4. Self-harm

Question 1

How common is it?

Answer 1

Increasing incidence

Question 2

Who does it affect?

Answer 2

All ages, often starts in teens

F>M but increasing incidence in men

Question 3

What causes it?

Answer 3

Needing to feel in control
Emotional distress
Self-punishment
Relieving tension

Question 4

What risk factors are there?

Answer 4

Mental health disorders eg schizophrenia, depression
Adverse life events
Lack of support
Isolation / loneliness

Question 5

How does it present?

Answer 5

Signs of intentional injury often on wrists, thighs, chest

Cuts, bruises

Question 6

What signs may the patient have on examination?

Answer 6

Signs of mental health disorders

Question 7

What other conditions might present similarly?

Answer 7

Physical abuse

Substance abuse

Question 8

How would you investigate?

Answer 8

Detailed questioning about cause of self-harm

Screen for infection / severe bleeding / fractures

Question 9

What treatments are there?

Answer 9

Psychological therapy

Drugs in cases of depression or schizophrenia

Question 10

What complications are there?

Answer 10

Suicide / parasuicide

Increasing severity of self-harm