Self-harm

Article (edit | visual edit | history) · Article talk (edit | history) · Watch • Watch article reassessment page • Most recent review

Result: No action. The article was significantly improved during the reassessment. It remains as a GA without prejudice. Geometry guy 22:59, 16 February 2010 (UTC)[reply]

A number of issues need to be addressed

• should be ordered per WP:MEDMOS

This should be now, I have changed the section titles back to those used in WP:MEDMOS and re-ordered the sections accordingly. Jdrewitt (talk) 21:31, 4 December 2009 (UTC)[reply]

• a number of references need expanding 44-46 for example

I have expanded many of the references now using the ((citation)) template. Jdrewitt (talk) 13:52, 13 December 2009 (UTC)[reply]

• no mention of Munchausen Syndrome and by proxy, should a least be discussed in the classification system to define how it is different / similar

This addition requires an expert to make, do you have any sources that discuss the links? Nevertheless I don't think the lack of this information would be reason to delist the article. Jdrewitt (talk) 19:56, 19 December 2009 (UTC)[reply]

By the way, in the Pathophysiology section we do mention that one motivation of self harm is to seek attention, however it is noted that in the majority of cases of repetitive self harm attention seeking is NOT the primary motivation. Jdrewitt (talk) 20:40, 19 December 2009 (UTC)[reply]

The attention seeking misconception is also already discussed in the classification section. So although we don't wikilink to Munchausen Syndrome we do certainly already deal with this issue. Jdrewitt (talk) 20:45, 19 December 2009 (UTC)[reply]

• Lesch-Nyhan syndrome is listed under diet and drugs but this is a rare genetic condition

I have removed the reference to the this syndrome. Jdrewitt (talk) 12:06, 5 December 2009 (UTC)[reply]

• The cause section should be broken in causes and pathophysiology ( the supposed psychological and neurochemical reasons )
• Self-injury awareness is more of a prevention measure rather than a treatment measure.

I have created a new "prevention" section and put SI awareness as a sub heading. Jdrewitt (talk) 21:34, 4 December 2009 (UTC)[reply]

• The wording in a number of sections is poor. For example in the lead after listing specific mental illness that are associated with self harm mental illness is mentioned as a cause.

I have removed the repetition of mental illness as a cause in the lead section. Jdrewitt (talk) 20:32, 19 December 2009 (UTC)[reply]

• Eating disorders are mentioned twice in the lead but not mentioned in the body of the text in the cause section

But eating disorders are discussed in the classification section. Jdrewitt (talk) 20:51, 19 December 2009 (UTC)[reply]

• The cause section has no subsection specifically on psychiatric illnesses even though this is the primary "cause"
• Red links such as culturally sanctioned self-mutilation should not be linked at all.

This has been de-linked by Guerillero. However I think Self-injury Awareness Day should stay as it a legitimate red link, unless red links are not allowed in good articles? Jdrewitt (talk) 21:38, 4 December 2009 (UTC)[reply]

They are not disallowed but having many red links does not look good. The link has to be WP:notable and if it is not it should not be linked. BTW it looks like it is American?Doc James (talk · contribs · email) 21:42, 4 December 2009 (UTC)[reply]

A google search for the exact phrase "self injury awareness day" gives 9,720. I know that doesn't necessarily make it notable but it does seem to be a recognised annual event. I've seen references to it from both american and UK websites. It is the only red link left in the article, I don't think it needs to go but if others do then I wouldn't mind. Jdrewitt (talk)21:51, 4 December 2009 (UTC)[reply]

Have started the page with its one google scholar hit. Will see if it people add to it and it passes notability.Doc James (talk · contribs · email) 22:47, 4 December 2009 (UTC)[reply]

• Psychological explanations, Motives, Cultural motives are sort of all the same.

