13 responses to “Non-suicidal self-injury: reducing future risk”

  1. Would be interested in Dr. McBeath’s guidelines but couldn’t find the attachment on the website – just an article from American Journal of Psychiatry.

    Thanks for the discussion on this difficult topic!

  2. This was great. Apparently there were handouts attached, but I was unable to see how to access these. Please advise.

  3. Helpful

  4. Difficult problem and even more difficult patient

  5. These “cutters ” are bipolar not borderlines. Cutting is aan addiction that has to be stopped and then appropriate treatment can begin.

  6. These can be difficult patients and its difficult to not discuss future self injurym though it may be futile. I certainly have found this approach works and people are more likely to come in sooner after an injury or, on one occasion, even before the patient injured herself!

  7. Please see above under “Additional materials” for guidelines. Thank you.

  8. very difficult patients with obsessive features and great inner pain

  9. I was surprised to see the significant incidence of successful suicide in these patients. I plan to ask about suicidal ideation in patients with cuts on the wrist.

  10. I look after many patients who cut or self mutilate. The model I use involves patient education about the addictive nature of self abuse and how common it is in the population especially in teens. I see self mutilation as a cry for help and a poor coping strategy for uncomfortable emotions. I like to separate the self mutilation from suicidal behaviour and do not assume that they are equivalent or even predictive. For patients who are escalating in self abuse I would fully evaluate them for suicidal risk. I also tell my patients that if they decide to kill themselves then I can’t stop them, but I do care what happens to them. I talk about how beginning to identify the triggers for the abuse can help us work out a safety plan and list of behaviours that nurture and soothe. A neutral supportive approach without taking control from the patient will allow them to feel part of the solution. Many patients who are diagnosed as Borderline Personality Disorder often have other mental health disorders. Often Bipolar patients are misdiagnosed as BPD. It is possible to have both diagnoses. As a family doctor I would not want to feel I had to do suicide assessments every time these patients harm themselves. For me, keeping the lines of communication open is a better strategy and taking care of our own feelings of helplessness.

  11. I think need more articles for this difficult subject about difficult pt. thank you

  12. helpful

  13. Good resources and ino

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