冊第五版》出版以後。

最常見的自傷方法是使用尖銳的物體割破當事人自身的皮膚，但自傷也包括各式各樣的行為，包括自焚、划伤身體部位、把身體撞向硬物、用拳頭或其他會造成傷害的物件打向自己、干擾傷口癒合（摳皮症）、拔毛（拔毛癖），以及攝入有毒物質^[4]^[7]^[8]。

物質濫用和进食障碍一般不會視作自傷，因為所造成的組織損傷通常都是無意的附加後果^[9]。以及纹身和穿孔等社会可接受的身体修饰一也不被认为是自我伤害。^[10]然而，相關定義的界線並不總是明確的：如果當事人故意以一些通常不視作自傷的行為傷害自己，那麼亦可界定為自傷^[9]。

雖然自殺並不是自傷者的意圖，但自傷與自殺之間存在著一段複雜的關係，因自傷行為具有致命的潛在風險^[11]。自傷者擁有相對較高的自殺風險^[7]^[12]；40–60%的自殺者亦曾出現過一定程度的自傷行為^[13]。儘管如此，只有少数自残者有自杀倾向。仍不能归纳性地認定大多數自傷者最終都會自殺^[14]^[15]。

有很多种疾病会导致「對自我伤害的渴求」。自我伤害是一些人格障碍的普遍症状。除此之外，有研究表明很多心理疾患的患者也会有该症状，包括抑郁症、焦虑症、自閉症譜系障礙、創傷後壓力症候群、精神分裂症、物质滥用、情绪障碍、进食障碍、創傷後壓力症候群、精神分裂症、解离障碍的人，以及经历性别焦虑症的人^[4]。同时该研究证明自我伤害是自我惩罚功能的一种表现形式，根据研究自我伤害的动机可能是阶段性的反分离、反自杀、寻求感觉和人际关系影响, 根据个例不同, 自我伤害的动机各不相同^[4]。在没有潜在心理健康诊断的高功能个体中也会发生自我伤害^[16]。有些人将自我伤害用作因应，暂时缓解焦虑、抑郁、压力、情绪麻木或失败感等强烈情绪。自我伤害通常与创伤史有关，包括情感和性虐待。^[17] 有许多不同的手段可用于治疗自我伤害，这些手段有些是专注于治疗根本原因, 有些是治疗自我伤害行为本身。其他方法包括回避治疗，重点是让个人忙于其他活动，或用不会导致永久损害的更安全的方法取代自我伤害的行为。^[18] 自我伤害往往始于青春期。在童年的自我伤害相对罕见，但自20世纪80年代以来，比例有所上升。^[19]老年人也有可能有自我伤害的行为。^[20]自残的老年人严重受伤和自杀的风险更高。^[21]被人类的圈养动物中, 鸟类和猴子也被观察到有自我伤害行为。^[22]关于自我伤害的一个常见观念是，这是一种寻求注意力的行为；在许多情况下，这个观念是错误的。许多自我伤害者对暴露自己伤口和疤痕非常在意，对自己的行为感到内疚，导致他们不遗余力地向他人隐瞒自己的行为。^[23]他们可能会为自己的伤害找一些借口，或用衣服隐藏他们的伤疤。^[24]^[25]

