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Self-Harm Assessment

Self-harm is a serious mental health concern for teens and adults. As a mental health practitioner, you may be the first to learn that a person is self-harming.

Individuals between the ages of 15 and 24 are the most likely to self-harm. It is estimated that 5% of adolescents engage in serious or frequent self-harm, and 1-4% of adults report some form of self-harm. Despite these statistics, many clinicians don’t regularly assess for this issue.

The Self-Harm Assessment is a tool for gathering information about a client’s thoughts, behaviors, and intentions related to self-harm. The categories of questions are as follows:

  • Suicidal ideation. Even though self-harm isn’t usually about suicide, some people think about suicide when they self-harm. Research has shown that using self-harm as way to avoid suicide is actually one of the strongest risk factors for attempting suicide, and a history of self-harm is a predictor of future attempts.
  • Onset, frequency, and methods. Gather information about a client’s first and most recent self-harm behaviors, as well as frequency and methods (e.g., cutting, biting, etc.).
  • Aftercare. Learn whether/how the client cares for their self-harm wounds.
  • Reasons. Clients may self-harm to try to relieve stress, punish themselves, counteract feeling numb, and more.
  • Stage of change. Learn about your client’s motivation to change or stop their self-harm.

This assessment can provide information on the next treatment steps. Common treatment approaches for addressing self-harm include the following:

  • Motivational interviewing (MI)
  • Cognitive behavior therapy (CBT)
  • Dialectical behavior therapy (DBT)
  • Emotion-regulation group therapy

As with other issues, self-injury should be met with empathy, and without judgment, to encourage your client to be honest, forthcoming with information, and help-seeking.

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References

1. Brickell, C. M., & Jellinek, M. S. (2014). Self-injury: Why teens do it, how to help. Contemporary Pediatrics, 31(3), 22-28.

2. Junker, A., Bjørngaard, J. H., & Bjerkeset, O. (2017). Adolescent health and subsequent risk of self-harm hospitalisation: a 15-year follow-up of the Young-HUNT cohort. Child and adolescent psychiatry and mental health, 11(1), 1-14.

3. Kerr, P. L., Muehlenkamp, J. J., & Turner, J. M. (2010). Nonsuicidal self-injury: a review of current research for family medicine and primary care physicians. The Journal of the American Board of Family Medicine, 23(2), 240-259.

4. Muehlenkamp, J. J., & May Lau, M. D. (2016). SOARS model: Risk assessment of nonsuicidal self-injury. Contemporary Pediatrics, 33(7), 25.

5. Muehlenkamp, J. J., Walsh, B. W., & McDade, M. (2010). Preventing non-suicidal self-injury in adolescents: The signs of self-injury program. Journal of youth and adolescence, 39(3), 306-314.

6. Murray, D. (2016). Is it time to abandon suicide risk assessment? BJPsych open, 2(1), e1-e2.

7. Sahlin, H., Bjureberg, J., Gratz, K. L., Tull, M. T., Hedman, E., Bjärehed, J., ... & Hellner, C. (2017). Emotion regulation group therapy for deliberate self-harm: a multi-site evaluation in routine care using an uncontrolled open trial design. BMJ open, 7(10), e016220.

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