Self-harm

Question 1

Define

Who is it more common in?

Where is most self harming done?

What causes 50% of self harming?

What percentage attempt suicide?

Answer 1

Intentional destruction of own tissue without suicidal intent

Adolescents

Arms, hand, wrists

Depression

50%

Question 2

Symptoms of depression in young children

Answer 2

Apathy 
Boredom
Separation anxiety appears 
Educational decline 
Social withdrawal 
Hypochondria 
Irritable 
Antisocial

Question 3

Red flags for suicide risks

Mnemonic - CRISIS

Answer 3

Critical of self
Repulsed or Indifferent/apathetic about life
Suicide doesn’t scare them
Isolated from family (or has poor relationship with them)

Question 4

Management:

Overview

Answer 4

Understand that self harm is often coping strategy for mental distress
Involve the patient in Rx decisions
Involve family in care if patient agrees

Question 5

Management:

When to go to A&E?

How to assess suicide risk?

Answer 5

Urgent medical referral if there is significant physical harm

Assess suicide risk - CAMHS crisis team if at risk

Question 6

Management:

What needs to be for long-term planning?

What advice can be given for those who repeatedly self-injure?

Long term treatment

Answer 6

Full biopsychosocial assessment for their needs and risks:

• Protective and risk factors
• Assess risky behaviour - drug abuse, unsafe sex

Harm minimisation techniques
Self-management of superficial injuries
Alternative coping strategies

3-12 sessions of psychological therapy - CBT, psychodynamic therapy