I don't agree that Cultural motives are the same as Psychological motives and these should be kept under seperate sub-headings. But I do agree that the causes section needs sorting out. I propose renaming "Psychological explanations" to "Psychological motives" and merging the text that is currently in "motives" into this new section. Jdrewitt (talk) 00:16, 5 December 2009 (UTC)[reply]

OK, I've done this now but some more work needs to be done to make the subsection "Psychological motives" more coherent and succinct.Jdrewitt (talk) 00:30, 5 December 2009 (UTC)[reply]

I've now improved this section somewhat. Jdrewitt (talk) 01:28, 5 December 2009 (UTC)[reply]

• Non stable as effort made to keep this from meeting WP:MEDMOS
• The epidemiology section does not give number / estimates of the rate of occurrence. This ref gives some numbers [1]
• Some of the paragraphs should be broken up into two as they are too long.

I've now split the longest paragraphs. Jdrewitt (talk) 20:56, 19 December 2009 (UTC)[reply]

• The naming of the article needs to be address with WP:RS The ICD10 says self harm thus we need significant justification not to use this terminology also self harm get 1517 pubmed hits as opposed to 844 with Self injury. A this text says the main forms of deliberate self harm are self injury and self poisoning. Self harm is therefore slightly more inclusive. [2] Currently under the classification section we say that self harm includes poisoning but the above ref indicates that it does not.

But that is a list of every way a person can commit suicide...--Guerillero (talk) 13:59, 5 December 2009 (UTC)[reply]

The problem here is that re-naming would expand the scope of the article, the article currently stands at 48kb, so any significant addition of material to cover the broader area would necessitate splitting anyway, the most sensible solution would seem to be creating a second article which covers the broader definition, and could act as a grouping article for the related issues. --Nate^t/_c 20:47, 5 December 2009 (UTC)[reply]

I don't really think it would expand the scope too much. If the term self-harm includes everything mentioned in this article plus self-poisoning then that isn't really much of an expansion. We do already talk a little about self-poisoning in this article. I think a name change to self-harm would be the way forward and then a new article could be created for self-poisoning if necessary. By the way, I have seen examples where Deliberate Self-Injury is used as an equivalent term to deliberate self-harm. For example, Klonsky, Clinical Psychology Review 27 (2007) 226–239. So I don't think the definition is formally defined. Some academics do still use the terms interchangeably. But I agree, in the vast majority of academic papers the term "deliberate self harm" is used and covers both "self-injury" and "self poisoning". Jdrewitt (talk) 10:40, 6 December 2009 (UTC)[reply]

It isn't thats the problem. --Guerillero (talk) 22:12, 6 December 2009 (UTC)[reply]

The problem is the need for focus in an article. To cover (non-lethal) self-poisoning would mean needing to cover alcoholism and drug use, self harm would also reasonably cover self-inflicted wounds and potentially body modification etc. not a small scope. I think having a separate article called self-harm that discussed all these in summary style, and directed to the relevant articles, would split out some of the definition material from the SI article and would allow the inclusion of any overlap as relevant, rather than having to exclude it entirely of include a great detail of information that is only related tangentially. --Nate^t/_c 10:52, 16 December 2009 (UTC)[reply]

Once these are addressed further issues will be discussed.Doc James (talk · contribs · email) 18:54, 4 December 2009 (UTC)[reply]

What needs done now? --Guerillero (talk) 04:47, 13 December 2009 (UTC)[reply]

A number of the above still need to be done. Some references need formatting. Some content needs citing. The section on mental illness need to clarify the degree that different mental illnesses are associated with this problem.

The issue of the naming of the article has not be sufficiently address. The disease box needs to be expanded. The article lacks depth of coverage and is still narrow in scope.

