self-injurious behavior; self mutilation
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Etiology
- borderline personality
- factitious disorder
- malingering
- sexual masochism
- intellectual disability/developmental disorder
- factors associated with self-harm include
- mixed depression-anxiety state
- high-risk alcohol use
- cigarette smoking
- marijuana use
- antisocial behavior[2]
- victim of bullying[4]
Epidemiology
- 1.1-1.6% of adolescent emergency department trauma visits
- most common methods of self-injury
- factors associated with self-inflicted injury include
- age 15-18 years
- Asian race
- comorbid conditions
- public insurance
- female gender[7]
- adolescents with self-injury are more likely to die from their injuries than those with other injuries[7]
- most adolecents who exhibit self-injurious behavior stop by early adulthood[2]
- persistence of self-harm into adulthood is associated with depression-anxiety[2]
- 8% of 3rd-graders, 4% of 6th-graders, & 13% of 9th-graders report nonsuicidal self-injury[5]
- nonfatal self-injury among young U.S. girls age 10-14 years increased 19%/year between 2009-2015[12]
Complications
- adolescents who self-harm are more likely to experience psychosocial problems in adulthood[10]
Management
- psychiatric evaluation[3]
- positive behavioral support[8]
- selective serotonin reuptake inhibitor (SSRI)
- melatonin reduces risk of self-harm in adolescents with psychiatric disorders[13]
- for patient with intellectual disability presenting with recurrence of self injurious behavior
- ask caregivers to calm patient
- examine patient as tolerated
- additional help may be required
- obtain samples for therapeutic drug monitoring[6]
- electrical stimulation devices not recommended[8]
Notes
- non-suicidal self-injury syndrome is defined as: at least 5 days in the past year of intentional self-injury without suicidal intent[11]
More general terms
More specific terms
References
- ↑ DSM-IV
- ↑ 2.0 2.1 2.2 2.3 2.4 Moran P et al The natural history of self-harm from adolescence to young adulthood: a population-based cohort study The Lancet, Early Online Publication, 17 November 2011 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22100201 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61141-0/abstract
Hawton K and O'Connor RC Self-harm in adolescence and future mental health The Lancet, Early Online Publication, 17 November 2011 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22100202 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61260-9/fulltext - ↑ 3.0 3.1 Olfson M et al. Emergency treatment of deliberate self-harm. Arch Gen Psychiatry 2012 Jan; 69:80 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21893643
- ↑ 4.0 4.1 Fisher HL et al Bullying victimisation and risk of self harm in early adolescence: longitudinal cohort study. BMJ 2012;344:e2683 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22539176 <Internet> http://www.bmj.com/content/344/bmj.e2683
- ↑ 5.0 5.1 Barrocas AL et al. Rates of nonsuicidal self-injury in youth: Age, sex, and behavioral methods in a community sample. Pediatrics 2012 Jul; 130:39. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22689875
- ↑ 6.0 6.1 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - ↑ 7.0 7.1 7.2 7.3 7.4 Cutler GJ et al Emergency Department Visits for Self-Inflicted Injuries in Adolescents. Pediatrics. June 15, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26077475 <Internet> http://pediatrics.aappublications.org/content/early/2015/06/09/peds.2014-3573
- ↑ 8.0 8.1 8.2 FDA News Release. April 22, 2016 FDA proposes ban on electrical stimulation devices intended to treat self-injurious or aggressive behavior. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm497194.htm
DEPARTMENT OF HEALTH AND HUMAN SERVICES. Food and Drug Administration 21 CFR Parts 882 and 895 Banned Devices; Proposal to Ban Electrical Stimulation Devices Used to Treat Self-Injurious or Aggressive Behavior. https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-09433.pdf - ↑ Rana F, Gormez A, Varghese S. Pharmacological interventions for self-injurious behaviour in adults with intellectual disabilities. Cochrane Database Syst Rev. 2013 Apr 30;(4):CD009084. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23633366
- ↑ 10.0 10.1 Borschmann R et al 20-year outcomes in adolescents who self-harm: a population- based cohort study. The Lancet Child & Adolescent Health. July 7, 2017 Not indexed in PubMed http://thelancet.com/journals/lanchi/article/PIIS2352-4642(17)30007-X/fulltext
Steeg S Self-harm in adolescence: a marker for psychosocial problems in early adulthood. The Lancet Child & Adolescent Health. July 7, 2017 Not indexed in PubMed http://thelancet.com/journals/lanchi/article/PIIS2352-4642(17)30022-6/fulltext - ↑ 11.0 11.1 Breuner CC, Levine DA, THE COMMITTEE ON ADOLESCENCE Adolescent and Young Adult Tattooing, Piercing, and Scarification. Pediatrics. September 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28924063 <Internet> http://pediatrics.aappublications.org/content/early/2017/09/14/peds.2017-1962
- ↑ 12.0 12.1 Mercado MC, Holland K, Leemis RW et al Trends in Emergency Department Visits for Nonfatal Self- inflicted Injuries Among Youth Aged 10 to 24 Years in the United States, 2001-2015. JAMA. 2017;318(19):1931-1933. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29164246 https://jamanetwork.com/journals/jama/article-abstract/2664031
- ↑ 13.0 13.1 Anderson P Melatonin a New Way to Reduce Self-Harm? Medscape. March 27, 2023 https://www.medscape.com/viewarticle/990150
Leone M, Kuja-Halkola R, Lagerberg T et al Melatonin use and the risk of self-harm and unintentional injuries in youths with and without psychiatric disorders. J Child Pscychol Psychiatr 2023. March 23 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36950769