Self-injurious behaviors

Abstract One of the most challenging patient presentations in correctional settings is self-injurious behavior (SIB). Approximately 2% of individuals incarcerated in state and federal prisons self-injure each year. Almost all prisons report at least weekly SIB incidents, and 98% report housing at least one individual who has engaged in self-injury. The most common psychiatric conditions associated with SIB include psychotic, personality, cognitive, and mood disorders, along with histories of trauma, anxiety, and substance use. Environmental factors play a key role in SIB in jails and prisons. Self-injury can return a degree of control and autonomy to incarcerated persons who otherwise have limited means to affect their environment, cope with stress, or communicate their unmet wants and needs. Effective treatment and management of self-injurious behaviors in correctional settings requires partnership and cooperation among health care and custody staff. This chapter provides an overview of SIB, including its epidemiology, as well as best practices for assessment, management, and treatment in jail and prison settings.