Deliberate self-harm has recently begun to receive more systematic attention from clinical researchers. However, there remains a general lack of consensus as to how to define and measure this important clinical construct. There is still no standardized, empirically validated measure of deliberate self-harm, making it more difficult for research in this area to advance. The present paper provides an integrative, conceptual definition of deliberate self-harm as well as preliminary psychometric data on a newly developed measure of self-harm, the Deliberate Self-Harm Inventory (DSHI). One hundred and fifty participants from undergraduate psychology courses completed research packets consisting of the DSHI and other measures, and 93 of these participants completed the DSHI again after an interval of 2–4 weeks (M = 3.3 weeks). Preliminary findings indicate that the DSHI has high internal consistency; adequate construct, convergent, and discriminant validity; and adequate test-retest reliability.

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Measurement of Deliberate Self-Harm: Preliminary Data on the Deliberate Self-Harm Inventory

The internet is the most comprehensive electronic archive of written material representing our world and peoples' opinions, concerns, and desires. Physicians who surf the internet for the first time are often stunned by what they learn on websites set up by lay people or patient self support communities. Material on these venues can be a rich source for researchers interested in understanding the experiences and views of people and patients. Qualitative analysis of material published and communicated on the internet can serve to systematise and codify needs, values, concerns, and preferences of consumers and professionals relevant to health and health care. While the internet makes people's interactions uniquely accessible for researchers and erases boundaries of time and distance, such research raises new issues in research ethics, particularly concerning informed consent and privacy of research subjects, as the borders between public and private spaces are sometimes blurred.

#### Summary points

Internet communities (such as mailing lists, chat rooms, newsgroups, or discussion boards on websites) are rich sources of qualitative data for health researchers

Qualitative analysis of internet postings may help to systematise and codify needs, values, and preferences of consumers and professionals relevant to health and health care

Internet based research raises several ethical questions, especially pertaining to privacy and informed consent

Researchers and institutional review boards must primarily consider whether research is intrusive and has potential for harm, whether the venue is perceived as “private” or “public” space, how confidentiality can be protected, and whether and how informed consent should be obtained

Internet communities provide a way for a group of peers to communicate with each other. They include discussion boards on websites, mailing lists, chat rooms, or newsgroups. Examples of health related mailing lists can easily be found by inserting a key word such as “cancer” in the search box at the …

https://www.bmj.com/content/bmj/323/7321/1103.full.pdf

Ethical issues in qualitative research on internet communities

Currently little research exists examining self-mutilation (SM) in community samples of adolescents, despite tentative findings suggesting that self-harming behaviors, including SM may be increasing. The present study provides a comprehensive review of previous literature on the frequency of SM as well as preliminary epidemiological data concerning the frequency of SM in a community sample of high schools students. The relationship between SM, anxiety, and depressive symptomatology was also assessed. Four hundred and forty students from two schools, an urban and a suburban high school, were given a screening measure designed to assess for SM. Students who indicated that they hurt themselves on purpose also participated in a follow-up interview. Based on interviews it was found that 13.9% of all students reported having engaged in SM behavior at some time. Girls reported significantly higher rates of SM than did boys (64 vs. 36%, respectively). Self-cutting was found to be the most common type of SM, followed by self-hitting, pinching, scratching, and biting. Finally, students who self-mutilate reported significantly more anxiety and depressive symptomatology than students who did not self-mutilate. Results are also presented concerning demographic information and patterns of SM behavior.

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A Study of the Frequency of Self-Mutilation in a Community Sample of Adolescents

OBJECTIVE: Research on deliberate self-harm (intentionally injuring oneself without suicidal intent) has focused on clinical and forensic populations. Studying only these populations, which typically have serious psychopathology, may lead to inflated estimates of the association between self-harm and psychiatric disorder, as well as of the prevalence of deliberate self-harm. The present study investigated the prevalence and correlates of deliberate self-harm in a large group of nonclinical subjects. METHOD: Participants were 1,986 military recruits, 62% of whom were men, who were participating in a study of peer assessment of personality traits and pathology. Individuals who did and did not report a history of self-harm were compared on measures of personality and psychopathology. RESULTS: Approximately 4% of the participants reported a history of deliberate self-harm. Compared with participants without a history of deliberate self-harm, self-harmers scored higher on self- and peer-report measures of bord...

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Deliberate Self-Harm in a Nonclinical Population: Prevalence and Psychological Correlates

Since the mid-1990s, there have been frequent reports of individuals whose use of the computer and internet is problematic. Given the recent expansion and the expected increase in internet availability and usage in the coming years, it is important that healthcare professionals be informed about this behavior and its associated problems. Recently, psychological and psychiatric literature has described individuals that exhibit problematic internet use who often suffer from other psychiatric disorders. In the face of this comorbidity, it is essential to evaluate whether these individuals represent a distinct class of disorder, or a manifestation/coping mechanism related to other underlying diagnosis. In either event, problematic internet use negatively impacts social and emotional functioning. Based on the current limited empirical evidence, problematic internet use may best be classified as an impulse control disorder. It is therefore imperative that problematic internet use be appropriately identified among symptomatic individuals. For these reasons, we propose specific diagnostic criteria that will allow for consistent identification and assist in further study of this behavior.

Problematic internet use: proposed classification and diagnostic criteria.

The challenge of self-mutilation: A review

:Within the past few years, the Internet has exploded into a medium of choice for those interested in health and medicine. Along with the promise of immediate access to authoritative resources via websites, the Internet offers “virtual support groups” through formats such as chat rooms and n

Munchausen by Internet: detecting factitious illness and crisis on the Internet.

Factitious disorder: a systematic review of 455 cases in the professional literature

Malingering in the Medical Setting

Objectives. The objective of the present study was to characterize physicians’ estimates of MUS, including clinically significant MUS, and to demonstrate in a single study how estimates vary based on the definition used. Methods. Two hundred and thirteen physicians completed an online questionnaire regarding the number of patients who present to their clinic with MUS. To reduce memory biases, participants reported on the number of patient seen in their most recent clinic day who met increasingly restrictive case definitions for MUS. Weekly estimates were also obtained. Results. The least restrictive definition yielded an estimate of 11%. When certainty criteria were added to the definition of MUS, the estimate decreased considerably to 4%. Approximately 3% of patients were estimated to have chronic MUS that affected their daily functioning or caused significant distress (i.e. psychologically significant MUS), and only half of these, 1.5%, were assigned a diagnosis of somatoform disorder or factitious disorder. The proportion of MUS cases accounted for by malingering was 18%. Conclusions. The present study documents significantly lower estimates of MUS than chart review studies. However, our results suggest that a significant proportion of the total number of patients who present with MUS have abnormal illness behaviour associated with significant impairment or distress. Despite physicians’ recognizing significant distress and dysfunction in these cases, formal diagnoses of somatoform or factitious disorder are rarely assigned.

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Marc D. Feldman

Papers

The challenge of self-mutilation: A review

Munchausen by Internet: detecting factitious illness and crisis on the Internet.

Factitious disorder: a systematic review of 455 cases in the professional literature

Malingering in the Medical Setting

Physician-based estimates of medically unexplained symptoms: a comparison of four case definitions.