Working in an emergency room, you quickly learn that self-harm cases are far more common than most people would ever guess.

Many patients have a prior psychiatric history, but it’s equally common to see people with none at all — individuals who acted in a single moment of unbearable emotion. And every time, I’m reminded of the same thing: self-harm is never just one thing. It comes in many forms — overdose, lacerations, hanging, falls — and the outcomes are just as varied.

Overdose — More Common Than You’d Think, and More Dangerous

Overdose cases come in nearly as often as lacerations. The most common scenario is psychiatric medication overdose. Because many of these drugs carry sedative properties, patients typically arrive barely conscious.

The more dangerous cases, however, are the ones that don’t involve psychiatric medications at all. Overdosing on antihypertensives or diabetic medications may not raise immediate alarm, but these cases frequently escalate into something far more critical. The same goes for chemical ingestion — pesticides, bleach, corrosives. The scale and speed of organ damage operate on an entirely different level.

Treatment depends heavily on antidotes, but the reality is that clear, targeted antidotes exist for only a small fraction of substances. Most cases default to symptomatic management — treating each complication as it surfaces. When vital signs deteriorate or organ damage becomes a serious concern, hemodialysis may enter the picture.

Lacerations — What You See Isn’t the Whole Story

Self-inflicted lacerations most commonly involve cuts to the wrist or upper arm, though injuries from punching through glass aren’t uncommon either.

Wounds that stay superficial can be sutured and closed on the spot. But the arm’s anatomy tells a different story. Tendons, vessels, and nerves run much closer to the surface than most people realize — close enough that a wound appearing routine on presentation can turn out to require surgery. What looks clean on the outside can be significantly more complicated beneath it.

Hanging — Whether the Feet Touched the Ground Changes Everything

When assessing a hanging patient, one of the first things I confirm is whether their feet were fully suspended or whether they maintained some ground contact, allowing partial weight-bearing. That single variable can dramatically shift the prognosis.

More decisive, though, is time. The brain starts dying within minutes of oxygen loss. Patients found quickly have a fighting chance. But those who weren’t — or who arrive in cardiac arrest — face a far grimmer reality. Even when CPR works and the numbers stabilize, the best realistic outcome can still be permanent disability: a life measured in assisted breaths and caregiver hours.

That burden then lands entirely on the family. Anyone who has witnessed it up close understands the weight of that without needing it explained.

Falls — When Confirming Death Comes Before Resuscitation

Falls in this context are rarely from low places. Patients who arrive in cardiac arrest are frequently assessed as non-survivable from the outset. In cases where resuscitation is attempted — sometimes because external injuries appear deceptively minor — imaging later reveals the truth: intracranial hemorrhage, pelvic fractures, catastrophic internal blood loss. The body doesn’t always show what it’s been through.

Among fall cases, those involving water — rivers, open water — carry marginally better odds, largely because the impact is partially absorbed on entry.

Even when resuscitation succeeds, significant long-term disability is common, placing the same prolonged weight on families that we see following hanging survivors.

Doctors Are Human Too

When a self-harm patient arrives, the emotional toll on the team is real — and the workload is rarely light. There are shifts where it honestly feels like too much.

I struggled with it early on. Every case used to land differently. These days I can manage — though I’m still not entirely sure whether that reflects experience gained or something quietly numbed over time.

What I do know is that something has shifted. Early in my career, I focused on the injury: treat it, stabilize, refer to psychiatry. Now, when the patient is ready to talk, I ask why. I try to understand what brought them to that moment, and I offer what little I can — a few words, sometimes just a question about what comes next. It might seem like a small thing. But I’ve come to believe that being asked why can mean something to a person who felt entirely unseen.

So Why Do People Hurt Themselves?

When I’ve been able to have those conversations, the most common answer is something like: “I just couldn’t take it anymore.” An emotion that overwhelmed everything in a single instant. The second most common is quieter: “Things aren’t going to get better. They never do.”

The first group tends to fare better. As the body heals and the acute intensity fades, psychiatric care can build a bridge back to ordinary life.

The second group is harder. The body recovers, but nothing about their circumstances has changed. Medicine can treat the wound. It can’t fix a broken home, a predatory environment, or years of compounded hopelessness. That requires social support, welfare infrastructure, genuine follow-through — and whether those systems actually deliver is an entirely separate problem. In those gaps, even experienced clinicians feel the limits of what they can do.

A Final Thought — Deaths That Don’t Have to Happen

In South Korea, suicide is the leading cause of death among people in their teens and twenties — ahead of traffic accidents. Globally, suicide ranks among the top three causes of death in the same age group.

If medicine’s ultimate goal is to reduce mortality, then self-harm and suicide represent deaths that are, to a meaningful degree, preventable — not primarily through clinical intervention, but through sustained attention at the social and family level.

There’s intense national focus on birth rates and demographic decline. But if young people are dying by suicide at this rate, the loss runs far deeper than any statistic can capture. These aren’t just numbers — they are the people who were supposed to carry the next generation forward.

Every time a self-harm patient comes through those doors, I carry that thought with me. If even one person who reads this pauses to check on someone they’ve been meaning to reach out to — that’s enough.

📚 References
– WHO, “Suicide Fact Sheet”, March 2025.

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