Selvskading – hva gjør vi?

Abstract

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. 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. 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. Self-harm in adolescents is a large public health problem that needs to be taken seriously through early identification, assessment and treatment.