Should i cut my wrists

I don't know I don't know that either. But I live each day as it comes and I still let it get to me. Be strong don't let depression get a hold of you. I don't see how knowing about someone's need of medication should affect anything. It makes no sense to me. My best friend's friend commited suicide this year and it was so sad. I don't think that's the right thing to do. He said he was at work, but he was at the pub getting drunk.

He used to come home drunk out of his mind and my mum and brothers used to just pack up and leave sometimes. Also, in the middle of being a teenager and everything changing so fast, I hated myself and my body. I ended up turning bulimic 'cause I thought I was fat, and I had broken up with my boyfriend. I used to slit my wrists and I still do. It's a sudden rush and helps me feel alive when nobody seems to listen. Now, my dad stopped drinking but I'm still bulimic, and my parents don't know I'm so depressed and haven't been happy in months.

I don't know where to turn. I considered suicide because of my mom. She punished me for something I never did, and I could not take it anymore, so I thought it would be the easy way out. Changing schools from junior high to the high school was a big change. I was stressed out all the time, and having a boyfriend didn't help. We always got in fights, because he didn't know what I was going through, and neither did I.

I didn't know what was wrong with me, and hated how everything was going. I started to cut myself as a way to take out my emotions on myself, and not him. In the long run though, it wasn't the right thing to do.

I am now on medication, and I'm doing much better. I hope my story helps those to get help soon, because cutting is only the beginning of a serious situation. Cutting can lead to other serious self-injuries, even suicide. She is on anti-depressants. But, thinking less of her for taking the medicine is like thinking less of a diabetic for taking insulin.

For psychiatric diagnosis and treatment, all patients who are admitted to the emergency department for attempted suicide should be assessed by a psychiatrist [ 9 ]. In addition, in order to prevent any functional impairment, an initial appropriate evaluation and proper referral are of pivotal importance.

Thus, the objective of this study was to investigate the characteristics of self-inflicted wrist injuries in a single institution and share the perspectives from a hand surgeon so that those who deal with these patients primarily in the emergency room can manage these injuries more appropriately. We investigated all self-inflicted wrist injury patients who were referred to the Department of Hand Surgery from the Emergency Medicine Department in Seoul National University Bundang Hospital from to This study was conducted as a pilot study before a prospective study in the same institution had been initiated from The patients who had skin only injuries were excluded because primary closure was performed at the Emergency Medicine Department.

Demographic data age, gender, alcohol intake, psychological state and clinical features injury side, injury pattern, anatomical structures involved, distance from wrist crease were analyzed. A psychological evaluation of all the patients was performed following attempted suicide by a psychiatrist from the Department of Psychiatry within the same institution. Patients were initially assessed in the Emergency Medicine Department and surgical treatment and postoperative wound care were performed by the Hand Surgery Department of Plastic and Reconstructive Surgery Department in the same institution.

The outpatient follow-up period was at least three months and postoperative long-term disability was evaluated. The long-term motor function was assessed by range of motion, opposition of the thumb, intrinsic function tests. Two-point discrimination test was performed in order to evaluate sensory function.

A total of 17 patients who attempted suicide by cutting their wrists were included in our study. Among the patients, four were females and 13 were males. The left wrist was involved in In Only in one case the injury occurred on the radial side of the forearm with involvement of the abductor pollicis longus and the extensor pollicis longus tendons.

The most frequently injured structures was the palmaris longus tendon The most frequently injured nerve was the median nerve The ulnar neuro-vascular bundle and the radial artery were involved only once each. Injuries of important anatomical structures are summarized in Table 1. Knife was the most common tool for suicide attempts, followed by glass Table 2.

Alcohol intake prior to suicide attempts was higher in male patients. All 4 patients with mood disorder had major depression and 2 patients with personality disorder had borderline personality disorder. Among the 8 patients with deep injuries, 6 had a history of psychiatric disorders, whereas among the 9 superficially injured patients, only 3 had a previous psychiatric diagnosis. When it comes to the long-term outcomes, 4 patients showed functional deficit in long-term follow-up period and all of these patients had nerve injuries including injuries of the median and the ulnar nerve.

Patient no. Suicide is a global public health problem that impacts individuals and society. Suicide rates have increased substantially over the past two decades. Suicide in Korea is the tenth highest in the world according to the World Health Organization, making it the fourth leading cause of death [ 3 ]. Due to increasing cases of self-inflicted wrist cutting and its low mortality rate, initial evaluation when facing this injury is the most important aspect to prevent long-term functional impairment.

