Comportamentos autolesivos: Que relação com os comportamentos suicidários? = Deliberate self-harm: What relationship to suicidal behaviours?

Os Comportamentos Autolesivos (CAL) e as Tentativas de Suicidio (TS) nos jovens sao um grave problema de saude publica. Os CAL sao destrutivos, auto-dirigidos e deliberados, caracterizando-se por danos fisicos que podem ou nao ter intencao suicida e que metacomunicam um estado de sofrimento psicologico. Nesta comunicacao, temos dois objectivos: 1) Tentar responder a controversia sobre a relacao teorica entre os CAL e as TS, ou seja, se estes dois fenomenos sao independentes ou se estao relacionados e, no caso de estarem relacionados, de que forma isso acontece. 2) a) Analisar os conteudos das narrativas experienciais dos adolescentes sobre os CAL e b) Comparar estas narrativas com as narrativas dos respectivos pais. Foram realizados dois estudos, um estudo de natureza quantitativa, com 500 adolescentes, para responder ao 1o objectivo e um 2o estudo de natureza qualitativa, para responder ao 2o objectivo, com 438 adolescentes com CAL e 56 pais. No 1o estudo verificamos que a maioria dos adolescentes que realizou TS tambem realizou CAL. Verificamos tambem que entre alguns factores de risco, como por exemplo a depressao, a ansiedade e a ideacao suicida, o factor de risco mais determinante para as TA e a diversidade dos metodos dos CAL utilizados pelos adolescentes. Estes dados permitem-nos colocar como hipotese que os CAL podem representar uma porta de entrada para os comportamentos suicidarios. No 2o estudo, os adolescentes referiram diversas narrativas ligadas as emocoes, algumas das quais ligadas as TS. Verificamos tambem uma assimetria de emocoes entre os adolescentes e os pais. As investigacoes sobre os CAL tem dado pouca importância as emocoes, que estao subjacentes aos CAL. Ora, no trabalho clinico as emocoes sao extremamente importantes, nomeadamente trabalhar o controle e a gestao das suas emocoes de modo a evitar a passagem ao acto. Deliberate Self-Harm (DSH) and suicide attempts (SA) in young people are a serious public health problem. DSH are destructive and self-directed behaviours, characterized by physical damage that may or may not have suicidal intent and that metacommunicates a state of psychological suffering. In this communication, we have two objectives: 1) To try to respond to the controversy about the theoretical relationship between DSH and SA, that is, if these two phenomena are independent or if they are related and, if they are related, in what way this happens. 2) a) To analyze the contents of the adolescents' experiential narratives about DSH and b) To compare these narratives with the narratives of the respective parents. Two studies were carried out, a quantitative study to answer the 1st objective, with 500 adolescents; and a 2nd qualitative study to answer the 2nd objective, with 438 adolescents with CALs and 54 their parents. In the first study, we found that the majority of adolescents who presented SA also presented DSH. We also found that among some risk factors, such as depression, anxiety and suicidal ideation, the most important risk factor for SA is the diversity of DSH methods used by adolescents. These data allow us to hypothesize that DSH may represent a gateway to suicidal behaviour. In the 2nd study, the adolescents referred to several narratives related to emotions, some of which were related to SA. We also verified an asymmetry of emotions between adolescents and their parents. Investigations about DSH have given little importance to emotions, which underlie these behaviours. However, in clinical work, emotions are extremely important, namely working on the control and management of emotions in order to avoid acting out. Palavras-chave / Keywords: Comportamentos Auto-lesivos, Metodos, Tentativas de suicidio, Narrativas, Emocoes. Deliberate self-harm, Methods, Suicide attempt, Narratives, Emotions.