EpistemisNon-suicidal self-harm
Specialty: Psychiatry.
Why it occurs
- Borderline personality disorder (BPD)
- Major depressive disorder in adolescents
- Post-traumatic stress disorder (PTSD)
- Autism spectrum disorder (especially stereotypical self-mutilations such as hitting the head or biting)
- Dissociative identity disorder
- Lesch-Nyhan syndrome (rare metabolic cause)
Initial workup
Psychiatric evaluation of the lethality and intentionality of the act; detailed physical examination of typically hidden body areas (thighs, abdomen, inner arms); analysis with coagulation profile if there is persistent bleeding.
red flags
Escalation in the physical severity of the injuries that endangers main vascular structures (deep cuts in the wrist/forearm), severe bacterial superinfection of the wounds, or transmutation of self-injurious behavior into a real lethal autolytic attempt due to failure of the regulatory function of the cut.
Standard management
- Naltrexone — opioid antagonist that blocks the release of endorphins that the patient seeks with physical pain to relieve emotional pain, reducing the urge to self-harm
- Aripiprazole or Risperidone at low doses — to reduce impulsivity and emotional reactivity
- Lamotrigine — as an affect stabilizer in BPD
- Sertraline (to treat anxious/depressive comorbidity).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Psychiatry
- Listed causes
- 6
- Treatment options
- 4