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Self-harm

Specialties > Child health

Background knowledge 🧠

Definition

  • Self-harm refers to intentional self-inflicted injury, typically as a way to cope with distressing emotions.
  • It can involve cutting, burning, or other forms of injury.
  • Different from suicidal behavior; self-harm is often used to alleviate emotional pain rather than to end one’s life.

Epidemiology

  • Affects approximately 1 in 10 people at some point in their lives.
  • More common in adolescents and young adults.
  • Higher prevalence in females compared to males.
  • Often associated with mental health disorders such as depression, anxiety, and borderline personality disorder.
  • Increased risk in individuals with a history of trauma or abuse.

Aetiology and Pathophysiology

  • Complex interplay of psychological, biological, and social factors.
  • Often associated with emotional dysregulation and maladaptive coping mechanisms.
  • May involve neurotransmitter imbalances, particularly in serotonin and endorphin systems.
  • Social factors include trauma, abuse, and poor social support.
  • Psychological factors include underlying mental health conditions and low self-esteem.

Types

  • Cutting: Most common form, typically involves sharp objects.
  • Burning: Use of heat to cause skin damage.
  • Hitting or punching: Causing bruises or fractures.
  • Overdosing: Taking more than the prescribed amount of medication.
  • Other methods: Includes biting, scratching, or embedding objects into the skin.

Clinical Features 🌡️

Symptoms

  • Frequent unexplained injuries, such as cuts, burns, or bruises.
  • Wearing long sleeves or pants even in warm weather to cover injuries.
  • Behavioral changes, such as increased isolation or withdrawal from social activities.
  • Mood swings or episodes of depression or anxiety.
  • Verbal expressions of distress or hopelessness.

Signs

  • Visible scars or wounds in various stages of healing.
  • Unusual patterns of injury that do not match the explanation given.
  • Signs of depression or other mental health disorders.
  • Frequent use of bandages or other materials to cover wounds.
  • Presence of tools or instruments associated with self-harm.

Investigations 🧪

Tests

  • Mental health assessment to evaluate underlying psychiatric conditions.
  • Physical examination to assess the extent and severity of injuries.
  • Blood tests if there is suspicion of overdose or internal injury.
  • Toxicology screening in cases of suspected poisoning or overdose.
  • Imaging studies (e.g., X-rays) if bone fractures or other serious injuries are suspected.

Management 🥼

Management

  • Immediate medical care for physical injuries.
  • Psychiatric evaluation and ongoing mental health support.
  • Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) are effective.
  • Medication may be prescribed for underlying mental health conditions.
  • Involvement of multidisciplinary teams, including psychologists, psychiatrists, and social workers.
  • Safety planning and crisis intervention strategies.

Complications

  • Infection or sepsis from untreated wounds.
  • Permanent scarring or disfigurement.
  • Risk of accidental severe injury or death.
  • Worsening of underlying mental health conditions.
  • Social and interpersonal difficulties.

Prognosis

  • Varies depending on underlying causes and the effectiveness of treatment.
  • Better outcomes with early intervention and comprehensive care.
  • Chronic self-harm may persist if underlying issues are not addressed.
  • Risk of suicide is higher in individuals with a history of self-harm.
  • Supportive care and long-term mental health management are crucial.

Key Points

  • Self-harm is a significant public health issue with complex causes.
  • Early recognition and intervention are critical to improving outcomes.
  • Multidisciplinary approach is essential in managing self-harm effectively.
  • Prevention strategies should focus on mental health promotion and support.
  • Ongoing research is needed to better understand and address self-harm.

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Child health