Makindo Medical Notes

🩹 Self-harm refers to deliberate injury to one’s own body, often as a way of coping with overwhelming distress, emotional pain, or a perceived lack of control. It is not always linked to suicidal intent, but it is a major risk factor for suicide and signals significant psychological suffering. Commonly associated conditions include depression, anxiety, post-traumatic stress disorder (PTSD), and borderline personality disorder.

🧬 Understanding the Behaviour

• Acts of self-harm may provide temporary relief from emotional distress by triggering endorphin release.
• It can act as a form of emotional regulation, expressing feelings that cannot be verbalised.
• Some individuals describe it as a way to feel “real” when emotionally numb.
• Repeated self-harm can become a maladaptive coping mechanism, reinforcing the cycle of distress and injury.

✂️ Common Forms of Self-Harm

• Cutting or scratching the skin
• Burning with heat or chemicals
• Hitting, punching, or head-banging
• Ingesting harmful substances (poisoning, overdose)
• Interfering with wound healing or reopening old wounds

⚠️ Risk Factors

• Mental health disorders (e.g., depression, anxiety, personality disorders)
• Previous history of self-harm or suicide attempts
• Substance misuse (alcohol, drugs)
• Trauma, neglect, or abuse (childhood or recent)
• Poor coping mechanisms or lack of social support
• Bullying, relationship breakdowns, or major life stressors

🔎 Diagnosis & Assessment

• A thorough, non-judgemental clinical evaluation is essential.
• Key steps include:
  • 🧠 Psychiatric history: Explore mood, past trauma, and risk-taking behaviours.
  • 🩺 Physical exam: Assess extent and pattern of injuries.
  • 📊 Risk assessment: Identify suicidal ideation, intent, and access to means.
  • ⚡ Stressors: Explore triggers such as interpersonal conflict, academic/work pressures, or loss.

🏥 Initial Medical Management

• Stabilise airway, breathing, circulation if overdose/poisoning.
• Immediate treatment of injuries (suturing cuts, burn care, tetanus prophylaxis).
• Monitor for complications such as sepsis or rhabdomyolysis (in overdose cases).
• Observation in hospital may be needed for safety.

🧑‍⚕️ Psychiatric & Psychological Management

• Comprehensive suicide risk assessment.
• Referral to psychiatric services, crisis teams, or safeguarding if appropriate.
• Therapies:
  • Cognitive Behavioural Therapy (CBT): Builds healthier thought patterns and coping skills.
  • Dialectical Behaviour Therapy (DBT): Evidence-based for emotional dysregulation, especially in borderline personality disorder.
• Medication: Treat underlying depression, anxiety, or psychosis (SSRIs, antipsychotics as indicated).
• Involve family and support systems where safe and appropriate.

🔄 Long-Term Management

• Ongoing therapy (individual, group, or family-based).
• Medication monitoring for mental health disorders.
• Developing healthy coping strategies (journaling, exercise, mindfulness, art therapy).
• Relapse prevention planning, identifying triggers, and early warning signs.

🛡️ Prevention Strategies

• 🧠 Early identification of individuals at risk (schools, primary care, mental health services).
• 📞 Easy access to crisis support (helplines, walk-in crisis centres).
• 👨‍👩‍👧 Strengthening family and social support networks.
• 📚 Education in schools about mental health and resilience.
• ⚖️ Addressing underlying trauma, poverty, or domestic violence.

🚩 Red Flags

• Repeated self-harm with increasing severity.
• Self-harm accompanied by suicidal thoughts or plans.
• Lack of protective factors (no support, no future goals).
• Severe depression, psychosis, or substance dependence.

💡 Summary: Self-harm is a complex behaviour reflecting deep psychological distress. It requires a multifaceted approach — treating physical injuries, addressing underlying psychiatric illness, and building long-term coping strategies. 👉 Every case of self-harm should be taken seriously, with sensitive assessment and prompt referral to mental health services to prevent escalation to suicide.