Self-harm, self-mutilation, self-injury (SI)

Self-harm, self-mutilation, self-injury (SI): The act of physically intentionally injuring one's self to experience relief from anxiety and inner pain, to express anger, for interpersonal influence and/or self-punishment. There is a difference between self-injurious and suicidal behaviors. Self-injurious behaviors are also referred to as para-suicidal. It's important to assess if the intention is self-injurious or suicidal to determine lethality. It is possible that although the initial intent may be to harm that over time the behavior can become increasingly lethal leading to death even if unintended. Additional risk factors include infection.

Individuals suffering from eating disorders experience intense guilt and discomfort physically & emotionally and self-harming behaviors can be a means of ineffectively managing these emotions that are perceived as otherwise intolerable. Cutting or scraping the skin is the most common form of self-harming, particularly on the forearm. Other forms may include: burning oneself, taking small drug overdoses or non-prescribed medications, hitting/punching oneself, pulling out hair, scratching self, skin picking to the point of bleeding, interfering with wound healing. When a patient is working on decreasing/abstaining from primary eating disorder behaviors i.e. restriction or purging and also engages in self-harming it is important to monitor for potential increase in incidences. For example: patient is reporting improved meal plan adherence and decrease in purging but increase in frequency and/or intensity of cutting.

It can be beneficial to plan in advance by preparing the patient that there is a risk of this happening and identifying specific ways of using skills and support to effectively manage emotions and urges. It is beneficial for the patient and family members to have open discussions with treatment team members about self-harm patterns to enhance use of support and accountability. Recommended discussion topics include: What are common triggers? What are the highest risk times, places and situations? 

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