Child Psychology and Psychiatry

Risk associated with self-harm
The factors associated with high risk from self-
harm are given in Box 30.1. The physical severity
of the self-harm is not a good indicator of intent as
young people are often unaware of the objective
degree of lethality of specific substances and quan-
tities; it is their belief about potential lethality that
is important.
Box 30.1
Factors associated with
high suicidal intent
•
Carried out in isolation
•
Timed so that intervention is unlikely,
e.g. after parents are at work
•
Precautions taken to avoid discovery
•
Preparations made in anticipation of
death, e.g. leaving directions as to how
possessions should be distributed
•
Other people informed of individual’s
intention beforehand
•
Advance planning of attempt
•
Suicide note
•
Failure to alert others following the
attempt
Course
At least 10% of adolescents who self-harm do
so again in the following year; this is especially
likely in the first two or three months. Factors that
increase the likelihood of repetition include previ-
ous self-harm, personality disturbance, depression,
substance misuse, extensive family psychopathol-
ogy, poor social adjustment, social isolation and
a poor school record [25]. Approximately 0.5%
eventually kill themselves; risk factors include male
gender, older age, high suicidal intent, mood disor-
der, substance abuse, violent method of self-harm
and previous psychiatric admission.