La adolescencia es un período de desarrollo con elevado riesgo de autolesiones . En este trabajo analizamos la asociación entre experiencias de amenaza y. Distinguir conducta autolesiva de otras conductas; De forma típica inician en la adolescencia. Seguimiento. Autolesión; Pensamiento. [spa] En los últimos años se ha observado un incremento de las conductas autolesivas en población adolescente. Altos niveles de disociación.

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Laura Silva Thyssen, 1 Ingrid van Camp 1. In areas with a Caucasian majority population, such as the USA, Canada and Europe, it is a rapidly increasing phenomenon, especially among young people. During a ten-month period of field work in Belo Horizonte, Brasil, a systematic search was conducted of the international press, the popular local press, television broadcasts, Internet sites and blogs.

Semi-structured elite interviews were conducted of academic professionals and practitioners. Adoleacentes conversations on NSSI took place with local inhabitants.

Three reasons for the authors’ prior lack of success in finding publications on NSSI in Latin America could be distinguished: NSSI has a high prevalence in Latin America, which can be compared to that adolrscentes the northern hemisphere.

Although there are some differences in the ways of engaging in NSSI and in its functions, there are also important similarities. Scientific information on NSSI in Latin America remains difficult to find for researchers in other parts of the world.

Therefore we advocate a consensus in terminology and suggest dn all publications would provide English key words and would be included in international scientific databases to ensure a world-wide dissemination.

An alternative is the construction of one centralized global Latin Adolescehtes database for Spanish and Portuguese publications.

“Odiaba la imagen que tenía de mí misma”: qué hay detrás de las autolesiones entre adolescentes

Deliberate self-harm, non-suicidal self-injury, scientific databases, terminology. This puzzled the authors because, from a newspaper clipping by Schemo, 7 we knew of the high NSSI prevalence among homeless girls at Passage House, a day program for street children in Recife, Brazil. Belo Horizonte is the capital of the Minas Gerais state, Brazil. It is one of the largest cities of the country with little foreign influence. There is little inflow from immigrants, and ecotourism flourishes only in the inland of the state.

Traditional values of family, religion and hard work are present everywhere in this ten-million inhabitants city which still fosters a lot of countryside characteristics. Semi-structured elite interviews 8,9 were conducted of several first-aid attendants, two psychologists in a psychiatric hospital, one independent psychologist and one professor in clinical psychology, all situated in Belo Horizonte.

Spontaneous conversations on NSSI took place with local inhabitants whenever the opportunity arose. Based on this fieldwork, the authors could distinguish three reasons for our prior lack of success in finding publications on NSSI in Latin America: The gap between academics professionals, practionitioners and inhabitant population.

Maldonado 10 literally states that in most countries NSSI is still a taboo, and that Latin America and his homeland Ecuador are no exception to this observation. Patients will rather consult friends, family or members of the clergy to talk about the problem instead of seeking professional help from doctors, psychiatrists or psychotherapists. After discovery of NSSI the patient’s family seldom seeks professional help because of the patient’s wish to keep the matter a secret.

This attitude might be the result of the strong ties with family and religion that reign most parts of Latin America. In Belo Horizonte, NSSI previously occurred on the intake list of first aid stations, but was later removed because of the apparent low prevalence. Whenever someone was treated for self-inflicted injuries, the patient either withheld information about their cause or lied about it. The fact that the injuries were self-inflicted was evidenced by the type of wound or because of inconsistencies in the story.

Injuries that necessitated medical attention were subsequently listed as a suicide attempt. A poll among the middle class population in Belo Horizonte revealed that adults quickly deny the existence of self-inflicted injury without suicidal intent, although they are aware of youngsters deliberately hurting themselves without viewing this in the light of psychopa-thology or abnormal behavior.


The interviewed academic psychologists in the region only were aware of psychotic self-injuring behavior and genital mutilation. Psychologist practitioners in the field knew about the occurrence of NSSI and could give examples from patients of all ages but especially youngsters.

They were not aware, however, that literature existed on non-psychotic self-injuring behavior without suicidal intent. Most of the youngsters themselves were well-acquainted autoleisones the phenomenon and often could give examples from among their peers. Some admitted having engaged in NSSI, after which they quickly diverted attention away from themselves.

La autolesión en América Latina

autolfsiones At the moment there is however an inclination to break through this taboo. Research is initiated, prevention campaigns against different types of “suicidal behavior” are run, newscasts on public television are broadcasted to sensitize the population, and special websites and blogs that discuss NSSI are erected.

The reason is that Latin American scientific publications are mostly written in Spanish and in Portuguese, while most of the international scientific press is written in English. This leads to adooescentes lesser dissemination because, although an English abstract is usually provided, these publications are harder to find adolesventes the large international databases that use English as a main language. Instead, these Spanish and Portuguese publications are disseminated across different Latin American databases, with many papers that are only accessible on the website of the respective university 12 or medical institu-tion.

Terms used in Portuguese are: Adolescentee used in Spanish are: The confusion in terminology and between avolescentes traditions. As was already mentioned, in prevention campaigns NSSI is seen as part of suicidal behavior.