參考文獻

^ 自伤. 术语在线. 全国科学技术名词审定委员会. （简体中文）
^ self-harm. 樂詞網. 國家教育研究院（中文（臺灣））.
^ Laye-Gindhu, A.; Schonert-Reichl, Kimberly A., Nonsuicidal Self-Harm Among Community Adolescents: Understanding the "Whats" and "Whys" of Self-Harm, Journal of Youth and Adolescence, 2005, 34 (5): 447–457, doi:10.1007/s10964-005-7262-z
^ ^4.0 ^4.1 ^4.2 ^4.3 ^4.4 Klonsky, D., The functions of deliberate self-injury: A review of the evidence, Clinical Psychological Review, 2007, 27 (2): 226–239, PMID 17014942, doi:10.1016/j.cpr.2006.08.002
^ Muehlenkamp, J. J., Self-Injurious Behavior as a Separate Clinical Syndrome, American Journal of Orthopsychiatry, 2005, 75 (2): 324–333, PMID 15839768, doi:10.1037/0002-9432.75.2.324
^ Groschwitz RC, Plener P. The Neurobiology of Non-suicidal Self-injury (NSSI) : A review (PDF). Suicidology Online: 24–32. [2018-03-07]. （原始内容存档 (PDF)于2021-01-20）.
^ ^7.0 ^7.1 Skegg, K., Self-harm, Lancet, 2005, 366: 1471–1483, doi:10.1016/s0140-6736(05)67600-3
^ Truth Hurts Report, Mental Health Foundation, 2006 [2008-06-11], ISBN 978-1-903645-81-9, （原始内容存档于2019-11-02）
^ ^9.0 ^9.1 Klonsky, E. D., Non-Suicidal Self-Injury: An Introduction, Journal of Clinical Psychology, 2007, 63 (11): 1039–43, PMID 17932979, doi:10.1002/jclp.20411
^ Klonsky 2007b，第1040頁: "[B]ehaviors associated with substance and eating disorders—such as alcohol abuse, binging, and purging—are usually not considered self-injury because the resulting tissue damage is ordinarily an unintentional sideeffect. In addition, body piercings and tattoos are typically not considered self-injury because they are socially sanctioned forms of cultural or artistic expression. However, the boundaries are not always clear-cut. In some cases behaviors that usually fall outside the boundaries of self-injury may indeed represent self-injury if performed with explicit intent to cause tissue damage."
^ Farber, S.; et al, Death and annihilation anxieties in anorexia nervosa, bulimia, and self-mutilation, Psychoanalytic Psychology, 2007, 24 (2): 289–305, doi:10.1037/0736-9735.24.2.289
^ Haw, C.; et al, Psychiatric and personality disorders in deliberate self-harm patients, British Journal of Psychiatry, 2001, 178 (1): 48–54, PMID 11136210, doi:10.1192/bjp.178.1.48
^ Hawton K., Zahl D. and Weatherall, R., Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital, British Journal of Psychiatry, 2003, 182: 537–542, PMID 12777346, doi:10.1192/bjp.182.6.537
^ Fox, C; Hawton, K, Deliberate Self-Harm in Adolescence, London: Jessica Kingsley, 2004, ISBN 978-1-84310-237-3
^ Suyemoto, K. L., The functions of self-mutilation, Clinical Psychology Review, 1998, 18 (5): 531–554, PMID 9740977, doi:10.1016/S0272-7358(97)00105-0
^ Meltzer H, Lader D, Corbin T, Singleton N, Jenkins R, Brugha T. Non Fatal Suicidal Behaviour Among Adults aged 16 to 74 (PDF). Great Britain: The Stationery office. 2000 [2023-11-16]. ISBN 978-0-11-621548-2. （原始内容存档 (PDF)于2024-03-15）.
^ Rea K, Aiken F, Borastero C. Building therapeutic staff: client relationships with women who self-harm. Women's Health Issues. 1997, 7 (2): 121–125. PMID 9071885. doi:10.1016/S1049-3867(96)00112-0.
^ Klonsky ED, Glenn CR. Resisting Urges to Self-Injure. Behavioural and Cognitive Psychotherapy. March 2008, 36 (2): 211–220. PMC 5841247 . PMID 29527120. doi:10.1017/S1352465808004128.
^ Thomas B, Hardy S, Cutting P. Stuart and Sundeen's mental health nursing: principles and practice. Elsevier Health Sciences. 1997: 343. ISBN 978-0-7234-2590-8.
^ Pierce D. Deliberate self-harm in the elderly. International Journal of Geriatric Psychiatry. 1987, 2 (2): 105–110. S2CID 145408278. doi:10.1002/gps.930020208.
^ National Institute for Clinical Excellence. National Clinical Practice Guideline Number 16: Self-harm (PDF). The British Psychological Society. 2004 [2009-12-13]. （原始内容存档 (PDF)于2012-09-05）.
^ Jones IH, Barraclough BM. Auto-mutilation in animals and its relevance to self-injury in man. Acta Psychiatrica Scandinavica. July 1978, 58 (1): 40–47. PMID 99981. S2CID 24737213. doi:10.1111/j.1600-0447.1978.tb06918.x.
^ Truth Hurts Report. Mental Health Foundation. 2006 [2008-06-11]. ISBN 978-1-903645-81-9. （原始内容存档于2019-11-02）.
^ Spandler H. Who's Hurting Who? Young people, self-harm and suicide. Manchester: 42nd Street. 1996. ISBN 978-1-900782-00-5.
^ Pembroke LR (编). Self-harm – Perspectives from personal experience. Chipmunka/Survivors Speak Out. 1994. ISBN 978-1-904697-04-6.

外部链接

[1] 自伤. 术语在线. 全国科学技术名词审定委员会. （简体中文）

[2] self-harm. 樂詞網. 國家教育研究院（中文（臺灣））.

[Gindhu05-3] Laye-Gindhu, A.; Schonert-Reichl, Kimberly A., Nonsuicidal Self-Harm Among Community Adolescents: Understanding the "Whats" and "Whys" of Self-Harm, Journal of Youth and Adolescence, 2005, 34 (5): 447–457, doi:10.1007/s10964-005-7262-z

[Klonsky07-4] 4.0 ^4.1 ^4.2 ^4.3 ^4.4 Klonsky, D., The functions of deliberate self-injury: A review of the evidence, Clinical Psychological Review, 2007, 27 (2): 226–239, PMID 17014942, doi:10.1016/j.cpr.2006.08.002

[Muehlenkamp05-5] Muehlenkamp, J. J., Self-Injurious Behavior as a Separate Clinical Syndrome, American Journal of Orthopsychiatry, 2005, 75 (2): 324–333, PMID 15839768, doi:10.1037/0002-9432.75.2.324

[6] Groschwitz RC, Plener P. The Neurobiology of Non-suicidal Self-injury (NSSI) : A review (PDF). Suicidology Online: 24–32. [2018-03-07]. （原始内容存档 (PDF)于2021-01-20）.

