Harakiri: a clinical study of deliberate self-stabbing.

BACKGROUND: Stabbing is an uncommon method of self-harm that has not been previously described in the psychiatric literature. The aim of this study was to describe the clinical features and management of patients presenting with self-inflicted stab injuries.
METHOD: Case notes of all patients presenting with deliberate self-inflicted injuries during a 2-year period to a teaching general hospital were screened to identify the sample of interest. Clinical data were then collected by means of a detailed case-note study.
RESULTS: Ten patients who deliberately stabbed themselves were identified. The patients fell into two distinct clinical groups: the first consisted mostly of young men with antisocial personalities who were intoxicated at the time of the self-stabbing and who reported ambivalent suicidal intent; the second consisted of psychotic patients, most of whom were actively ill at the time of the self-stabbing, and who reported clear suicidal intent. Patients in the first group were noncompliant with treatment and difficult to engage; those in the second group needed psychiatric hospitalization and often responded to antipsychotic medication.
CONCLUSION: Persons who stab themselves tend to fall into two clinical groups that have different diagnoses and management. Distinctions between violent suicidal behavior and self-mutilation are blurred because suicidal intent can be difficult to assess.