Some of the history section is not history but belongs under classifications.Doc James (talk · contribs · email) 05:06, 13 December 2009 (UTC)[reply]

To resolve the name problem we would need a consensus. How do you go about getting that? Start a vote in the talk page? Most of this seems to technical for me. I know why you need this. But I don't know where to start looking for sources.--Guerillero (talk) 05:21, 13 December 2009 (UTC)[reply]

You could just go about moving the page, you could fill a request for comment, or you could start a pool on the talk page. The world health organization guidelines is what we should go by. I have posted a link to it somewere. Google scholar can help.Doc James (talk · contribs · email) 05:31, 13 December 2009 (UTC)[reply]

I guess we will find this out soon.The vote is here

The name has been changed. Is there anything that needs to happen because of it? --Guerillero (talk) 20:17, 12 January 2010 (UTC)[reply]

I've made all the fixes resulting from the name change I think. The question is, does the article now meet the GA criteria? Fresh bulleted comments below would be appreciated. Thanks, Geometry guy 20:57, 12 January 2010 (UTC)[reply]

Break

A number of the above have not yet been dealt with. Will add to this as time permits.

1. The causes section is tagged with an expand section. Munchausen syndrome should be discussed under mental disorders. This paper mentions it. [3]

   I've already commented about this above. The article does deal with the issue of attention seeking. This is essentially what Munchausen syndrome is right? However, it is noted in the article that it is a common misconception that self-harm is attention seeking behaviour whereas in fact for many people it is the opposite and individuals often conceal their injuries, which is also a reason why the statistics for self-harm prevalence are inaccurate because many sufferers do not seek attention or help. So I don't think it is the same thing and it definetly isn't a reason to downgrade the article. It should instead be discussed on the talk page. Jdrewitt (talk) 08:12, 13 January 2010 (UTC)[reply]

   Munchausens is not attention seeking it is a mental disorder of unknown cause with the primary symptom of the condition being self harm. The causes section does not go into sufficient depth at this point. Eating disorders is another condition that should be discussed under causes as they are mentioned in the lead.Doc James (talk · contribs · email) 20:18, 13 January 2010 (UTC)[reply]

2. In other animals is also tagged.

   I have expanded this section, added some images and removed the tag. Jdrewitt (talk) 19:05, 13 January 2010 (UTC)[reply]

3. There are three citation needed tags.
4. Lacking in images

   I have added two images, also see my comment below. Jdrewitt (talk) 19:05, 13 January 2010 (UTC)[reply]

Doc James (talk · contribs · email) 21:33, 12 January 2010 (UTC)[reply]

Image wise what are we looking for? My guess is we may want picutures of the diffrent types of self-harm. And how graphic is in good tastes?--Guerillero (talk) 17:54, 13 January 2010 (UTC)[reply]

I've added a couple of images of self-harm in other animals. The use of images in this article has been the topic of numerous conversations which can be found in the tak archives. In short it is difficult to find suitable freely available images of self inflicted injuries, note the word suitable. Other images would include those that give insight into the demographics or statistics associated with e.g. the prevalence of self-harm but this also assumes reliable data and suitable free images. Note, The previous world map image, that I removed, would have been ok if it had been explained properly and that the data was deemed reliable, i.e. if it was showing worldwide prevalence of self-harm then is there really a greater than 2:1 prevalence in russia compared to the uk? Jdrewitt (talk) 19:02, 13 January 2010 (UTC)[reply]

I do not think we really need more than a single image of self harm. I was thinking further graphical comparisons of data such as worldwide prevalence. I re added a map based entirely on WHO data.Doc James (talk · contribs · email) 20:36, 13 January 2010 (UTC)[reply]

Well you shouldn't have re-added the map, in fact I find the behaviour quite reckless. It has already been removed TWICE and you have failed to address my concerns about the map, refused to even enter discussion. I have left the image in for now as I'm not interested in having an edit war with you but I would appreciate some discussion about the usefulness of the image you added, its accuracy and what it actually shows. Also an image without appropriate explanation is useless and you have refused to provide that explanation. I'm not happy about this, I haven't got some personal grievance with you or your images I just wanted my concerns addressed. The image should NOT be in the article without sufficient explanation and until the concerns on the talk page are addressed, i.e. what does the map exactly show and is it reliable enough to include. It may be WHO data but that doesn't automatically make it accurate, as I have already said "is there really a greater than 2:1 prevalence in russia compared to the uk?". Jdrewitt (talk) 20:46, 13 January 2010 (UTC)[reply]

