Intentional self-injury Intentional self-injury is: “the act of intentionally inflicting nonlethal injury to oneself using somatic, drug overdose, and intoxication methods, with the knowledge that the actor is damaging his or her health by said methods” (Morgan 1979). Self-injury is more common among psychiatric patients, and the meaning of self-injury varies. Intentional self-injury is often considered to have the same meaning as suicide. Intentional self-injury tends to occur in more socially stratified populations, with a higher incidence in densely populated and poorer areas, and is often associated with unemployment. There is little difference in the rate of intentional self-injury admissions between the sexes, with a higher incidence in females aged 15-19 years, and self-inflicted cuts occurring more often in younger people, although epidemiological studies have shown no gender differences. Etiology of intentional self-injury Mental illness About 2/3 of people who self-injure have definite psychiatric symptoms, and about 30% are accompanied by acute psychiatric symptoms at the time of taking this approach. The type of illness is predominantly depression. In anorexia nervosa there are also cases of drug overdose and self-injury. One-third of those who self-injure have long-term psychological problems, and these patients often have early life experiences of separation of loved ones, abuse and family breakdown, and self-injury is often associated with antisocial and borderline personality. Intentional self-injury can occur in any psychiatric disorder, and intentional self-injury syndrome and Munchausen syndrome are also common. Psychosocial factors Pessimism about the future is an important factor in suicide and is also closely associated with intentional self-injury. In addition, negative social events are a key factor. One study found that when comparing the number and type of pre-morbid life events in people with intentional self-injury, depressive episodes, and first-episode schizophrenia to measure the relative risk of the three disorders, the relative risk of intentional self-injury 6 months after experiencing a life event was 6.7, compared with 5.4 for depression and 3.0 for schizophrenia, indicating the sensitivity of intentional self-injury to life events. In addition, the predominance of psychotropic substance use and chronic physical illness among intentional self-injurers was more pronounced among females in particular. As in the case of suicide, imitation behavior is also an important factor. Intentional self-injury 90% of the people who self-injured in the UK were drug overdoses, with painkillers, antidepressants, and Valium being the main drugs taken. This is followed by self-inflicted cuts, mostly to the wrist and forearm. Psychotic self-inflicted injuries are rare, mostly to the eyes, tongue, and genitals. It is commonly seen in schizophrenia. Greilsheimer and Groves (1977) summarized 53 publicly reported cases of self-castration from 1901-1977. Most of them were schizophrenic patients aged 20-40 years. Self-castration was mostly secondary to command hallucinations, but also secondary to cross-dressing and aptitude problems. Treatment Immediate management of trauma and different treatment for different disorders. Antipsychotics, antidepressants and electroconvulsive therapy can be considered for schizophrenic patients and depression. For intentional self-injury syndrome as well as Munchausen’s syndrome. In contrast, psychological interventions should be considered, and if the treatment is not effective, antipsychotic or antidepressant treatment may also be used, and lithium salts or β-blockers may be used for those with mental retardation. Prognosis of intentional self-injury Intentional self-injury is often seen to recur, and some studies have found that the risk of suicide is most likely to occur within 3 years of the appearance of intentional self-injury, especially within 6 months, and 15% of those who intentionally self-injure eventually die by suicide, which should be given special clinical attention.