Self-harm

Self-harm is one of the commonest reasons people present to hospital emergency departments and the most frequent form of self-harm is overdose. Most patients who self-harm have an emotional disturbance, commonly an adjustment or mood disorder, often in a context of situational or relationship stresses, and personality difficulties. Some have more severe psychiatric disorders. Intoxication with alcohol is common. All patients presenting with self-harm require both a medical and a psychiatric assessment. The latter should include an assessment of problems, needs and suicide risk. Children require particularly careful assessment. In assessing suicide risk, it should be noted that the medical dangerousness of the act does not necessarily reflect the intent, and that repeat self-harm greatly increases the risk of eventual suicide. Psychiatric management depends on the patient's problems and diagnosis. There is some evidence that brief psychological intervention can decrease the risk of repeat self-harm.