Thus, we suggest appropriate evaluation and aim to share the perspectives of a hand surgeon. In this study, there were gender differences in self-inflicted wrist cutting 4 female and 13 male patients , as opposed to other studies which showed a higher proportion of women with self-cutting injuries [ 7 , 10 ]. This suggests that deep injuries involving deep flexor tendons, artery and nerve are more likely to occur in male patients.

Male wrist-cutting patients showed more extensive injuries and all patients who had deep structural injuries were also male. Furthermore, as patients with psychiatric disorder have a higher rate of recurrent suicide attempts [ 11 ], multidisciplinary approach together with the Psychiatric Department is essential in order to effectively treat these patients. Schizophrenic patients are more likely to get devastating injuries and other psychiatric disorders including depression and borderline personality disorder have a higher risk of attempted suicide [ 12 ].

Even though some patients have not been previously diagnosed with psychiatric disorders, it is likely that they have an underlying mental problem [ 13 ]. In this study, two patients with the deepest injuries Patient no. Therefore, in case of male patient who have attempted suicide by wrist cutting and who have been diagnosed with a psychiatric disorder such as schizophrenia, the high possibility of deeper injury should be considered.

Ironically, this unpredictable trauma can be one of the most predictable injuries to a hand surgeon in three ways. First of all, as there are more right-handed people who hold implements with their right hands, there is higher probability of injury to the left wrist [ 7 ], as confirmed in our study, which showed injuries to the left wrist in Secondly, almost all patients have flexor side injuries 16 patients with injuries of the flexor side and one with injury of the radial side.

Wrist flexor tendons were the most frequently injured anatomical structures because they are located close to the skin surface and therefore more likely injured. As can be seen through the results of this study, The author drew an axial anatomy of the left wrist focusing on the most common injury site Fig. Arterial bleeding from both the radial and the ulnar side on the wrist indicates the high probability of structural injuries in intentional self-cutting [ 15 ].

Similarly, injury of the radial artery is often accompanied by an associated injury of the flexor carpi radialis tendon Patient no. Thus, we should keep in mind the possibility of accompanying structural injuries if arterial bleeding is suspected in the patient. Axial anatomy of left wrist of the most commonly injured level. When we consider the type of implements used and mechanism of injuries, they can be classified into cutting wounds and stabbing wounds [ 9 ].

From an anatomical perspective, cutting wounds can be considered as horizontal injuries and stabbing wounds as vertical injuries. In terms of the implements used, Knife was the most common tool for suicide attempts, followed by glass.

In cases of injuries caused by cutter and razor, they were all horizontal injuries, whereas in case of injuries caused by glass or scissors, vertical injuries were observed. Injuries by knife could be of both injury types, but cutting wounds were more common 8 cases of horizontal injuries and 1 case of vertical injury.

Especially, if the patient has vertical injury on their wrists, more attention should be paid to the motor and sensory evaluation. In case of Patient No. At initial examination, no specific functional deficits were detected and the patient was treated with primary wound closure in the emergency department. At further examination in our outpatient clinic, indication to surgical exploration was given: intraoperatively injuries to the 4th flexor digitorum superficialis and profundus tendons were detected and repaired.

Since this kind of injury is often inconspicuous, proper evaluation is necessary depending on the mechanism of injury and implements used.

Especially, when vertical injury is suspected, it is important to check the injured area through proper exploration. As mentioned above, initial evaluation and proper treatment are the most important in the prevention of long-term functional impairment.

Accordingly, it would be helpful to undertake a proper evaluation in order to understand the axial anatomy schematically at the level where wrist cutting injury occurs most commonly. From the point of view of an initial examiner, not a hand surgeon, it is one of the best ways to estimate the possibility of structural injury by using the palmaris longus tendon, which is the most prominent structure on the flexor side, as an anatomical landmark Fig.

We noted that deep layer injuries, the worst in the three-layered taxonomy, were significantly less common in self-cutting patients than in the other two groups. Therefore, in the current study, we classified anatomical injuries dichotomously. We created a virtual line on the anatomy of the wrist, immediately above the median nerve, to examine the relationship between various patient-related factors and the severity of the wrist-cutting injury.

If structures beneath this virtual line were damaged, the injury was classified as deep, while injuries to anatomical structures located above this virtual line were classified as superficial. The rationale for this classification was that injury of neurovascular structures, including the ulnar artery and radial artery, can lead to critical self-harm.

Skin-only injuries with subcutaneous fat exposure were considered to be the most minor. We simplified the anatomy of the wrist structures in a schematic manner and the relative location of each structure was drawn according to the study by Lee et al. Injuries were dichotomized as deep or superficial based on their location relative to a virtual line running immediately above the median nerve.

