Self-Harm Flashcards
Define self-harm
Actions that are intended to bring harm to oneself, involving painful but usually non-lethal methods where there is no conscious intention to die, but to escape an intolerable situation
What may drive someone to self-harm
Coping technique to deal with negative feelings
Positive feelings of control when they harm
Physical pain distracts from emotional stress
Allows them to feel something instead of feeling numb
Escape consciousness
Self-punishment
Communicating distress
What are the common methods of self-harm
Cutting (most common)
Self-poisoning (90% of cases referred to hospital)
Burning
Biting
Bruising
Scratching the skin
Tying ligatures around the neck (self-strangulation)
Punching of walls
Hitting
Give examples of contributing factors to self-harm through systemic thinking
Individual: genetics, illness, drugs, psychiatric disorder
Family: FHx, stress, poor support
Work/school/peers: problems in peer relationships
Local, community
National
Global
Give examples of contributing to self-harm through systematic thinking
Individual to child:
- Predis: chronic physical problems
- Precip: relationship problems
- Perpet: lack of confidence
Family
- Prot: close relationship, supportive
- Predis: FHx
- Precip: marital difficulties, abuse
- Perpet: poor communication
Broader social
- Precip: bullying, school exclusion, relationships
What are the risk factors for self-harm
Female
Psychiatric disorder e.g. depression, psychosis etc.
Previous psychiatric admission
Conduct problems
Substance misuse
Social and emotional isolation
Socio-economic disadvantage
Stressful life events e.g. relationship difficulties, previous experience in the armed forces, domestic violence
Chronic physical health problems
Genetics: FHx of self-harm
ACEs e.g. abuse, neglect, bullying
Subcultures or minorities
What is the epidemiology of self harm
Common and increasing in incidence - 22% of 15 year olds self-harmed themselves (32% females, 11% males)
Lifetime risk is 7-13%
More common in adolescents and young adults
What questions should be asked to assess the self harming event
Explain exactly what happens
Is there anything that happens before that prompts you to take these actions
How do you feel during the action
How do you feel afterwards
How often does it happen
What are the red flags that suggest suicide risk
Evidence of planning
Clear unambiguous wish to die
Persistent suicidal intent
Still hopeless
Persistence of the trigger
Final act in anticipation of death e.g. suicide note or text
Effort to avoid discovery
Regretting a method that failed
Choice of a violent or potentially lethal method e.g. overdose, hanging, jumping
Belief about lethality about the chosen method
What is the management for self harm on presentation to hospital
Assess and treat physical consequences e.g. fractures, burns, blood loss
Assess mental capacity, especially if they are trying to leave hospital
Risk assessment
High risk → admit to psychiatric ward, consider 1:1 with restricted leave
Ensure they have: care plan, access to crisis support, risk management plan, crisis plan
+ follow up within 1 week of discharge
Low risk → treat at home
Must be willing to seek help for suicidal ideation and a supportive network.
+ follow up within 1 week of the incident
What is the long term management for self-harm
Bio:
Treat underlying disorders
Anti-depressants e.g. SSRIs (short-prescription)
Psycho:
Brief psychological interventions: CBT + psychodynamic or problem-solving elements or psychodynamic techniques
Mentalisation based, dialectical, transference etc.
Harm reduction and coping strategies
Social
Address stressors triggering self-harm or depression
Recruit friends and family to a support network for crisis
Psychoeducation and harm reduction
Give examples of some harm reduction and coping strategies
Prevention of self-harm
- Put tablets and sharp objects away
- Stay in public places with supportive people
- Call a friend/ support line
- Avoid drugs and alcohol
- Avoid self-harm ‘triggering’ images (e.g. self-harm photo- graphs online)
Alternatives to painful, damaging self-harm
- Squeeze an ice cube/plunge fingers into ice cream
- Snap a rubber band around the wrist
- Bite into something strongly flavoured e.g. ginger, lemon
Red food dye on the dull side of a knife and draw across the skin
What is the prognosis for self-harm
50% who complete suicide have past self-harm (suicidal or non-suicidal)- this is the STRONGEST risk factor for completed suicide
1% will commit suicide within the next 2 years
1/6 will self-harm within a year after being discharged from psychiatric ward
Inpatients are more likely to complete suicide in early stages of recovery (i.e, in the first week of admission), immediately following discharge (within the first month) and Bank holidays