You justification for removing the map ( that I have not yet provided text to accompany it ) is not sufficient for removal and you did not have consensus to remove it. The fact that it is WHO data does make it reliable. It is explained right in the title what this make shows DALYs. This is neither prevalence nor mortality data but DALYs. Yes few will have a good understanding of this idea but they can click the link to find more information.

We are by the way in no position to determine the accuracy or reliability of the World Health Organization. I am not sure who you think should determine this but the WHO?Doc James (talk · contribs · email) 19:11, 14 January 2010 (UTC)[reply]

I am not a fan of the map. It uses a fairly obscure measurement unit. (Remember wikipedia is for laymen not doctors) It adds nothing directly to the article;p just because its from the WHO does not mean its needed.--Guerillero (talk) 20:12, 14 January 2010 (UTC)[reply]

However we have an entire page describing DALYs? Much of Wikipedia is obscure. Were else do we have a global perspective on self harm? If we had I better map I would be happy to look at it. A number of other parameters were looked at by the WHO. Would you prefer a map with a different one?Doc James (talk · contribs · email) 20:17, 14 January 2010 (UTC)[reply]

Please could you take this discussion to the article talk page, I don't think it is overly relevant to the GA reassessment process. Regards, Jdrewitt (talk) 20:23, 14 January 2010 (UTC)[reply]

Agree as it is not directly related to this review.Doc James (talk · contribs · email) 20:35, 14 January 2010 (UTC)[reply]

1. There is issues with the wording. "Self harmers" is similar to using patient and IMO should be avoided as unencyclopedic.Doc James (talk · contribs · email) 20:36, 13 January 2010 (UTC)[reply]
2. We also have issues with the references. This statement is not a good synopsis of the original "due to this prevalence the term self-harm is increasingly used to denote any non-fatal acts of deliberate self-harm, irrespective of the intention." "As a result, the term deliberate self-harm is increasingly used in Europe to denote any nonfatal acts of self-harm, irrespective of the intention.)"
3. Also the above ref has a copy avaliable online that was not linked too.Doc James (talk · contribs · email) 20:39, 13 January 2010 (UTC)[reply]

• Notification of intention to close. This is a community reassessment, not a battleground. Recent edits have been moved to the talk page. I intend to close it shortly as "No action". If editors believe that this article does not still meet the GA criteria then a new community reassessment can be opened. Thank you. Geometry guy 22:44, 13 January 2010 (UTC)[reply]

  There appears to have been a misunderstanding, so I do not intend to act on this notification yet. Geometry guy 23:10, 13 January 2010 (UTC)[reply]

  Thanks for the revert. Was mistaken regarding the assessment type.Doc James (talk · contribs · email) 23:21, 13 January 2010 (UTC)[reply]

That sounds reasonable G Guy --Guerillero (talk) 03:01, 14 January 2010 (UTC)[reply]

I personally would also be relieved if the reassessment is closed as no action. I am happy to address any remaining concerns with the article on the article talk page. If a future reassessment is required then I hope it can be first discussed on the article talk page. Thanks Jdrewitt (talk) 08:18, 14 January 2010 (UTC)[reply]

There continues to be issues of references, prose, and insufficient detail regarding causes. Thus this article does not yet fulfill these three GA criteria. Some of the details regarding this are discussed above.

