Refers to an intentional act of self-poisoning or self-injury, irrespective of the motivation or apparent purpose of the act. It is an expression of emotional distress

Aetiology

• Common methods of self harm include:
  • Hanging, strangulation, and suffocation
  • Poisoning (including overdose)

Risk factors

• A wide range of psychiatric problems, such as borderline personality disorder, depression, bipolar disorder, schizophrenia, drug misuse and alcohol abuse are associated with self-harm
• Other risk factors include victims of domestic violence, socio-economic disadvantage, and those with eating disorders

Pathophysiology

• Self-harm promotes the release of endorphins
• It brings temporary distress reduction, so through negative reinforcement these behaviours tend to be repeated
• History of deliberate self-harm is the single strongest risk factor for suicide HOWEVER deliberate self-harm is not an attempt at suicide in the vast majority of cases
  • It is usually an attempt to maintain control in very stressful situations or emotional pressures

Management

• Initial management includes e.g. activated charcoal for most drug overdoses
• Assessment and further management involves risk assessment and the formation of a care plan
  • Psychological intervention that is structured for people who self-harm should be offered
  • Psychological, pharmacological and psychosocial interventions should be used for any associated mental health conditions