Tracy, DK; Shergill, SS; David, AS; Fonagy, P; Zaman, R; Downer, J; Eliott, E; Tracy, DK; Shergill, SS; David, AS; Fonagy, P; Zaman, R; Downer, J; Eliott, E; Bhui, K; - view fewer (2015) Self-harm and suicidal acts: a suitable case for treatment of impulsivity-driven behaviour with repetitive transcranial magnetic stimulation (rTMS). BJPsych Open , 1 (1) pp. 87-91. 10.1192/bjpo.bp.115.000315.

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Abstract

Globally, an estimated 5% of adults will attempt suicide at some point in their life1. Suicidal thinking and self-harm occur with many mental states and include passive neglect, putting oneself in risky situations, and many types of self-harm with varying combinations of intent and threat to life. Inevitably such a spectrum makes determining prevalence rates difficult, but typical figures estimate self-harm occurs in up to about one fifth of adolescents2 and over half of psychiatric inpatients3. A helpful way of explaining self-harming is to invoke the diathesis-stress model that proposes genetic, developmental, and temperamental factors constitute a diathesis disposition; whilst acute environmental, social, and psychological factors are situational stressors4. Gender, age, ethnicity and religion5,6, early-life7 and recent adverse events8 are associated factors in suicidal thinking and acts. Problematically most of the identified risks are common, non-specific, and of themselves reasonably weak predictors of completed suicide9-13. However self-harm itself is a strong predictor of future such behavior; it predicts adverse outcomes in adolescents14; 16% of adults repeat self-harm within a year (2% fatally so) and 7% die by suicide within nine years15. There is a need to move beyond descriptive epidemiology to understand the mechanisms behind self-harm and suicidal acts16. They are associated with high-risk decision-making, self-criticism, sensitivity to social disapproval, and an inability to use memory and reflection about alternative positive outcomes of a stressful situation. Neuropsychological work implicates deficits in impulse control and curtailment of aggression17-20, executive functioning, and emotional and affective regulation21. These mechanisms are found in many mental illnesses and are thus considered as pan-diagnostic explanations for the emergence of suicidal acts and thinking4

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