Looked at the GA review from two years ago and it was a tentative keep at that point in time WP:Good article reassessment/Self-injury/1 Many of the comments made than have not been addressed. Doc James (talk · contribs · email) 18:53, 14 January 2010 (UTC)[reply]

<Moved to talk>

Break 2

• Review. This reassessment needs independent review comments, and I've been asked to provide some. Here they are.
  1. I found it hard to verify some of the content of this article. This mostly concerns the definition of "self-harm" and the motivations and causes, so I will start with that. The first sentence

     • "Self-harm (SH) or deliberate self-harm (DSH) includes self-injury (SI) and self-poisoning and is the deliberate infliction of tissue damage, alteration, or poisoning without suicidal intent."

     seems to exclude suicidal intent (although the prose here is ambiguous, and may only be excluding suicidal intent in self-poisoning). While I can see from the sources that self-harm does not usually involve suicidal intent, some include it. Conversely, the term "suicidal behaviour" is used in some sources (including the major source "Deliberate self-harm in adolescence") to include self-harm without suicidal intent. This is confusing for the reader (e.g., the sentence "Self-harm in such individuals is not associated with suicidal or para-suicidal behaviour.").

     I also looked into the issue as to whether self-harm is attention seeking. The sources and article concur that it quite often isn't but I wasn't able to verify

     • "A common belief regarding self-harm is that it is an attention-seeking behaviour; however, in most cases, this is inaccurate."

     For this I would need a source both for the common belief and for "in most cases". I also do not know what "some individuals suffer from dissociation" means or how to verify it.

     Regarding Münchausen syndrome, it is clear from that article that self-harm is one behaviour that syndrome sufferers use, so there is an overlap, worth mentioning, perhaps even to illustrate that this is atypical self-harm. Obviously "by proxy" and other variants have nothing to do with self-harm.

  2. "Signs and symptoms" also begins with some general statements that could be attributed to generic sources but aren't.
  3. Many of the sources concern self-harm in the young (c. 11-30?) and state that this demographic is particularly prone to self-harm. This isn't made very explicit in the article, and hardly at all in the lead.
  4. This brings me to WP:LEAD which might fix much of the above. The lead does a good job explaining the complexity of self-harm, but does not summarize the article well (for instance epidemiology, history, and animals are unaddressed). Both article and lead may need fixes to work in harmony.
  5. "In a study of undergraduate students in the United States..." Which study?
  6. Gender differences. I'm surprised there is nothing on the tendency for males not to report illness/harm compared to females.
  7. In the developing world. This is a case study based on Sri-Lanka. There is no original research on Wikipedia, so the article should confine itself to describing the finds in the study.
  8. The reference (currently #60) to the WHO "Ad Hoc Committee on Health Research Relating to Future Intervention Options" surely has a weblink.
  9. Images are not required for GAs. In particular, the last section on animals only needs one image, not two, to avoid sandwiching the text.
  10. The Wellcome Trust Reference seems quite helpful as a back-up source for accepted material: it could be cocited more often.

  Thats all. I've numbered my comments so that it should not be necessary to break up the above review with replies: please comment below. Geometry guy 23:04, 14 January 2010 (UTC)[reply]

Thanks Geometry guy. Also, for clarity purposes, would it be possible for Doc James (or any other user who wishes to do so) to re-list any of the outstanding issues that they feel have not yet been addressed above. If they could also be numbered (if its possible to continue the same sequence?) then it will be easier to reply to everything. Thanks. Jdrewitt (talk) 06:59, 16 January 2010 (UTC)[reply]

11)My greatest concern currently is the causes section. It has been reordered substantially but still needs to be expanded and clarified. When it says "some" it should state how many. Information on genetic conditions and mental illness should be expanded. Currently we have only one line on LNS. A number of prominent mental disorders are not mentioned ( muchausens). The diet section does not provide any evidence that diet causes self harm just aggressive behaviour. The two people in the case studies had obvious mental illness that failed other treatments and implying that allopurinal is promising generally is not supported by this evidence.Doc James (talk · contribs · email) 20:50, 16 January 2010 (UTC)[reply]

