Intentional suicidal and non-suicidal self-cutting in clinical practice

Self-inflicted cuts are a common form of injury in the population, most of which do not require medical intervention. However, direct external damage to the skin and soft tissues is not always accidental. Cuts to one's own body can also be committed intentionally, both with and without suicidal motives. The aim of this research was to study the main characteristics of persons who committed deliberate self-cuts with and without suicidal motive based on an analysis of literature data and using authors’ own clinical experience. Results: In Russia, the share of self-injuries in the structure of suicide methods in individual regions ranges from 0.7 to 8.3%. Among suicide attempters this indicator is significantly higher reaching 54.5% for men and 38.5% for women. The frequency of cuts among those died by suicide and attempted suicide is at least 10 times different. Among those admitted to the hospital after a suicidal attempt, the proportion of those committed self-cuts can reach 34-44%. The highest rates of self-cut prevalence are associated with intentional non-suicidal injuries (NSSI) and are most often recorded during adolescence: in Russia it is about 17%, in European countries and the USA it ranges from 17.1 to 46.5%. Females predominate. Self-cutting is characterized by repeated repetition, including over a long period. More often self-cutting is done without suicidal motive, but their presence dramatically increases the risk of dying from suicide within the coming year (for adolescents it exceeds the average more than 30 times). In those seeking medical help, forearm cuts of various depths in the area of superficial veins prevail. Lesions of the non-dominant hand prevail (94.5%), more often multiple (78.6%). Every fifth person (19.1%) has scars from cuts inflicted earlier. Up to 40% of cuts are made in places hidden from outside view, and are usually associated with previous self-harm. Risk factors for deliberate self-harm are similar in many ways to other forms of NSSI: female, adolescence or young age, emotional disturbances, low self-esteem, anxiety and impul-sivity, sexual, emotional and physical abuse, deliberate self-harm committed by friends, single-parent family, deliberate self-harm in a family, and additionally for adults - living in the city, no fixed place of residence. Alcohol is detected in only 16-22% of victims, but its use is associated with more severe cut wounds and significantly increases the risk of suicide. With self-cuts, medical attention is usually limited to the surgical component, but surgeons are often unable to assess patients' suicidal intentions based on the characteristics of the wound. Therefore, it is important that they initiate a psychiatric consultation. In working with this contingent, a multidisciplinary approach is proposed, which includes four stages: 1. Initial assessment. 2. Psychological interview. 3. Surgical aid. 4. Rehabilitation. The authors cite observations from their own clinical practice as illustrations. It is concluded that it is necessary to increase the level of training of medical personnel in the field of suicidology and deviant behavior, as well as to organize specialized databases for registration and registration of cases of self-injury (registers).