[Skegg05-7] 7.0 ^7.1 Skegg, K., Self-harm, Lancet, 2005, 366: 1471–1483, doi:10.1016/s0140-6736(05)67600-3

[MHl-8] Truth Hurts Report, Mental Health Foundation, 2006 [2008-06-11], ISBN 978-1-903645-81-9, （原始内容存档于2019-11-02）

[Klonsky07_JCP-9] 9.0 ^9.1 Klonsky, E. D., Non-Suicidal Self-Injury: An Introduction, Journal of Clinical Psychology, 2007, 63 (11): 1039–43, PMID 17932979, doi:10.1002/jclp.20411

[10] Klonsky 2007b，第1040頁: "[B]ehaviors associated with substance and eating disorders—such as alcohol abuse, binging, and purging—are usually not considered self-injury because the resulting tissue damage is ordinarily an unintentional sideeffect. In addition, body piercings and tattoos are typically not considered self-injury because they are socially sanctioned forms of cultural or artistic expression. However, the boundaries are not always clear-cut. In some cases behaviors that usually fall outside the boundaries of self-injury may indeed represent self-injury if performed with explicit intent to cause tissue damage."

[11] Farber, S.; et al, Death and annihilation anxieties in anorexia nervosa, bulimia, and self-mutilation, Psychoanalytic Psychology, 2007, 24 (2): 289–305, doi:10.1037/0736-9735.24.2.289

[Haw01-12] Haw, C.; et al, Psychiatric and personality disorders in deliberate self-harm patients, British Journal of Psychiatry, 2001, 178 (1): 48–54, PMID 11136210, doi:10.1192/bjp.178.1.48

[Hawton_BMJ_03-13] Hawton K., Zahl D. and Weatherall, R., Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital, British Journal of Psychiatry, 2003, 182: 537–542, PMID 12777346, doi:10.1192/bjp.182.6.537

[fox_hawton-14] Fox, C; Hawton, K, Deliberate Self-Harm in Adolescence, London: Jessica Kingsley, 2004, ISBN 978-1-84310-237-3

[Suyemoto98-15] Suyemoto, K. L., The functions of self-mutilation, Clinical Psychology Review, 1998, 18 (5): 531–554, PMID 9740977, doi:10.1016/S0272-7358(97)00105-0

[meltzer-16] Meltzer H, Lader D, Corbin T, Singleton N, Jenkins R, Brugha T. Non Fatal Suicidal Behaviour Among Adults aged 16 to 74 (PDF). Great Britain: The Stationery office. 2000 [2023-11-16]. ISBN 978-0-11-621548-2. （原始内容存档 (PDF)于2024-03-15）.

[rea-17] Rea K, Aiken F, Borastero C. Building therapeutic staff: client relationships with women who self-harm. Women's Health Issues. 1997, 7 (2): 121–125. PMID 9071885. doi:10.1016/S1049-3867(96)00112-0.

[Klonsky08-18] Klonsky ED, Glenn CR. Resisting Urges to Self-Injure. Behavioural and Cognitive Psychotherapy. March 2008, 36 (2): 211–220. PMC 5841247 . PMID 29527120. doi:10.1017/S1352465808004128.

[ThomasHardy1997-19] Thomas B, Hardy S, Cutting P. Stuart and Sundeen's mental health nursing: principles and practice. Elsevier Health Sciences. 1997: 343. ISBN 978-0-7234-2590-8.

[Pierce87-20] Pierce D. Deliberate self-harm in the elderly. International Journal of Geriatric Psychiatry. 1987, 2 (2): 105–110. S2CID 145408278. doi:10.1002/gps.930020208.

[NICE04-21] National Institute for Clinical Excellence. National Clinical Practice Guideline Number 16: Self-harm (PDF). The British Psychological Society. 2004 [2009-12-13]. （原始内容存档 (PDF)于2012-09-05）.

[Jones07-22] Jones IH, Barraclough BM. Auto-mutilation in animals and its relevance to self-injury in man. Acta Psychiatrica Scandinavica. July 1978, 58 (1): 40–47. PMID 99981. S2CID 24737213. doi:10.1111/j.1600-0447.1978.tb06918.x.

[MHF-23] Truth Hurts Report. Mental Health Foundation. 2006 [2008-06-11]. ISBN 978-1-903645-81-9. （原始内容存档于2019-11-02）.

[spandler-24] Spandler H. Who's Hurting Who? Young people, self-harm and suicide. Manchester: 42nd Street. 1996. ISBN 978-1-900782-00-5.

[pembroke-25] Pembroke LR (编). Self-harm – Perspectives from personal experience. Chipmunka/Survivors Speak Out. 1994. ISBN 978-1-904697-04-6.

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自傷

參考文獻

外部链接

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