🏥 Stations

🧠 Qbank

📖 Book

😃 More

💳 Pricing

🔒 Dashboard

📖 OSCE Learning

🔒 OSCE Stations

🔒 Qbank

🔐 Membership
Share your insights

Help us by sharing what content you've recieved in your exams


Self-harm

Specialties > Child health

Differential Diagnosis Schema 🧠

Psychiatric Conditions

  • Depression: Often presents with low mood, anhedonia, and feelings of hopelessness; self-harm may be an expression of self-punishment.
  • Anxiety disorders: Can lead to self-harm as a coping mechanism to relieve anxiety or panic symptoms.
  • Borderline personality disorder: Characterized by emotional instability, impulsivity, and recurrent self-harm.
  • Post-traumatic stress disorder (PTSD): Self-harm may occur in response to flashbacks or intrusive thoughts related to past trauma.
  • Eating disorders: Self-harm may be associated with body image issues and control-related behaviors.
  • Psychotic disorders: In some cases, self-harm may result from command hallucinations or delusional beliefs.
  • Substance use disorders: Intoxication or withdrawal can lower inhibitions, leading to self-harm.
  • Adjustment disorder: Self-harm may occur in response to a significant life event or stressor.
  • Obsessive-compulsive disorder (OCD): Rarely, self-harm may be related to compulsions or intrusive thoughts.

Medical and Other Conditions

  • Chronic pain conditions: Self-harm may occur as a way to distract from or express chronic pain.
  • Neurological disorders: Conditions such as epilepsy or traumatic brain injury may predispose to impulsive behaviors, including self-harm.
  • Autism spectrum disorder: Some individuals may engage in self-harm as a response to sensory overload or frustration.
  • Developmental disorders: Intellectual disability or developmental delay may be associated with self-injurious behavior.
  • Social and environmental factors: Bullying, abuse, or significant life changes can contribute to self-harm in individuals with or without underlying psychiatric conditions.
  • Psychosocial stressors: Family conflict, relationship problems, academic or occupational stress may lead to self-harm as a coping mechanism.
  • Medication side effects: Certain medications, particularly those affecting mood or cognition, can increase the risk of self-harm.
  • Cultural and societal influences: Cultural attitudes towards mental health, self-harm, and coping strategies can influence the prevalence and expression of self-harm.
  • Sexual orientation and gender identity: Individuals who identify as LGBTQ+ may be at higher risk of self-harm due to stigma, discrimination, and internal conflict.
  • Internet and social media: Exposure to online content related to self-harm can sometimes trigger or exacerbate self-injurious behavior.

Key Points in History 🥼

History of Presenting Complaint

  • Onset: Determine when the self-harm behavior began and if there was a specific trigger or event.
  • Frequency: Ask how often the individual engages in self-harm and whether the frequency has changed over time.
  • Methods: Discuss the methods of self-harm used (e.g., cutting, burning, hitting) and any escalation in severity.
  • Triggers: Identify common triggers for self-harm, such as emotional distress, arguments, or feelings of numbness.
  • Intent: Explore whether the self-harm is intended as a coping mechanism or if there is suicidal intent.
  • Relief: Determine if the individual feels relief or other emotions after self-harming.
  • Previous attempts: Ask about any previous self-harm episodes or suicide attempts and the context in which they occurred.
  • Support system: Assess the availability and quality of the individual’s support system, including family, friends, and mental health professionals.
  • Coping mechanisms: Discuss alternative coping mechanisms the individual uses or has considered using.
  • Medical treatment: Inquire about any medical treatment sought after self-harm episodes, including wound care or hospital admissions.
  • Comorbidities: Ask about any co-existing psychiatric or medical conditions that may contribute to or result from self-harm.
  • Substance use: Assess for substance use that may be related to or exacerbate self-harm behavior.
  • Recent changes: Explore any recent life changes, stressors, or trauma that may have contributed to the onset or worsening of self-harm.
  • Safety planning: Discuss any safety plans the individual has in place, including access to tools for self-harm and strategies for reducing risk.

Background

  • Medical history: Review for chronic physical conditions that may contribute to self-harm, such as chronic pain or disability.
  • Psychiatric history: Detailed exploration of any past psychiatric diagnoses, treatments, hospitalizations, and current mental health status.
  • Medication history: Review current and past psychiatric medications, including adherence and side effects.
  • Substance use history: Comprehensive assessment of alcohol and drug use, including recreational and prescription substances.
  • Family history: Explore any family history of psychiatric disorders, suicide, or self-harm behaviors.
  • Social history: Consider the individual’s living situation, employment or academic status, relationships, and social support networks.
  • Trauma history: Inquire about any history of abuse, neglect, bullying, or other traumatic experiences.
  • Cultural background: Consider cultural beliefs and practices that may influence the individual’s understanding of self-harm and coping strategies.
  • Developmental history: Discuss any developmental delays, learning disabilities, or early childhood experiences that may be relevant.
  • Sexual orientation and gender identity: Explore any related stressors or identity conflicts that may contribute to self-harm.
  • Legal history: Review any involvement with the legal system, including criminal charges or protective orders, which may be relevant to the context of self-harm.
  • Previous treatment: Document any past psychological or therapeutic interventions, including their effectiveness and the patient’s response.
  • Occupational history: Consider how work or school stressors may contribute to self-harm, including any recent changes or conflicts.
  • Religious and spiritual beliefs: Explore any beliefs that may influence the individual’s coping mechanisms or views on self-harm.
  • Environmental factors: Assess for environmental stressors, such as housing instability, financial stress, or access to care.
  • Physical health: Evaluate the impact of self-harm on physical health, including any chronic health conditions that may be exacerbated.
  • Psychosocial functioning: Determine the impact of self-harm on the individual’s daily life, including relationships, work, and leisure activities.

Possible Investigations 🌡️

Initial Investigations

  • Physical examination: Assess the extent of injuries, wound severity, and signs of infection or other complications.
  • Mental state examination (MSE): Detailed assessment of the individual’s appearance, behavior, mood, thought processes, and risk factors for further self-harm or suicide.
  • Risk assessment: Evaluate the risk of further self-harm or suicide, considering both static and dynamic factors.
  • Blood tests: Depending on the method of self-harm, consider tests such as full blood count, electrolytes, liver function tests, and toxicology screens.
  • Psychological assessment: Referral to a psychologist or psychiatrist for a more detailed evaluation of underlying mental health issues.
  • Substance use assessment: Screening for alcohol and drug use, including withdrawal symptoms and intoxication effects.
  • Collateral history: Gathering information from family, friends, or caregivers to gain additional context and support the individual’s self-report.
  • Imaging: If indicated, consider imaging studies to assess for deeper injuries or complications, particularly in cases of head trauma or ingestion of harmful substances.
  • Functional assessment: Assess the individual’s ability to perform daily activities, particularly if self-harm has led to physical impairments.
  • Safety planning: Develop a comprehensive safety plan that includes coping strategies, emergency contacts, and follow-up care.
  • Referral to mental health services: Consider urgent referral to mental health services, particularly if the risk of further self-harm or suicide is high.
  • Psychosocial assessment: Comprehensive evaluation of the individual’s social support, financial status, housing, and access to care.
  • Liaison with primary care: Ensure that primary care providers are informed and involved in the ongoing management of the individual.
  • Legal and ethical considerations: Assess any legal obligations, such as mandatory reporting, and consider the individual’s capacity to make informed decisions.
  • Community support services: Referral to community resources such as crisis hotlines, support groups, and counseling services.

No comments yet 😉

Leave a Reply

Child health