3.9.11 Self-harm and suicidality
Self-Harm and Suicidality
Self-harm and suicidality are significant public health problems that are associated with significant psychological, social, and economic costs. They are complex phenomena that involve multiple biological, psychological, and environmental factors. Understanding the neurobiology of self-harm and suicidality is essential for the development of effective prevention and treatment strategies (Mann, 2003).
Self-harm is described as the deliberate act of causing harm to oneself. People who self-harm frequently don’t inform their family or friends about it and inflict their injuries in places they can conceal. Most persons who injure themselves do not intend to commit suicide. Self-injury, another term for self-harm, is non-suicidal self-injury.
The neurobiological basis of self-harm and suicidality is thought to involve the interaction of several key brain systems, including the serotonergic, dopaminergic, and noradrenergic systems. Abnormalities in these systems have been linked to self-harm and suicidality in various studies.
| Neurological basis: | System: |
| Serotonergic system | The serotonergic system is involved in regulating mood, appetite, sleep, and impulse control. Serotonin deficiency has been linked to an increased risk for self-harm and suicidality, and serotonin-based treatments, such as selective serotonin reuptake inhibitors (SSRIs), are commonly used to treat individuals with suicidal behaviour. |
| Dopaminergic system | The dopaminergic system is involved in regulating motivation and reward. Abnormalities in the dopamine system, including dopamine receptor function, have been linked to self-harm and suicidality, and dopamine-based treatments, such as atypical antipsychotics, have been found to be effective in reducing suicidality. |
| Noradrenergic system | The noradrenergic system is involved in regulating arousal and stress responsiveness. Abnormalities in the noradrenergic system have been linked to increased risk for self-harm and suicidality, and noradrenergic-based treatments, such as tricyclic antidepressants and beta-blockers, have been found to be effective in reducing self-harm. |
(Oquendo, 2004), (Rinne, 2002), (Dwivedi, 2010).
In addition to these key brain systems, research has also suggested that the integration of multiple levels of analysis, including genetic, epigenetic, brain imaging, and behavioural data, can provide a more comprehensive understanding of the neurobiology of self-harm and suicidality.
In conclusion, the neurobiology of self-harm and suicidality is a complex and multi-faceted phenomenon that involves the interaction of several key brain systems. Further research is needed to better understand the underlying mechanisms and to develop effective treatments for individuals who engage in self-harm and suicidality.
Behavioural signs:
Avoid engaging in activities that expose the body, such as swimming, and dress inadequately for the weather, such as by wearing long sleeves in the summer.
Psychological signs:
Expressing anxious feelings
Exhibiting depressive feelings
Suicidality:
When someone kills themselves intentionally in an attempt to end their life, it is considered suicide.
When someone makes an effort to commit suicide but does not succeed, they have attempted suicide.
When discussing suicide and suicide attempts, avoid using words like “committing suicide,” “successful suicide,” or “failed suicide,” as these expressions frequently have negative connotations.
There are several warning signs that someone may be at extreme risk of trying to commit suicide.
- Expressing a desire to end one’s life or commit suicide.
- Talking about feeling stuck or believing there are no solutions talking about feeling empty, hopeless, or having no reason to live.
- Having excruciating bodily or emotional anguish.
- Expressing concerns about burdening others.
Suicide affects everyone equally. Risk can apply to people of all sexes, ages, and races. Suicidal behaviour is complicated, and no one factor causes it.
The primary suicide risk factors are:
- Depression, other mental illnesses, or an addiction
- Enduring pain
- Previous suicide attempts
- Family history of substance abuse or mental illness
References:
(1) Mann, J. J. (2003). Neurobiology of suicide and suicide prevention. CNS spectrums, 8(12 Suppl 15), 9-14.
(2) Oquendo, M. A., Galfalvy, H. C., Russo, S., Ellis, S. P., Grunebaum, M. F., Burke, A. K., … & Mann, J. J. (2004). Association of low neurotransmitter metabolites in cerebrospinal fluid with increased risk for completed suicide in patients with major depressive disorder. American Journal of Psychiatry, 161(3), 578-585.
(3) Rinne, T., de Kloet, E. R., & Wouters, L. (2002). Role of mineralocorticoid and glucocorticoid receptors in stress-related limbic activation. Neuroscience & Biobehavioral Reviews, 26(4), 365-384.
(4) Dwivedi, Y. (2010). Altered brain-derived neurotrophic factor signaling pathway in suicide brain: role of protein kinase A. Journal of Psychiatric Research, 44(14), 930-938.