Deliberate Self-harm and Predictors of Out-patient Attendance

1987 ◽  
Vol 150 (2) ◽  
pp. 246-247 ◽  
Author(s):  
G. O'Brien ◽  
A. R. Holton ◽  
K. Hurren ◽  
L. Watt ◽  
F. Hassanyeh
Keyword(s):  
Personality Disorder ◽  
Psychiatric Treatment ◽  
Psychiatric Practice ◽  
Deliberate Self Harm ◽  
Self Harm ◽  
Psychiatric Intervention ◽  
Patient Attendance

Kreitman (1979) reported that up to one-half of patients given out-patient appointments one week after an episode of deliberate self-harm (DSH) fail to attend, and gave a number of possible explanations for this. Firstly, parasuicide is often the result of a crisis which may have resolved (albeit temporarily) by the end of a further week. Secondly, someone in a state of heightened tension may find one week too long to wait, and may resort to other strategies to deal with his problems. Thirdly, many parasuicides may find a psychiatric label unacceptable in the context of their problems, and fourthly, an appoint ment made for a fixed day and a fixed hour may not fit the need for immediate action which the subjects subculture had inculcated in him as a habit pattern. Morgan et al (1976) reported that up to 40% of their DSH patients either did not attend any appointment or failed to complete their treatment. Two possible explanations for this were that they either felt that they did not need psychiatric treatment, or else believed that psychiatric treatment was not an answer to their problems. Kessel and Lee (1962), probably in line with much psychiatric practice, did not give a follow-up appointment to 40% of their self-poisoners; this was for two reasons. Firstly, these patients did not have a problem for which psychiatric treatment was appropriate and secondly, many of these patients had an entrenched personality disorder, which made it unlikely that psychiatric intervention would be beneficial.

THE TREATMENT OF DELIBERATE SELF-HARM IN BORDERLINE PERSONALITY DISORDER USING DIALECTICAL BEHAVIOUR THERAPY: A PILOT STUDY IN A HIGH SECURITY HOSPITAL

2001 ◽  
Vol 29 (1) ◽  
pp. 85-92 ◽  
Author(s):  
Gail Low ◽  
David Jones ◽  
Conor Duggan ◽  
Mick Power ◽  
Andrew MacLeod
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Suicide Ideation ◽  
Borderline Personality ◽  
Institutional Setting ◽  
Behaviour Therapy ◽  
Deliberate Self Harm ◽  
Dialectical Behaviour Therapy ◽  
Self Harm

Deliberate self-harm (DSH) presents a significant health problem, especially as treatments have not been particularly successful in reducing repetition. Dialectical behaviour therapy (DBT; Linehan, 1993) is one approach that has reported some success in reducing self-harm rates in borderline personality disorder patients, who self-harm frequently, though it remains largely untested outside its original setting. The present study aimed to assess the effectiveness of DBT in self-harming women in an institutional setting in the United Kingdom where self-harm is common. Female patients at Rampton Hospital who were displaying self-harming behaviour and met criteria for borderline personality disorder (N = 10) participated in the full one-year treatment package of DBT. Patients were assessed on self-harm rates and on a number of psychological variables, pre-, during- and post-therapy, including a 6-month follow-up. There was a significant reduction in DSH during therapy, which was maintained at 6-month follow-up. This was paralleled by a reduction in dissociative experiences and an increase in survival and coping beliefs, alongside improvements in depression, suicide ideation, and impulsiveness. The findings are preliminary but the results suggest that DBT might provide an effective treatment for severe self-harm in institutional settings, and also highlight some of the psychological mechanisms that might mediate these improvements in self-harming behaviour.

scholarly journals Psychiatric and personality disorders in deliberate self-harm patients

2001 ◽  
Vol 178 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Camilla Haw ◽  
Keith Hawton ◽  
Kelly Houston ◽  
Ellen Townsend
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Psychiatric Disorders ◽  
General Hospital ◽  
Representative Sample ◽  
Deliberate Self Harm ◽  
Common Diagnosis ◽  
Icd 10 ◽  
Self Harm

BackgroundPrevious UK studies have reported much lower rates of psychiatric and personality disorder in those who attempt suicide than in those who die by suicide.AimsTo determine the nature and prevalence of psychiatric and personality disorders in deliberate self-harm (DSH) patients.MethodA representative sample of 150 DSH patients who presented to a general hospital were assessed using a structured clinical interview and a standardised instrument. Follow-up interviews were completed for 118 patients approximately 12–16 months later.ResultsICD–10 psychiatric disorders were diagnosed in 138 patients (92.0%), with comorbidity of psychiatric disorders in 46.7%. The most common diagnosis was affective disorder (72.0%). Personality disorder was identified in 45.9% of patients interviewed at follow-up. Comorbidity of psychiatric and personality disorder was present in 44.1%.ConclusionsPsychiatric and personality disorders, and their comorbidity, are common in DSH patients. This has important implications for assessment and management.