I'm sorry but this isn't in any specific order:

(2) - I have added a couple of generic sources into the "signs and symptons" section. On the subject of generic sources, I personally think the Mental Health Foundation 2006 report truth hurts is an excellent source for general information on self-harm. Jdrewitt (talk) 21:20, 16 January 2010 (UTC)[reply]

(11) - I have removed the diet section, I don't think it did anything to improve the article, as you say it is concerning aggressive behaviour and not self-harm, although one of the patients did self-harm it certainly isn't conclusive evidence. Jdrewitt (talk) 21:25, 16 January 2010 (UTC)[reply]

(8) - On performing a google search for "Document TDR/Gen/96.1." many different publications were suggested. I'm not sure what the reference is referring to. The reference is citation number [15] in the Eddleston reference. Since its the Eddleston reference where the statement was orginally taken from I think its safer to cite Eddleston so that is what I have done. Jdrewitt (talk) 21:37, 16 January 2010 (UTC)[reply]

(5) - I think its referring to the Vanderhoff, H., and Lynn, S.J. (2001) paper, but I don't have access to the full text of this publication and so cannot verify, maybe someone with access to medical journals can verify this? Jdrewitt (talk) 21:43, 16 January 2010 (UTC)[reply]

(6) - This reference Rodham, K. et al. (2005), "Deliberate Self-Harm in Adolescents: the Importance of Gender", Psychiatric Times 22 (1) discusses gender differences and differences between genders in (i) presenting to the hospital following self-harm and (ii) in motive for engaging in this troubling behavior. This is already cited in the article so should be easy enough to mention. Jdrewitt (talk) 16:36, 17 January 2010 (UTC)[reply]

(1) - I have addressed your first points in the lead. Hopefully the definition is now clear and the association with suicide is clarified. Jdrewitt (talk) 16:58, 17 January 2010 (UTC)[reply]

(3) - I clarified the greater prevalence of self-harm amoung younger people in the lead section. Jdrewitt (talk) 18:01, 17 January 2010 (UTC)[reply]

(10) - I have cited the welcome trust reference some more in the lead. The reference also contains many citations that could be useful. Jdrewitt (talk) 18:03, 17 January 2010 (UTC)[reply]

Right that's about all I can do for now, I have work committments for some time now. I hope the changes I made to the lead have improved things and hope some other editors can step up to the mark because unfortunately I've run out of time for a bit. Cheers, Jdrewitt (talk) 18:16, 17 January 2010 (UTC)[reply]

(11) I added some more information on genetics and added some information on munchauusen's. Can you check if its in the correct place? I don't have a medical or pyschology background so not sure what heading it shoud go under. Thanks. Jdrewitt (talk) 13:46, 23 January 2010 (UTC)[reply]

Close

Since all points have been resolved (I think) and nothing else has been brought forward in the past 2+ weeks can we have a consensus to close this and keep it on the last of GAs? --Guerillero | My Talk 21:47, 9 February 2010 (UTC)[reply]

There is more I would like to do. I have addressed most of geometry guys and Doc James' points but some do still remain. Of course the time allocated for GAR has to be finite, it can't go on forever... I personally think this is a good article with excellent citations. I will continue to edit and improve the article to the best of my ability for as long as I am on wikipedia, which I have no intention of leaving anytime soon! I think also the GAR process has brought users together and I think that the article now has an effective collaboration of editors dedicated to improving the article. So the question that remains is does the article as it stands now meet GA criteria? Jdrewitt (talk) 21:59, 9 February 2010 (UTC)[reply]

• If this question is not answered by 16 February, I may close as "no action". I hope, however, that improvements to the article will continue to be made before then. Geometry guy 22:25, 11 February 2010 (UTC)[reply]

As I have been involved in editing this article will leave it to others to decide.--Doc James (talk · contribs · email) 22:33, 11 February 2010 (UTC)[reply]