Self-harm behaviors in patients with spinal cord injuries: From non-adherence to suicide

Psychosocial Consequences of Spinal Cord Injury: A Narrative Review

“…In medical settings, self-harm behaviors can present as mismanagement of medicine, missed appointments, too much or too little sleep, levels of concerning nonadherence, social isolation, alcohol or drug misuse, “giving up” statements, and decisions to medically hasten death [ 66 ]. It is helpful to think of these behaviors as “symptoms” that can provide information about the underlying contributors [ 66 ], rather than the actions are the result of clinical “depression” or defiance. For example, self-harm behaviors may be “symptoms” of problems adapting to disability, existential issues, medical mistrust, or behaviors that are simply patient preferences [ 67 , 68 , 69 , 70 ].…”

“…Clinical responses should focus on the core conflict of whatever triggers the maladaptive behavior [ 66 , 68 ]. For example, a person may display anger, or indifference, or may inconsistently adhere to essential medical recommendations, causing others sincere worry about consequential harm.…”

“…Interventions aimed at the conflict driving the maladaptive behavior will provide the most benefit, and often best when combined with psychopharmacological treatment. Additional clinical responses in the present example surrounding adapting to disability or loss of autonomy or external locus of control could be: to promote mastery of new and existing life-valued activities, bolster coping skills, facilitate peer support, or help with meaning making [ 66 ]. All behaviors suspected of causing substantial self-harm should be assessed professionally so appropriate interventions can be put in place.…”