In accordance with the study by Lee et al. The deep layer comprised structures 8—16, which correspond to the radial artery, flexor pollicis longus, median nerve, second flexor digitorum profundus 2-FDP , 3-FDP, 4-FDP, 5-FDP, ulnar nerve, and ulnar artery, respectively. As we categorized the severity of wrist injuries according to three levels skin only, superficial, and deep , the relationships of various factors with severity was evaluated using the linear-by-linear association test.

The sex ratio was compared to the cumulative population of Seoul during the study period — [ 7 ]. The sex ratios for incidence and repeated wrist cutting were evaluated using the chi-square test. The mean ages of men and women were compared using the independent t-test.

This study included patients who had cut their wrists for the purpose of self-harm, of whom 42 patients Women were significantly younger than men mean age, Alcohol consumption and drug abuse prior to wrist cutting were examined in all patients. Fifty-one patients In cases involving drug intoxication, the most common drugs used were prescription pills e.

In one case, a patient consumed a pesticide 50 mL of cypermethrin that was prepared in advance with the intention of committing suicide. Of the patients, 47 In total, 47 patients For patients who declined psychological counseling, we made several recommendations that they receive psychiatric care through the SPI.

The most adherent patient completed 10 SPI sessions. Twenty-six patients Of the 22 patients who had engaged in wrist cutting repeatedly, 19 The vast majority of patients patients; In addition, patients One patient performed amputation after cutting her wrist for 3 hours. In total, 82 patients None of the patients died.

Thirty-three patients had injured at least one anatomical structure of the wrist. The number of patients who injured each anatomical structure of the wrist are listed in Table 3.

The patient who performed amputation was counted once in all cases. The most commonly injured structure was the PL, which was injured in 24 patients The most commonly injured structure in the deep layer was the median nerve, which was injured in 10 patients Previous studies have pointed out the protective role of some tendons against neurovascular injuries [ 5 , 6 ]. Specifically, those studies indicated that the FCR functions as an important protective barrier for the radial artery, and the PL exhibits a similar effect for the median nerve.

In our study, all five patients with radial artery injuries had FCR injuries and all 10 patients with median nerve injuries had PL injuries; therefore, our findings validate the proposal that tendons are protective structures. Of the patients, three refused treatment for the wound, while received skin repair.

Tenorrhaphy was performed in 26 patients Neurorrhaphy, arteriorrhaphy, and venorrhaphy were performed in 13 Fascia reconstruction and nerve sheath reconstruction were performed in two patients each, with an acellular dermal matrix used to improve the prognosis.

Replantation surgery was conducted in the patient who performed amputation. Attempted suicide by wrist cutting is a major social problem, accounting for a large proportion of cases of upper extremity trauma presenting to the emergency room. Hence, many epidemiological studies have been conducted from a psychiatric perspective to examine the clinical features of self-inflicted wrist cutting [ 1 - 3 ].

Our results are consistent with those of previous studies on this topic. In addition, most patients who had engaged in wrist cutting repeatedly were women Table 1 [ 8 , 9 ]. Several studies have examined the relationship of suicide with substance use, one of which showed an association between alcohol consumption and suicide [ 10 ]. However, in the current study, alcohol consumption and substance abuse did not increase the severity of the injury or the risk of mortality in wrist-cutting patients.

In a study examining the epidemiology of wrist cutting in psychiatric inpatients, the proportion of patients with schizophrenia In contrast, most patients in the current study with a psychiatric history had mood disorders 36 patients; A large number of patients wanted only surgical treatment for their injuries, and they commonly considered their psychiatric disorders minor.

Our institution has shown that it is possible to improve the continuity of patient counseling by managing patients through psychiatric treatment program such as our SPI.

Our study is highly meaningful as the first study conducted in Korea to examine the psychological aspects of wrist cutting, and our findings indicate that repetitive wrist cutting can be prevented by ensuring regular contact with patients so that they continue to receive psychiatric consultations. Thus, physicians treating wrist-cutting patients should be well-informed regarding the epidemiology and psychologic features of these patients and should encourage them to receive subsequent psychiatric counseling as well as surgical treatment.

In the few studies that have examined wrist injury patterns, PL and median nerve injuries were significantly over-represented in self-cutting injuries than in other wrist injuries without suicidal intention [ 5 , 6 ].

Likewise, our study showed that PL injuries were the most common anatomical structure injuries Therefore, we emphasize that surgeons should carefully examine the structures that are most likely to be damaged after detailed history-taking in wrist-cutting patients. Likewise, in our study, the protective roles of the PL against median nerve injury and of the FCR against radial artery injury were confirmed.