Suicide And Self Harm

Question 0

Self harm is defined as

Answer 0

‘Intentional self poisoning or injury, irrespective of the apparent purpose of the act’ NICE 2004
‘A non-fatal deliberate act performed with the intention of causing harm to themselves’ Madge et al 2008

Question 1

Difficulties of treating self harm

Answer 1

Hard to understand and arouses anxiety and anger in professionals
Patients usually only present after a long time or going too far
Need to treat causes

Question 2

Self harming behaviours

Answer 2

Cutting,burning or bleeding -scars, burns, nerve damage, death
Overdosing/Poisoning - liver damage or renal failure
Ingestion/insertion of foreign objects - GI or UG damage
Pathological head-banging or asphyxiation
Risky behaviour/substance misuse/disordered eating

Question 3

Prevalence of self harm

Answer 3

Extent unknown,
170,000 hospital admissions/yr
Hawton et al 2002 --> studied 6000 15-16yro
7% SH'ed in the last year
65% cutting, 31% poisoning, 55% multiple

Question 4

Risk factors for self harm

Answer 4

Demographic –>Female, young, poor, gay/bisexual,
Psychiatric –> depression/low 5HT, anxiety, PD,
Personal –> impulsivity, poor executive function
Environmental –> adverse life events, alcohol, media coverage

Question 5

Risk groups for self harm

Answer 5

15-16 year old girls
Certain subcultures (goths etc)
Asian women 1.5x risk compared to white women
Prisoners -> 7.4% of all prisoners in previous year
30% of female prisoners

Question 6

Early life factors in self harm

Answer 6

Neglect/abuse/bullying
Parental pressure
Average age of onset is 13yrs

Question 7

Reasons people self harm

Answer 7

Release/Relaxing –> externalise internal pain, express anger, to cope with emotions or just to feel something
Communication –> asking for help or to get attention
Reaction seeking –> trying to make people care, feel guilty, drive them away or escape stress/responsibility

Question 8

Repetition of self harm

Answer 8

1/6 SH patients presenting to AnE will present again within 1 year
Self-harm is the strongest predictor of suicide (30x risk)
Risk of suicide is highest in the 6 months following an index episode of self harm

Question 9

Risk factors for Suicide after SH

Answer 9

Strongest factors –> not living with a close relative, avoiding discovery, current alcohol/substance misuse
Also –> being older, male, isolation, past psych care/disorder, repeated and severe SH, hopelessness, poor physical health

Question 10

When assessing an episode of self harm

Answer 10

Features of the episode –> circumstances leading up to and during, intentions and lethality
PMH/PPH –> previous SH, mental illness, family and personal Hx
Support –> living arrangements, coping strategies, family/friends
The future –> attitude to being alive, future SH, accepting support

Question 12

Factors in stopping SH

Answer 12

Sinclair & green 2005 –> 20 ex-SHers after 2yrs, themes:

• gaining control in family
• recognising alcohol as a factor
• getting treatment for mental illness

Question 13

PD and SH

Answer 13

Patients with EUPD or BPD show high rates of SH

very difficult to treat and refuse to engage

Question 14

Self poisoning

Answer 14

90% SH referrals to hospital – paracetamol most common

Only 23% make it to hospital

Question 15

SH in young people

Answer 15

11% in the last 12 month (boys) or 3% (girls) - 15-16yr olds
30-50% heritability while 3x higher risk in YP with relative who suicided.
SH is increasing while suicide is dropping
Usually starts at 13, peaking in late teens and reducing into adulthood