The following document was written by Dr Sayqa Azam (MBBS) Foundation year two in Psychiatry. March 2008.
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Deliberate Self Harm

One can make the mistake of confusing deliberate self harm and suicide hence I would like to define both first:

Deliberate self-harm is an acute non-fatal act of self-harm carried out deliberately with a high suicidal intent & high lethality or low suicide intent +low lethality.

While on the other hand suicide is defined as follows:

“Suicide” is defined as an act with a fatal outcome that is deliberately initiated and performed by the person with the knowledge or expectation of its fatal outcome.

Question arises as to what is self harm.Self harm can occur in various forms commonly presents as follows:


Statistically the figures noted are in UK, several thousand people take their own lives each year. Suicide accounts for 1 per cent of all deaths.

Male suicides outnumber female,while deliberate self harm is more common among women. Most occur in age ranges 22 to 54 and cases of DSH are 30 times more common than suicide.

Important point to note is that 10% of patients admitted in hospital following DSH commit suicide within 10 years hence a through assessment at presentation may prevent deaths in the future.

Risk factors for suicide include:

Protective factors:

Risk Assessment

Risk assessment of all clients presenting into psychiatry carries utmost importance. All hospitals have their own risk assessment tools but two commonly used are the following:

Beck’s suicide Scale and the Pierce Suicide intent scale.

Pierce Suicide Intent Scale and nearly all scales used follow the headings as below:
All the above relate to the scoring of the circumstances preceding the event.

Other headings related to rating score are as below:

The score depends on how much of the above are taken into account at the time of the self harm. Score would be higher if the above are taken into account at the time of self harm and vice versa.

History of Deliberate Self Harm

History plays an important role in the basic assessment of all patients. History for self harm revolves around the following headings:


Psychosocial Treatment

What Help Is Available

Case Example:

Question: can he receive medical treatment without his consent?

Assess patient’s capacity to give consent. If lacking one can go ahead with treatment in best interests of patient based on his / her capacity.

What is Capacity?

Capacity: individuals should be able to:


Hope this is sufficient information for you to grasp this delicate subject throughly.



Compiled by : Dr Sayqa Azam (MBBS)

Foundation year two in Psychiatry.


The authors of this document have attempted to provide information that is medically sound and up-to-date. The authors nor cannot take any reponsibility for the accuracy or completeness of this article. The reader should confirm the statements made in this website before using the information outside this website.