Question

Louise is a 20-year-old woman who has been admitted to an acute mental health inpatient ward following an episode of self harming behavior.this is her first contact with mental health services. Louise presents with lacerations to both arms; some are superficial scratches, others, while of varying severity and depth, are not life-threatening. There are also visible scars on her arms from apparently previous incidents of self-harming behaviors.

Louise has been admitted via the local accident and emergency department following an initial CRISIS assessment by the hospital Mental Health Liaison Team. Louise had consumed half a bottle of vodka and also admitted to smoking cannabis prior to the incident. She denies having taken an overdose of any type and this is corroborated by normal blood test results. she was originally accompanied there by her mother who did not remain with her.

Louise does not appear remorseful for what she has done. She says she is depressed and angry with her parents who 'think she is worthless and do not care about me because  i haven't gone to university like my brothers'. She maintains that she doesn't need any help with her problems, claiming that they are down to 'my immaturity, as my parents keep telling me' and that I'll grow out of it with time.

Pathology

Define the patient's disease process

Describe the patient's disease process

Clearly explain etiology of the disease process

Clearly explain the cause of the disease process

Thoroughly explain signs and symptoms of pathology

Answer 1

Self-harm, also known as self-injury, is defined as the intentional, direct injuring of body tissue, done without the intent to commit suicide.Other terms such as cutting and self-mutilation have been used for any self-harming behavior regardless of suicidal intent.The most common form of self-harm is using a sharp object to cut one's skin. Other forms include behaviour such as burning, scratching, or hitting body parts. While older definitions included behaviour such as interfering with wound healing, excessive skin picking (dermatillomania), hair pulling (trichotillomania) and the ingestion of toxic substances or objects as self-harm, in current terminology those are differentiated from the term self-harm.

In Louise's case, we have an episode of self harm of moderate severity because of following evidence -

• no severe wounds - but multiple lacerations

• non-lethal injuries - No major arteries have been damaged.

• no intent to take her own life - she presented to accident and emergency with her mother for treatment.

Louise's self harming behaviour appears to be result of family conflict. However, the motives for self harm may not be as straightforward as this.

• Current mental health problems - feels depressed, anxious, worthless, agitated.

• Current inability to constructively deal with emotions - anger.

Causes - Current alcohol and substance use

Family relationship problems,

Unemployment.

Signs and symptoms - Past history of self-harm.

• Multiple self-harming behaviours - cutting, over-dosing, and picking wounds.