GPAtlas🧭 When to suspect
Self-harm is defined by NICE as intentional self-poisoning or self-injury, irrespective of the apparent purpose. The definition deliberately spans acts with and without suicidal intent, and excludes repetitive, stereotyped behaviour such as head-banging. Suspect it in any patient with signs of self-inflicted injury or poisoning, whatever their stated motivation – and remember that, for most people, self-harm is a way of coping with overwhelming emotional distress rather than an attempt to die.
It is commonest in adolescents and young adults, with onset often between 12 and 14 years; the UK has among the highest rates in Europe, and around one in five adolescents report having self-harmed at some point. The single most important fact for primary care is that non-fatal self-harm is the strongest risk factor for later suicide, raising risk many-fold – so every episode warrants careful, compassionate assessment in its own right.
The GP is pivotally placed. Roughly 45% of people who die by suicide have seen their GP in the month beforehand, and escalating or more-than-monthly consultations are themselves associated with rising risk. The two core primary-care skills are therefore to assess intent and immediate safety without relying on risk-scoring tools, and to respond to the distress behind the behaviour while keeping the person physically safe.
| Higher-risk group or context | Note |
|---|---|
| Adolescents and young adults | Commonest age group; onset often 12–14 years. |
| Previous self-harm | The single strongest risk factor for later suicide. |
| Coexisting mental illness | Depression, anxiety, emotionally unstable personality disorder (EUPD), bipolar disorder, psychosis, eating disorders, post-traumatic stress disorder (PTSD). |
| Neurodevelopmental conditions | Attention deficit hyperactivity disorder (ADHD) and autism – impulsivity and difficulty regulating emotion. |
| Substance misuse | Alcohol and recreational drugs lower the threshold and impair judgement. |
| Recent psychiatric discharge | A high-risk period for both self-harm and suicide. |
| Older adults | Lower frequency, but higher suicidal intent and lethality. |
| Psychosocial stressors | Bullying, abuse, domestic violence, relationship breakdown, bereavement, debt or housing crisis, isolation; LGBTQ+ and other marginalised groups are at higher risk. |
Source: NICE NG225 · NHS
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