Self-harm and Suicide

Self-harm is the deliberate injury to oneself, typically as a manifestation of a psychological or psychiatric disorder. Other names for it are Self-injurious behaviour (SIB), self-mutilation, non-suicidal self-injury (NSSI), parasuicide, deliberate self-harm (DSH), self-abuse, and self-inflicted violence. It can lead to cutting, self-hitting, and burning, and suicide, therefore a risk assessment must be done in all of these patients.

Risk factors:

• Bereavement

• Childhood abuse/trauma

• Family substance abuse

• Negative body image perceptions/Body dysmorphia

• Lack of impulse control

• Neglect

• Lack of strong family attachments

Reasons one may self-harm includes:

• Feel better – Can release pent-up feelings or for those who feel ‘numb’ to feel something

• Communicate their emotional pain – Use wounds as a way of reaching out for help

• Feel a sense of control – They may feel powerless, lacking self-esteem. So, they use self-harm to regain control, esp. for those who’ve suffered childhood abuse

• Punish themselves – May lack self-esteem and think they’re at fault for the way they feel

Clinical features:

• Withdrawn, or quieter and more reserved than usual

• Stop participating in their regular activities

• Frequent mood changes

• Significant life event

• Unexplained cuts/scratches – Some may wear clothes inappropriate for the weather e.g. long sleeves on a hot day to hide marks

Management:

• CBT – Address issues, learning to challenge negative thoughts and situations

• Dialectical BT (DBT) – Variation of CBT, designed for those with self-harming behaviours, such as self-cutting, suicidal thoughts/attempts – Aim is to help them change self-destructive behaviours

• Problem Solving Therapy (PST) – Identifying specific problems and forming alternative solutions to them – They can clearly define the problem they face, brainstorm multiple solutions, and decide on the best course of action