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self-injurious behavior; self mutilation

Etiology: 1) borderline personality 2) factitious disorder 3) malingering 4) sexual masochism 5) intellectual disability/developmental disorder a) stereotypy/habit disorder -> Lesch-Nyhan syndrome b) Down syndrome b) autism 6) factors associated with self-harm include a) mixed depression-anxiety state b) high-risk alcohol use c) cigarette smoking d) marijuana use e) antisocial behavior [2] f) victim of bullying [4] Epidemiology: - 1.1-1.6% of adolescent emergency department trauma visits - most common methods of self-injury - cutting in females [7]; poisoning in females [2] - firearms in males [7] - factors associated with self-inflicted injury include - age 15-18 years - Asian race - comorbid conditions - public insurance - female gender [7] - adolescents with self-injury are more likely to die from their injuries than those with other injuries [7] - most adolecents who exhibit self-injurious behavior stop by early adulthood [2] - persistence of self-harm into adulthood is associated with depression-anxiety [2] - 8% of 3rd-graders, 4% of 6th-graders, & 13% of 9th-graders report nonsuicidal self-injury [5] - nonfatal self-injury among young U.S. girls age 10-14 years increased 19%/year between 2009-2015 [12] Complications: - adolescents who self-harm are more likely to experience psychosocial problems in adulthood [10] Management: 1) psychiatric evaluation [3] 2) positive behavioral support [8] 3) selective serotonin reuptake inhibitor (SSRI) 4) melatonin reduces risk of self-harm in adolescents with psychiatric disorders [13] 5) for patient with intellectual disability presenting with recurrence of self injurious behavior - ask caregivers to calm patient - examine patient as tolerated - additional help may be required - obtain samples for therapeutic drug monitoring [6] 6) electrical stimulation devices not recommended [8] Notes: - non-suicidal self-injury syndrome is defined as: at least 5 days in the past year of intentional self-injury without suicidal intent [11]

Specific

cinnamon challenge genital mutilation pathologic grooming suicide suicide attempt

General

sign/symptom

References

  1. DSM-IV
  2. Moran P et al The natural history of self-harm from adolescence to young adulthood: a population-based cohort study The Lancet, Early Online Publication, 17 November 2011 PMID: 22100201 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61141-0/abstract - Hawton K and O'Connor RC Self-harm in adolescence and future mental health The Lancet, Early Online Publication, 17 November 2011 PMID: 22100202 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61260-9/fulltext
  3. Olfson M et al. Emergency treatment of deliberate self-harm. Arch Gen Psychiatry 2012 Jan; 69:80 PMID: 21893643
  4. Fisher HL et al Bullying victimisation and risk of self harm in early adolescence: longitudinal cohort study. BMJ 2012;344:e2683 PMID: 22539176 http://www.bmj.com/content/344/bmj.e2683
  5. Barrocas AL et al. Rates of nonsuicidal self-injury in youth: Age, sex, and behavioral methods in a community sample. Pediatrics 2012 Jul; 130:39. PMID: 22689875
  6. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
  7. Cutler GJ et al Emergency Department Visits for Self-Inflicted Injuries in Adolescents. Pediatrics. June 15, 2015 PMID: 26077475 http://pediatrics.aappublications.org/content/early/2015/06/09/peds.2014-3573
  8. FDA News Release. April 22, 2016 FDA proposes ban on electrical stimulation devices intended to treat self-injurious or aggressive behavior. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm497194.htm - DEPARTMENT OF HEALTH AND HUMAN SERVICES. Food and Drug Administration 21 CFR Parts 882 and 895 Banned Devices; Proposal to Ban Electrical Stimulation Devices Used to Treat Self-Injurious or Aggressive Behavior. https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-09433.pdf
  9. Rana F, Gormez A, Varghese S. Pharmacological interventions for self-injurious behaviour in adults with intellectual disabilities. Cochrane Database Syst Rev. 2013 Apr 30;(4):CD009084. Review. PMID: 23633366
  10. Borschmann R et al 20-year outcomes in adolescents who self-harm: a population- based cohort study. The Lancet Child & Adolescent Health. July 7, 2017 Not indexed in PubMed http://thelancet.com/journals/lanchi/article/PIIS2352-4642(17)30007-X/fulltext - Steeg S Self-harm in adolescence: a marker for psychosocial problems in early adulthood. The Lancet Child & Adolescent Health. July 7, 2017 Not indexed in PubMed http://thelancet.com/journals/lanchi/article/PIIS2352-4642(17)30022-6/fulltext
  11. Breuner CC, Levine DA, THE COMMITTEE ON ADOLESCENCE Adolescent and Young Adult Tattooing, Piercing, and Scarification. Pediatrics. September 2017 PMID: 28924063 http://pediatrics.aappublications.org/content/early/2017/09/14/peds.2017-1962
  12. Mercado MC, Holland K, Leemis RW et al Trends in Emergency Department Visits for Nonfatal Self- inflicted Injuries Among Youth Aged 10 to 24 Years in the United States, 2001-2015. JAMA. 2017;318(19):1931-1933. PMID: 29164246 https://jamanetwork.com/journals/jama/article-abstract/2664031
  13. Anderson P Melatonin a New Way to Reduce Self-Harm? Medscape. March 27, 2023 https://www.medscape.com/viewarticle/990150 - Leone M, Kuja-Halkola R, Lagerberg T et al Melatonin use and the risk of self-harm and unintentional injuries in youths with and without psychiatric disorders. J Child Pscychol Psychiatr 2023. March 23 PMID: 36950769