National Suicide Research Foundation, Cork, Ireland.
Med Hypotheses. 2013 Aug;81(2):347-54. doi: 10.1016/j.mehy.2013.04.001. Epub 2013 May 17.
Individuals who present to emergency departments with self-harm are at elevated risk of further self-harm and suicide, and these risks are yet higher among patients who self-cut. Repetitive self-injury has previously been explained using a behaviourist approach focussing on operant conditioning, but we propose that the increased risk of self-harm repetition among those who present with self-cutting is at least partly mediated by pre-existing psychological risk factors. Several studies show that those who present with self-cutting differ from intentional overdose patients on demographic, psychiatric and social factors, but, based on findings from community-based studies, we hypothesise that there may be additional psychological differences that may also be associated with increased repetition risk. We conducted a small-scale cohort study of 29 self-harm patients presenting to A&E and compared theoretically-derived psychological variables between 8 self-cutting and 21 overdose patients. Those presenting with self-cutting scored significantly higher on hopelessness and lower on non-reactivity to inner experience and generally had a more vulnerable profile than those presenting with overdose. These findings support our hypothesis that the association between self-cutting and prospective repetition is at least partly due to pre-existing psychological vulnerabilities that increase both the likelihood of engaging in self-cutting as a method of self-harm and the likelihood of subsequent repetition of self-harm. Existing evidence suggests that self-cutting is a risk factor for repetition of self-harm, and it is possible that reducing and preventing repetition among these patients can be achieved by implementing psychological interventions to reduce hopelessness and increase tolerance of emotional distress.
到急诊科就诊的有自伤行为的个体有更高的进一步自伤和自杀风险，而那些有自割行为的患者的风险更高。先前使用行为主义方法，重点是操作性条件作用，解释了重复性自我伤害，但我们提出，在那些因自割就诊的患者中，自我伤害重复的风险增加至少部分是由先前存在的心理风险因素介导的。有几项研究表明，那些有自割行为的人与故意过量用药的患者在人口统计学、精神病学和社会因素方面存在差异，但基于社区研究的结果，我们假设可能存在其他与增加重复风险相关的心理差异。我们对 29 名到急诊科就诊的自我伤害患者进行了一项小规模队列研究，并在 8 名自割患者和 21 名过量用药患者之间比较了理论上得出的心理变量。与过量用药患者相比，自割患者的绝望感评分明显更高，对内体验的反应性更低，且总体上具有更脆弱的特征。这些发现支持我们的假设，即自割与前瞻性重复之间的关联至少部分归因于先前存在的心理脆弱性，这些脆弱性增加了以自割作为自我伤害手段的可能性，以及随后重复自我伤害的可能性。现有证据表明，自割是自我伤害重复的一个风险因素，通过实施减少绝望感和增加对情绪困扰的容忍度的心理干预措施，有可能减少和预防这些患者的重复。
