[Self-harm - what approach should we take?].
BACKGROUND
Epidemiological studies indicate that self-harm is highly prevalent among adolescents. However, only a minor fraction present with their problem to health care services. Adolescents with a pattern of repetitive self-harm are often characterized by emotional dysregulation and have a significantly increased risk of suicide. The aim of the paper was to provide an overview of clinical approaches towards self-harming adolescents with an emphasis on assessments and interventions that should be applied by physicians working in somatic medicine in hospitals and primary health care.


METHODS
The paper is based on a non-systematic literature search of PubMed, published treatment guidelines and therapy recommendations, and on the authors' experience with self-harming patients in research and clinical practice.


RESULTS
Physicians and other health care providers should target self-harm in at-risk adolescents through active and precise inquiry. A positive screening for self-harm behaviour should lead to further assessment and referral to specialist health services. The tendency for early drop-out from treatment should be actively combated through commitment strategies and increased therapeutic support. Several psychosocial treatment methods have shown promising results and are relevant to self-harming adolescents; examples are dialectical behaviour therapy, mentalization based therapy, schema focused therapy and multi-systemic therapy. Hospitalization is usually not required, but a safety plan concerning what the patient and the family can do in case of increasing suicidal risk should be worked out at an early stage in the treatment.


CONCLUSIONS
Self-harm in adolescents is a large public health problem that needs to be taken seriously through early identification, assessment and treatment.
Nasjonalt senter for selvmordsforskningog -forebyggingInstitutt for psykiatriUniversitetet i OsloSognsvannsveien 210320 Oslo. lars.mehlum@medisin.uio.no
Lars
L
Mehlum
Kristin
K
Holseth
D000293:Adolescent; D000294:Adolescent Behavior; D006801:Humans; D011613:Psychotherapy / Q000379:methods; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000517:prevention & control / Q000523:psychology / Q000628:therapy; D000092864:Suicide Prevention