Concise Version: Seven Management Essentials for Nonsuicidal Self-Injury | Expert Perspective

Non-suicidal self-injury (NSSI) refers to the direct, intentional injury of an individual body tissue, but not intended to cause death. Cutting is the most common form of NSSI, other forms include burning, scraping/scratching the skin, interfering with wound healing, hitting, biting, self-poisoning, and purposefully engaging in non-recreational high-risk activities.

Although most individuals who practice NSSI have no intention of seeking death, suicidal ideation often precedes NSSI, and repeated NSSI is later Risk factors for suicide attempts.

A systematic review showed that NSSI is most common in adolescents and young adults, with a peak at 12-14 years of age. The incidence of NSSI is 7.5%-46.5% in adolescents, 38.9% in college students, and 4%-23% in adults.

There is currently no drug that has shown consistent efficacy against NSSI. Cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) are effective, but may not quench their thirst for patients who are in an emergency crisis. The following is a brief introduction to the management points of NSSI in adults; there are subtle differences between NSSI in adolescents, such as the need for parental observation and reduction of the risk of contagion, but the following content can also be referred to.

First, to explore the reasons for patients to implement NSSI.

Determining why a patient develops NSSI helps us empathize with them and place us in a More ideal treatment location.

The most frequently reported NSSI motivations include coping with pain and influencing others. In a systematic review, patient self-reported causes of NSSI also included: punishing oneself for having positive feelings, punishing others, coping with dissociative states (eg, actively pursuing numbness), seeking sensory stimulation (eg, creating excitement) , avoiding suicide (eg, getting rid of suicidal ideation), maintaining or testing boundaries, expressing or coping with sexual orientation, etc.

When exploring a patient’s motivation to perform NSSI, it should be determined whether the behavior is based on genuine suicidal desire. Given the association of NSSI with mood disorders, anxiety disorders, personality disorders, and other psychiatric disorders, it is necessary to evaluate patients for any underlying psychiatric disorders and to initiate appropriate psychiatric treatment.

Second, carry out suicide risk assessment.

Regardless of the patient’s reason for NSSI, it is necessary to develop an individualized, comprehensive approach to suicide risk Evaluation to find variable and immutable risk factors and protective factors for reference when formulating treatment plans.

Key factors for suicide risk assessment include, but are not limited to: current and past urge to perform NSSI, previous NSSI and suicide attempts, exposure to lethality opportunities for means, and the ability to follow a safety plan.

Third, avoid the danger and importance of rendering NSSI.

If the patient’s NSSI is driven by genuine suicidal A hospital order and/or medication will be considered.

However, since most NSSIs are not driven by true suicidal urges, physician overreaction may inadvertently convey to patients a The message that self-injury is an effective way to maintain others’ attention to themselves, which in turn reinforces their behavior to seek support in this way when they are distressed. Also, overreacting does not help patients understand and cope with the reasons behind self-injurious behavior.

Fourth, avoid exposing patients to lethal methods.

Avoid exposing the patient to firearms, sharps, drugs, Potential poison, can effectively reduce suicide rate, and also reduce the possibility of individual implementation of NSSI.

It is important to ask the patient repeatedly if they have acquired a new tool, and to listen to the patient if they have information about it that they have not been told. It is also necessary to ask whether the patient has moved some of the existing means to other, more convenient places.

V. Improve the security plan.

The written safety plan includes a range of red flags (eg, thoughts, images, moods, situations, behaviors) ), coping strategies (eg, going out for a walk, exercising, engaging in hobbies, socializing with friends and family), and contact information for a 24-hour crisis helpline, emergency department, psychiatrist, etc.

The Suicide Prevention Resource Center (SPRC) provides a template for a safety program: /Brown_StanleySafetyPlanTemplate.pdf.8 for reference.

Six, express empathy.

In a sense, individuals implementing NSSI are signaling desperate help and needing attention and supportive responses, one of which is effective by offering empathy. In addition to expressing concern and empathy, empathy involves recognizing and sharing a patient’s emotions. Through empathy, we can also consider what words can be said to the patient and what words are not suitable to say, so as to avoid resistance in communication.

7. Manage countertransference.

You may have some negative feelings about the individual who implements NSSI, or even direct self-harm Intentional behavior for the patient to try to gain attention. However, this feeling may lead you to ignore the meaning of the patient’s behavior, which in turn pushes him toward a more dangerous self-harm behavior.

Acknowledging your concern for implementing NSSIndividuals of I have negative feelings such as ridicule, and understanding why they feel these feelings helps to better understand patients, improve doctor-patient cooperation, and do not delay the timely development of appropriate treatment measures.

Source: Kaustubh G. Joshi, MD . Caring for adults who engage in nonsuicidal self-injury. Current Psychiatry. 2021 January;20(01):11, 45 | doi:10.12788/cp.0081

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