Why is DSH important?

  • Between 7 and 14% of adolescents self-harm at some point in their lives
  • Can lead to suicide
  • Huge impact on NHS resources
  • Can lead to permanent disability
  • Prevents individuals achieving full potential through time lost at school

Methods of DSH

DSH can be divided into personal injury and poisoning

The way individuals self-harm can be divided into poisioning or personal injury.

    Poisoning - This is usually using easily accessible medications. These include those which can be bought over the counter, or those that are found in the home. The most common medications used are aspirin and paracetamol. Those who poison themselves are more likely to present to hospital compared to those who deliberately injure themselves.

      Personal injury - The most frequent method of personal injury is cutting. This is the most prevalent means of DSH. This is typically to the wrists and forearms, which can lead to disfiguring scarring and tendon damage.

      Other means of DSH which fall into this category include; battery, jumping from heights and burning.

      DSH may not be easily recognisable, as cessation of medications and recklessness are considered means of self-harm.

      What Motivates People to Self-Harm?

      There are many reasons why individuals self-harm. They include the following:

      • Wanting to kill themselves. This is more frequent in those who poison themselves, and those who use more lethal methods of DSH such as hanging or shooting.
      • Depression. This is most commonly reported in those who cut themselves.
      • To relieve tension due to anger at themselves
      • To make others feel guilty
      • To change the behaviour of other people
      • To get help
      • To escape from a situation

      Risk Factors

      As not everyone self-harms when confronted with a stressful situation, there are inevitably factors involved which predispose some individuals to engaging in this behaviour. The main risk factors can be divided into the following categories:

      Demographics

      • Female sex (although suicide is more prevalent in males)
      • <35 years old

       

        Family Circumstances

        • Separation of parents
        • Lack of harmony in the household
        • Neglect
        • Sexual abuse

         

          Psychiatric Conditions

          • Eating disorder
          • Depression
          • Anxiety
          • Personality disorder
          • Impulsivity
          • Perfectionism
          • Substance misuse

           

            Other

            • Poor school life
            • Higher educational needs
            • Same sex attraction

            Management and Prevention of DSH

            Management Steps

            1. Treat the acute event eg activated charcoal for poisoning, or wound assessment for self-injury

            2. Take a full history to assess precipitants of the event, suicidal ideation and likelihood of repetition - those at serious risk of harm to themselves or others, or deemed to be suffering from a serious psychiatric illness will need to be admitted for further treatment

            3. Treat any illness found eg depression

            Further management includes psychological therapies. There are numerous forms of these therapies which can be useful in DSH. The choices include:

            • cognitive behavioural therapy
            • interpersonal psychotherapy
            • dialectical behavioural therapy
            • problem-solving therapy

             

            Prevention

            The 1998 restriction of numbers of aspirin and paracetamol tablets sold over the counter has been effective in reducing mortalities due to overdoses from these medications.

            Crisis hotlines are available for individuals to ring at times of hardship.

            Risk assessments in schools and colleges to identify those likely to self-harm and help them.

            Promoting the knowledge of the lethality of medication overdoses through mediums such as the media.

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