Self-harm behavior

This discussion brings us to the function of suicidal behavior. For some people, the function of suicidal behavior is to die, but not for everyone. Clearly the most lethal attempts represent a clear intent to die, especially if done in secrecy. However, many other times self-harm behavior is found to have a function besides death after a comprehensive behavioral analysis is completed with a client. For example, some clients have told me that cutting and burning themselves was related to boredom, anger, sadness, shame, uncertainty how to solve a problem, or even revenge toward someone who had hurt them. Parasuicidal... 

A 13-year-old boy with ADHD was given atomoxetine and 5 weeks later developed changed behavior, disorientation, irrelevant speech, and self-harming behavior. He was very aggressive and hostile towards other children and adults. No organic cause was found. The boy improved after withdrawal of atomoxetine. 

Increasing evidence shows an effect of lithium on suicidal behavior that is superior to other mood-stabilizing drugs.28 Lithium reduces the risk of deliberate self-harm or suicide by about 70%. 

Parasuicidal. Behavior that involves self-harm without necessarily the intent to die. 

Over the last decade there has been a debate as to whether SSRIs might increase the risk of suicide in certain individuals. Some patients can respond to SSRIs by becoming agitated and restless and developing symptoms that resemble akathisia. Case reports have suggested that adverse effects of this type could underlie an increased risk of self-harm and aggression. However, results from the placebo-controlled randomized trials carried out for regulatory purposes have not supported the proposal that SSRIs increase the risk of suicide of suicidal behavior. 

The UK Committee of Safety of Medicines has previously warned that paroxetine appeared to be no more effective than placebo in the treatment of depression in adolescents and might be associated with a greater risk of self harm (SEDA-28, 16). In a meta-analysis of both published and unpublished placebo-controlled trials of SSRIs in childhood and adolescent depression, only fluoxetine seemed clearly to be associated with a positive benefit-harm balance (26). The evidence of efficacy for sertraline and citalopram was doubtful, while the risk of serious adverse events was significantly increased. Additionally, for both drugs the risk of suicidal behavior was numerically increased. In regard to venlafaxine, the risk of suicidal behavior was significantly greater than placebo. 

Codependency describes what happens to the conduct of communication, the definition of roles, and the interactions between family members when the dominant power in the family becomes the substance abuser or addict. When it is the child who has fallen victim to substances, parents increasingly depend their decisions, for how to feel, what to think, and what to do, on the child s self-destructive behavior. In consequence, parents experience at least three harmful effects. 

Substance abuse or addiction partly depends on selfdestructive beliefs and self-defeating behaviors that can only begin to be corrected once harmful reliance on drugs or alcohol has stopped. 

Andersohn F, Schade R, Willich SN, Garbe E. Use of antiepileptic drugs in epilepsy and the risk of self-harm or suicidal behavior. Neurology 2010 75(4) 335-40. 

As a researcher and therapist, I also do not like the use of colloquial terms such as addict or junkie. These terms, although potentially helpful for some who find recovery in self-help programs, are not useful for everyone with a drug problem, and can be demeaning to some. In fact, some of my clients have been put off by such labels in treatment, and found them stigmatizing, and therefore potentially harmful. Besides, such terms are highly pejorative and uncomplimentary descriptions of behavior and are not diagnostically accurate terms (i.e., are not defined in the DSM-IV). I choose not to use these terms with my own clients for these reasons. 

Economists have proposed rational choice models of addictive behavior (Becker and Murphy 1988 Becker, Grossman and Murphy 1991,1994). These models characterize how consuming harmful addictive products can decrease future well-being while at the same time increasing the desire for those products in the future. Because these models consider only time-consistent agents, however, they a priori rule out the possibility of self-control problems. 

In our discussions of stationary preferences and nonstationary preferences, we analyze behavior assuming that the extent of people s self-control problems does not vary at all over time. While observed propensity to succumb to temptation can vary because of changes in the scale of temptation—and indeed it is the role of habit formation in altering these trade-offs that is the crux of the role that self-control problems play in addiction—our examination of stationary and nonstationary preferences assumes that the degree of myopia itself is constant. We now consider two examples in which p varies over time. These examples further buttress our general impression that severely harmful addictive behavior... 

Erratic behavior associated with psychiatric symptoms like these can cause violence, accidents, suicide, or harm to self or others with permanent physical and legal consequences and irreversible damage to relationships, school work, and employment prospects. Hallucinations and delusions can be terrifying, leave permanent psychological damage, and even endanger life. 

Jacobs, D. J. (1995). Psychiatric drugging Forty years of pseudo-science, self-interest, and indifference to harm. Journal of Mind and Behavior 16, 421-470. 

A variety of underlying factors can lead to self-abuse. Munchausen syndrome describes the situation wherein patients actively but surreptitiously harm themselves. These patients sometimes go to great extremes to hide this behavior and may shift methods when detection is eminent. Although the specific reasons vary for each patient, such behavior is often an attention-seeking device. 

This client is at risk of harming self or others. Antipsychotic medications are used to control this type of behavior. 

In this instance, however, that principle would be applied not to the actions of single individuals that directly harm or create an unreasonable risk of harming others, but rather to the behavior of a large group of professionals, whose self-interested actions, taken in the aggregate, undermine some key social good or item of social capital in whose preservation everyone has a long-term interest. 

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