Psychiatry
AKT · Psychiatry/Personality & other
Self-harm
Overview
Intentional self-poisoning or self-injury, irrespective of motive or suicidal intent. A behaviour, not a diagnosis — and the strongest single predictor of future suicide.
Recognise
- Self-poisoning (most common in UK) or self-injury (cutting, burning)
- May be a coping mechanism, communication, or suicide attempt
- Strongly associated with EUPD, depression, substance misuse
Red flags
- High suicidal intent, ongoing plan, lethal method, or expressed wish to die → urgent psychiatric assessment
Differentials & how to tell them apart
Suicide attemptself-harm spans the spectrum from non-suicidal to high intent — assess intent, do not assume
Accidental injury/poisoningno intent
Investigations
Full biopsychosocial and risk assessment after every episode (NICE NG225). For self-poisoning: identify agent, timing, paracetamol level (4h), salicylate, ECG, bloods; treat the overdose (e.g. N-acetylcysteine).
Management
- 1Compassionate, non-judgemental psychosocial assessment of needs and risk after every episode (NICE NG225).
- 2Safety planning and follow-up; treat the underlying mental disorder; consider DBT-informed therapy for repeated self-harm.
Treat the overdose — e.g. N-acetylcysteine for paracetamol; naloxone for opioids
Treat underlying disorder — depression, EUPD
Key points
Do not use risk-stratification tools alone to decide management/discharge (NICE NG225). Every episode is assessed individually.
Monitor & prognosis
Recurrent self-harm, escalation of intent/lethality, engagement.
Repetition common; structured follow-up reduces risk.
Source: NICE NG225 (self-harm, 2022)