Personalised Interventions for Self-Harm in High-Risk Adolescents: A Case Report

Self-harm in adolescents is a complex clinical challenge often driven by profound emotional dysregulation and complicated by trauma history. This report describes the case of a 14-year-old female patient with a history of sexual abuse, post-traumatic stress disorder, and major depressive disorder, who was repeatedly hospitalised for severe self-inflicted wounds. Despite multiple hospitalisations following suicide attempts and low initial motivation for psychotherapy, a multidisciplinary team implemented a modified therapeutic approach. Due to the patient’s inability to participate in high-intensity dialectical behaviour therapy (DBT), a customised harm-reduction strategy was employed, featuring formal behavioural agreements, environmental controls, and a tangible reward system. The core component of this approach was a structured behavioural agreement, which was formulated by the clinical team, the patient, and her mother, to maintain environmental control and promote transparency. This intervention focused on stabilising wound severity and improving transparency rather than immediate cessation. Over the course of treatment, this individualised strategy led to a significant reduction in self-harm frequency, improved treatment adherence, and served as a clinical bridge towards more intensive therapeutic engagement. The case suggests that for high-risk adolescents with fluctuating motivation and treatment nonconformity, customised harm-reduction and modified DBT-informed strategies can effectively manage immediate risk while fostering long-term recovery.