Delicate wrist cutting behaviour in adult psychiatric patients: A review

Abstract

An accurate figure for the incidence of delicate wrist cutting in adult psychiatric patients is not available since the few studies that have been undertaken have not attempted to differentiate between the types of deliberate self harm. Ail that can be deduced from these and other studies like them is that between 1.6% and 3.4% of adult psychiatric patients engage in some type of deliberate self harm. Delicate wrist cutting, a term introduced by Pao (1969), is a low lethality form of non-fatal deliberate self harm and, unlike suicide, the adult psychiatric patients who engage in delicate wrist cutting report that they have no intention of killing themselves. In this review, a conceptual framework is provided within which non-fatal deliberate self harm, of which delicate wrist cutting is one type, can be understood and differentiated from other types of self-destructive behaviour. A description of the actual act of delicate wrist cutting and the clinical features often reported throughout the literature as being associated with it is presented. A behavioural-based treatment programme is outlined for dealing with the problem of delicate wrist cutting in adult psychiatric patients. The suggested treatment aims at breaking the chain of events frequently reported as being antecedent to the actual act of delicate wrist cutting. By intervening at crucial points within this chain, the aim is to prevent the patient from engaging in repeated episodes of delicate wrist cutting.