Therapy - Part V in Self-Injury series

The Rock Creek center still offers an inpatient self-injury management program and can be reached at 1-800-669-2426.

Treatment efficacy In a 1998 review, Hawton et al. evaluated the effectiveness of ten different approaches to treating self-harm: problem-solving therapy, a special emergency room card getting the patient faster treatment in the ER, intensive education and outreach, and dialectical behavior therapy were compared to standard aftercare; inpatient behavior therapy was compared to inpatient insight-oriented therapy; admission to the hospital was compared to discharge after the ER visit; flupenthixol (fluanxol, an antipsychotic drug not available in the US with severe potential side-effects) and antidepressants were each compared to placebo; followup by the initial treating therapist was contrasted to followup by a different therapist; and long-term therapy was compared with short-term therapy. They found no significant difference in % of repeaters who were in the long-term vs short-term therapy trials, the antidepressant vs placebo trials (which used mianserin, a drug that increases serotonin in the brain, and nomifensine, a dopaminergic drug that has serious side effects and is no longer available), the intensive intervention/outreach vs standard aftercare trials, the emergency card trials, and the hospital admission vs discharge trials and the (possibly too small to yield a significant effect) inpatient behavior vs insight-oriented therapy studies.

The problem solving studies showed a distinct reduction in SI among those who got problem-solving therapy, but the results of combined studies did not reach statistical significance. The flupenthixol study showed significant reduction in repeat self-harm, but it was a very small study and there is some concern that the possible side effects of fluanxol outweighed any benefit.

The two trials showing a significant decrease in repeat self-harm among the experimental group were the DBT studies (the DBT group has fewer repeaters) and the same vs different therapist doing followup (the % of repeaters was higher in the group that saw the same therapist).

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