Deliberate Self-Harm: A Follow-Up Study of 279 Patients

1976 ◽  
Vol 128 (4) ◽  
pp. 361-368 ◽  
Author(s):  
H. Gethin Morgan ◽  
Jacqueline Barton ◽  
Susan Pottle ◽  
Helen Pocock ◽  
Christopher J. Burns-Cox
Keyword(s):  
Clinical Management ◽  
Psychiatric Care ◽  
Psychiatric Treatment ◽  
Criminal Record ◽  
Deliberate Self Harm ◽  
Follow Up Study ◽  
Patient Appointment ◽  
Self Harm ◽  
Initial Episode

SummaryTwo-hundred-and-seventy-nine patients (103 men, 176 women) were followed-up 1–2 years after an act of non-fatal deliberate self-harm. Of 155 patients offered a psychiatric out-patient appointment at the time, only 68 completed the treatment. A further act of deliberate self-harm was committed by 26 men and 41 women within twelve months. The factors most highly associated with repetition were previous psychiatric treatment, a previous act of deliberate self-harm, and a criminal record. These factors held good for a separate series of patients. Significantly more repeaters received prolonged psychiatric care after the initial episode of deliberate self-harm. The implications of these findings for the clinical management of such patients are discussed.

scholarly journals Repetition of deliberate self-harm and subsequent suicide risk: Long-term follow-up study of 11 583 patients

2004 ◽  
Vol 185 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Daniel Louis Zahl ◽  
Keith Hawton
Keyword(s):  
Relative Risk ◽  
Suicide Risk ◽  
Single Episode ◽  
Deliberate Self Harm ◽  
Young Females ◽  
Follow Up Study ◽  
Increased Risk ◽  
Self Harm

BackgroundRepetition of deliberate self-harm (DSH) is a risk factor for suicide. Little information is available on the risk for specific groups of people who deliberately harm themselves repeatedly.AimsTo investigate the long-term risk of suicide associated with repetition of DSH by gender, age and frequency of repetition.MethodA mortality follow-up study to the year 2000 was conducted on 11583 people who presented to the general hospital in Oxford between 1978 and 1997. Repetition of DSH was determined from reported episodes prior to the index episode and episodes presenting to the same hospital during the follow-up period. Deaths were identified through national registers.ResultsThirty-nine percent of patients repeated the DSH. They were at greater relative risk of suicide than the single-episode DSH group (2.24; 95% CI 1.77–2.84). The relative risk of suicide in the repeated DSH group compared with the single-episode DSH group was greater in females (3.5; 95% C11.3–2.4) than males (1.8; 95% C1 2.3–5.3) and was inversely related to age (up to 54 years). Suicide risk increased further with multiple repeat episodes of DSH in females.ConclusionsRepetition of DSH is associated with an increased risk of suicide in males and females. Repetition may be a better indicator of risk in females, especially young females.

scholarly journals Background stressors and deliberate self-harm

2003 ◽  
Vol 27 (11) ◽  
pp. 411-415 ◽  
Author(s):  
Helen S. Keeley ◽  
Mary O'Sullivan ◽  
Paul Corcoran
Keyword(s):  
Life Events ◽  
Interpersonal Problems ◽  
Dysfunctional Family ◽  
Deliberate Self Harm ◽  
Monitoring Study ◽  
History Of ◽  
Self Harm ◽  
Background History ◽  
Prospective Monitoring

Aims and MethodIn this study we aimed to identify negative life events, especially those associated with repetition, in the background histories of patients in a 2-year prospective monitoring study of hospital-treated deliberate self-harm (DSH). Thematic analysis of the narratives recorded during assessment was used to produce general categories of life events.ResultsIn 3031 DSH episodes (n=2287 individuals), women reported more life events than men. Family and interpersonal problems were most commonly reported. Reporting a dysfunctional family of origin, a history of sexual abuse and the imprisonment of self or other were associated with repetition retrospectively and prospectively.Clinical ImplicationsThe background history of patients who harm themselves should be explored routinely on assessment in order to help establish risk of repetition and to determine appropriate follow-up.

Early predictors of deliberate self-harm among adolescents. A prospective follow-up study from age 3 to age 15

2006 ◽  
Vol 93 (1-3) ◽  
pp. 87-96 ◽  
Author(s):  
Andre Sourander ◽  
Minna Aromaa ◽  
Leena Pihlakoski ◽  
Antti Haavisto ◽  
Päivi Rautava ◽  
...  
Keyword(s):  
Deliberate Self Harm ◽  
Follow Up Study ◽  
Early Predictors ◽  
Self Harm

Hostility, hopelessness and deliberate self-harm: a prospective follow-up study

1990 ◽  
Vol 81 (3) ◽  
pp. 280-283 ◽  
Author(s):  
A. D. Brittlebank ◽  
A. Cole ◽  
F. Hassanyeh ◽  
M. Kenny ◽  
D. Simpson ◽  
...  
Keyword(s):  
Deliberate Self Harm ◽  
Follow Up Study ◽  
Self Harm

Which Neurotic Patients Do Psychiatrists Treat?

1988 ◽  
Vol 152 (2) ◽  
pp. 222-228 ◽  
Author(s):  
John M. Eagles ◽  
David A. Alexander
Keyword(s):  
Alcohol Abuse ◽  
Short Duration ◽  
Psychiatric Treatment ◽  
Deliberate Self Harm ◽  
Factors Associated ◽  
Main Hospital ◽  
Duration Of Illness ◽  
History Of ◽  
Self Harm

Of 336 newly referred neurotic patients, 80 were not offered continuing psychiatric treatment. The factors associated with patients' not being offered continuing treatment were: short duration of illness; history of alcohol abuse and/or deliberate self-harm; age over 50 years; being widowed; and living more than 20 miles from the main hospital complex. The implications of these findings are discussed.

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