REGULAR ARTICLE Deliberate self-harm by Taiwanese adolescents Mei Hua Tsai 1 , Yi Hua Chen (yichen@tmu.edu.tw) 2 , Chih Dao Chen 1 , Chih Yin Hsiao 1 , Chia Huei Chien 2 1.Department of Family Medicine, Far Eastern Memorial Hospital, Panchiao, Taipei, Taiwan 2.Department of Public Health, Taipei Medical University, Taipei, Taiwan Keywords Adolescents, Avoidance Learning, Deliberate self- harm, Sexual Behavior, Suicide Correspondence Yi Hua Chen, Department of Public Health, Taipei Medical University, 250 Wu Shing St., Taipei 110, Taiwan. Tel: +886-227361661 ext 6528 | Fax: +886-22735-7714 | Email: yichen@tmu.edu.tw Received 19 October 2010; revised 15 February 2011; accepted 12 May 2011 DOI:10.1111/j.1651-2227.2011.02357.x ABSTRACT Aim: Prevalence rates for deliberate self-harm (DSH) are unusually high among Tai- wanese high school students. Several models have been advanced to explain the occur- rence of DSH. One, the experiential avoidance model suggests that self-mutilation helps the individual escape from unwanted emotional experiences. The purpose of this study was to examine the demographic, health and behavioral correlates of DSH in a population (Taiwanese adolescents) known to have a high rate of DSH. Method: A structured, self-administered questionnaire survey was completed by a sample of 742 vocational high school students in Taiwan. Results: Eighty-four students (11.3%) acknowledged DSH behavior. Results of mul- tivariate logistic regression analysis indicated that female students were 3.47 times as likely as male students to be in the DSH group. Avoidance behaviors of running away from school [odds ratio (OR) = 3.45] and suicide attempt (OR = 13.05), a history of headache (OR = 8.96), a history of sexual abuse (OR = 4.26) and drinking (OR = 4.12) were also significantly associated with DSH. Conclusions: Gender and a history of headaches, a history of sexual abuse, drinking, running away from school, or suicidal attempts were factors associated with DSH among Taiwanese adolescents. School personnel should be aware of these to formulate appropri- ate and timely interventions. INTRODUCTION Deliberate self-harm refers to any self-injurious behavior that does not involve an intent to die (1). Skegg (2) has pointed out that the term ‘self-harm’ is commonly used to describe a wide range of behaviors and intentions includ- ing attempted hanging, impulsive self-poisoning and superficial cutting in response to intolerable tension. Such acts are deliberate, repetitive and intentional in nature as well as unacceptable. Self-harmers describe a sense of ten- sion or anxiety prior to the act and a sense of relief or anxiety reduction after the self-damage. There is no intent to die (3,4). A study of a community sample of adoles- cents found self-cutting to be the most common method of self-harm (5). Prevalence rates range from 5% to 13% among high school students in the United Kingdom and Australia (6), 16.9% among community-based youth in Canada (7), 3.3% among Japanese university students (8), 5.1% among mainland Chinese adolescents (9) and an unusually high 22.4% among Taiwanese high school stu- dents (10). One study demonstrated that the single most common reason reported by participants for engaging in DSH was to obtain emotional relief or regulate emotions (11). DSH may then be conceptualized as a behavior that fits within the broader class of experiential avoidance behaviors. Experi- ential avoidance includes any behavior that functions to avoid, or escape from, unwanted internal experiences or those external conditions that elicit them (1). Chapman et al. further proposed that DSH was primarily a behavior of emotional avoidance, but may include a variety of seem- ingly dissimilar behaviors that serve this function. These include coping styles, thought suppression, drug or alcohol use to escape from unwanted moods, and avoidance of feared objects, places or situations. In addition, DSH is often associated with the presence of depressive symptoms. Some researchers have suggested that thought suppression (one form of experiential avoidance) accompanies and exacerbates the experience of depression. Moreover, recent Key notes • Deliberate self-harm (DSH) by Taiwanese adolescents showed a significant association with a personal history of sexual abuse, headaches, drinking, smoking, suicide attempts and unprotected sex. Affect regulation by escape from unwanted emotional experiences may explain some DSH behavior in this population. Clini- cians and educators who observe scars from cuts may address other health risk behaviors with adolescents and their families and arrange possible interventions for this potentially lethal condition. Acta Pædiatrica ISSN 0803–5253 ª2011 The Author(s)/Acta Pædiatrica ª2011 Foundation Acta Pædiatrica 2011 100, pp. e223–e226 e223