On the other hand, on the Internet and in news broadcasts it is stressed autlesiones people injuring themselves usually do not have a suicidal intent. On the contrary, NSSI is seen as a means to stay alive. Also in Latin American scientific literature, NSSI sometimes is included under parasuicidal behavior or it is considered as part of deliberate self-harm DSH without ascribing intent. Most Latin American authors, however, describe self-harming behavior without suicidal intent.

This reflects two research traditions that exist in the northern hemisphere. Depending on research groups, DSH can refer to self-harming behavior in the absence of suicidal intent 3,4 or self-harming behavior without ascribing intent.

While the first research group has a northern American background, the second group originated in the UK and was adopted by the countries under its autolesoones sphere of influence. On the European mainland both trends are adhered. The difference between both is rooted in the history of DSH research.

For a long time NSSI was considered equal to a suicide attempt. In contrast, NSSI is attributed to a large scale of -often multiple- functions, 27 with a minimal interpersonal involvement. In contrast to a suicide attempt, NSSI also seems more strongly related to anxiety than to depres-sion.

Walsh, 31 moreover, points to an important difference in the method used. Whereas most self-harmers cut themselves, cutting is only used in 1. When someone cuts with the aim to die, they mostly cut the neck thereby severing the carotid artery or the jugular vein. Self-harmers, however, tend to cut the fleshy parts of the extremities or the abdomen instead of the neck. Other studies report similar differences in the method used between NSSI and suicide attempts.

In a sequence of suicide attempts mostly one method with a large lethality is chosen, which almost always requires medical intervention.

Also the age of onset differs. NSSI tends to start in early adolescence and has an average -usually chronic- course of ten to fifteen years, although this can vary from one year to several decades.

Suicide attempts usually start at a later age and occur notably less frequently. Due to the many observed differences between both, there is a consensus that NSSI has to be differentiated from suicide attempts: The reason for this disagreement on terminology is that on the one hand most authors have extensively argued that NSSI and suicide attempts are two related but distinctive phenomena, as became clear in the preceding paragraphs.


On the other hand, some authors view suicidal intent as a dimensional phenomenon, 5 based on the observation that NSSI is associated with an elevated risk for suicide, and because the motives for DSH are not readily discerned.

In order to solve this terminology confusion, Silverman et al. Despite a number of advantages, this new nomenclature never seemed to have caught on. The term non-suicidal self-injury NSSI made its appearance at the beginning of this century and is gaining ground ever since. Therefore it will be used throughout this article.

Since then more data are available in five countries: They are not the only countries that score high on this ranking, yet from the other areas little or no information seems to be available. Because of the large geographical area one should also take into account the different counties within each country. A country like Brazil, for example, has a mixed population from county to county. Also countries in the north of Latin America will have a different population from countries in the outmost south.

Therefore the experts that were interviewed stressed the importance of ethnicity, because of its association with psychosocial and economic factors that influence health and well-being. A blog from Colombian university alumni reports that, among patients that direct themselves to first aid stations, In Latin America the same forms of self-injuring behavior are observed as in North America and Europe, such as scarring, cutting and burning.

Besides these forms, what is typical for Latin America is white phosphor intoxication by means of the indigestion of firecrackers.

Based on the expert interviews of first-aid doctors, psychiatrists and psychologists, trichotillomania seems to occur regularly and to such an extent that medical care is necessary. Comparable to the U. Most Latin American authors see NSSI as a form of self-help fulfilling an affect-regulation function, in which self-harm is a way to alleviate negative affect.

According to Nock and Prinstein’s four-dimensional model, 46 this coincides with a negative automatic reinforcement function, which is also the most prevalent function NSSI fulfills in the US and Europe. Positive interpersonal reinforcement is a less prevalent function in the US and Europe. In Latin America, on the contrary, this function in which one engages in NSSI to receive attention or help seems to be much more prevalent although it still occurs less than the affect-regulation function.

Primarily, the authors attribute this high prevalence to the hostile setting with a lack of communication, attention, daily pursuits, and a predominantly monotonous life. Secondly, they point to the obvious advantages associated with NSSI, such as being transported to a different location: NSSI can also be engaged in as a means of solidarity, collective protest or social acceptance of newcomers by way of imitation behavior.

A comparable instrumental function appeared in the expert interviews. They described patients that engaged in NSSI to be admitted to the care system, to receive attention, and even one patient who injured herself to accuse her husband of the injuries. Although there are some differences in the forms of NSSI and the function they fulfill, there are important similarities between NSSI as it occurs in Latin America and its occurrence in countries with a primarily Caucasian population.

Therefore we suggest that all publications would provide English key words and would be included in international scientific databases in order to ensure a worldwide dissemination of the information.

Alternatively, the formation of one global centralized Spanish and Portuguese database on mental health issues would be of great interest to researchers and health-care professionals worldwide. The first author performed this study as part of her master dissertation at the Department of Psychoanalysis and Clinical Consulting at Ghent University.

The authors wish to thank Mrs. Annick Ermens and Dr.

Jessica Castillo for correcting the Spanish summary.

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