When self-harm is about preventing harm: emergency management of obsessive–compulsive disorder and associated self-harm

Abstract

<jats:title>Summary</jats:title> <jats:p>Mental health staff may have limited exposure to emergencies associated with obsessive–compulsive disorder (OCD) during postgraduate training. The first time they encounter a person in the midst of severe obsessions, or one who has compulsively self-harmed in response to such obsessions, might be when working on call covering the emergency department. This educational article presents the lived experience of one of the authors as a clinical scenario. The scenario is then used to illustrate the severity of disability and the rates of self-harm and suicide-related mortality caused by OCD. The recognition and assessment of OCD is described, along with what helps in emergency situations. Written informed consent was obtained for the publication of clinical details.</jats:p>

‘Relieved to be seen’—patient and carer experiences of psychosocial assessment in the emergency department following self-harm: qualitative analysis of 102 free-text survey responses

“…Collaborative assessments that focus on building a therapeutic relationship could engage people in the process and build up trust in mental health services. 44 4 People who have self-harmed receive the monitoring that they need while in the healthcare setting, to reduce self-harm repetition risk.…”

“…Co-designed advance directives with accessible crisis may provide more control and understanding over assessment/treatment options for some patients. 44 Given the challenges in accessing specialist services, emergency department presentations for self-harm provide an important opportunity for intervention at a time of crisis for the patient. Good-quality, compassionate assessments and collaboratively developed safety plans may help to ease acute distress and prevent repeat self-harm.…”

Knowledge and competency standards for specialized cognitive behavior therapy for adult obsessive-compulsive disorder

“…Further research on relapse prevention should aim to elucidate the contributing factors and what interventions would best reduce this outcome. related to OCD and/or comorbid disorders may require crisis intervention followed by disorder-specific interventions (e.g., acute suicidality; life-threatening eating disorder; uncontrolled substance abuse, bipolar disorder, or psychotic disorders) (Veale et al 2009;Albert et al 2019;Dell'Osso et al 2020;Mawn et al 2020;Palombini et al 2020). Attempts to classify comorbidity in OCD to reduce heterogeneity require further research and replication (e.g., van Oudheusden et al 2020).…”

A retrospective research on non-suicidal self-injurious behaviors among young patients diagnosed with mood disorders

“…To a certain extent, some subtypes of OCD symptoms were originally self-harm thoughts and behaviors, for example, aggressive obsession, in which a person felt the impetus to hurt himself or others, washing/cleaning, compulsion, in which a person kept washing till erosion of skin, or trichotillomania, in which a person could not help pulling hairs (41,42). In addition, the association between NSSI and psychiatric comorbidities had been mentioned in depressive disorder and OCD symptoms (43). Additionally, the type of amusement with smartphones in leisure time before COVID-19 was concerned with NSSI.…”