TO THE EDITOR: I reviewed with inte...

TO THE EDITOR: I reviewed with interest the article forward screening for suicide risk (1) from the U Preventive Services Task Force department in American Family Physician, especially the association with deliberate self-inflicted harm. I have been encountered with this phenomenon repeatedly end my work in college health and in my supervisory character in our Family Medicine Teen Clinic. There appears to be a lack of information in the medical literature onward deliberate self-inflicted harm and a certain number of misunderstanding about this disorder in the medical community. It is receiving more attention in the popular media and literature, however, with television exhibits and movies addressing this topic and Web sites devot to self-inflicted harm.

I am regarded by one of the Clinical Quiz questions related to this department: "Which of the following is/are risk factors for attempted suicide?" Answer B "cutting oneself" might support the mistaken belief that cutting is a suicide attempt or the first degree on a continuum toward suicidal behavior. However, self-inflicted injury is a coping mechanism, albeit not a particularly healthy undivided used by those who want to live and are struggling to govern their emotions. This behavior was documented previously in somebodys with comorbid depression, obsessive-compulsive disorder, borderline personality disorder, substance abuse, or pervasive developmental disorders. Designations have now been propos to classify the increases we are seeing in adolescent populations not associated with these disorders. In 1983 Pattison and Kahan (2) propos a diagnostic entity, "the deliberate self-harm syndrome" as a distinct category that exclud suicidal behavior. In 1993 Favazza and Rosenthal (3) propos the diagnosis of "repetitive self-harm syndrome" in which patients repeatedly harm themselves without intent to kill moreover with the purpose of relieving mental and emotional pain. I believe we will descry a greater push in the psychiatric and medical literature toward developing a separate diagnostic entity to address self-injury in adolescents who are using this mode to regulate emotional distress and who do not have suicidal intent or an associated personality disorder.

Reactions by means of parents, health care professionals, friends, or teachers to episodes of self-inflicted injury can be highly variable, ranging from dismissal of the behavior as simply a phase to disgust, anger, and fear, or to misinterpretation as suicidal behavior with succeeding inappropriate admission to a psychiatric facility. I am affected that this latter option will be overutilized if those reading the article or quiz were to venture cutting was equated with suicidal behavior. If the patient does not exhibit suicidal intent or more rigid psychopathology, and the method is of grave lethality, they would likely be frequently better served by being linked with a therapist who is experienced in treating this disorder and trained to help them disclose more healthy and effective meanss of coping with their emotions.

REFERENCES

(1) Calonge N Screening for suicide risk: recommendation and rationale [USPSTF]. Am Fam Physician 2004;70:2187-90

(2) Pattison EM Kahan J The deliberate self-harm syndrome Am J Psychiatry 1983;140:867-72

(3) Favazza AR, Rosenthal RJ Diagnostic issues in self-mutilation. Hosp Community Psychiatry 1993;44:134-40

VICTORIA M HAYES, MD

Maine Medical Center

22 Congres St

Portland, ME 04101

COPYRIGHT 2005 American Academy of Family Physicians

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