Management of patients who deliberately harm themselves

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Göran Isacsson (Goran.Isacsson@neurotec.ki.se), associate professora,
Charles L Rich, professorb

^a Karolinska Institute, Neurotec, Division of Psychiatry, Huddinge University Hospital, S-141 86 Stockholm, Sweden
^b University of South Alabama, Department of Psychiatry, Mobile, AL 36617-2293, USA

Correspondence to: G Isacsson

Accepted 19 October 2000

Deliberate self harm is a behaviour not an illness. It is defined as any act by an individual with the intent of harming himself or herself physically and which may result in some harm. Deliberate self harm has also been called “attempted suicide” or “parasuicide.” Although attempted suicide should be restricted to cases where a fatal intent can be assumed, these terms are often used synonymously. Suicide is the subcategory with a fatal outcome.

Summary points

Patients who deliberately harm themselves should be assessed as comprehensively and thoroughly as possible, including the risk for suicide

A multidisciplinary team approach to assessment and management is optimal

A psychiatrist should be involved in the evaluation

Management should be individualised on the basis of the assessment; mostly treatment for associated psychiatric disorders and assistance with precipitating circumstances

Patients accepting offers for help should be followed up quickly

Incidence

Typically 10-30 per 100 000 people commit suicide annually. Deliberate self harm that is non-fatal may be 10-20 times more frequent. Both fatal and non-fatal deliberate self harm constitute considerable public health problems regarding both individual suffering and costs to society.

Cause

The motivations behind acts of deliberate self harm vary. One motivation may be a wish to die. Deliberate self harm may also constitute a more or less dysfunctional way of achieving wanted changes of life—for example, escape, attention, manipulation of others. The intent in each person is complex and ambivalent. Although some aspects of suicidal behaviour might be interpreted as rational, the behaviour is contrary to basic biological principles of survival. Therefore it may be postulated that some link in the individual's perception, cognitive and emotional processing, and behaviour is disordered—that is, a psychiatric disorder. This is corroborated by empirical studies.