Healthy Living: Self Injury in Children
By: Dr. Anthony Ng A phenomenon that occurs in many children is the act of self injury. Such self injury will come in various types. It may range from cutting self to hitting oneself. In a recent article from the journal Pediatrics from the American Academy of Pediatrics, it was revealed that 8% of 665 survey youths had engaged in some form of self injurious behaviors. These youths range in age from 7 to 16. Almost 8% of third graders had engaged in some form of self injurious behavior at some point, vs. 4% for sixth-graders and 12.7% for ninth-graders. Ninth-graders girls were three times more likely then boys to engage in self injuries. Self injury is characterized by a child or an adolescent cutting self, often superficially, on their extremities, such as their arms and legs. They would use knives, razor blades, pen or pencils, paper clips, etc. Other modalities may include punching objects, burning oneselves or hitting their heads repeatedly. In most instances, the intent on the part of the child is not to kill himself or herself. Often, such behavior is a response to stressful situations and negative emotions. They would describe that they are cutting to reduce some psychological pain they are having. Many of these self injuries are NOT suicide attempts, though they may inadvertently lead to greater harm and even risks of death accidentally. It is unclear why a person, especially a child, will inflict pain on themselves to relieve another unpleasant and distressful feeling. It is interesting that other species of animals do engage in similar self injuries in their relief of discomfort. For example, cats and dogs will lick and chew their bodies until they have wounds. There are medical conditions that may lead to self injuries in children and adolescents. Lesch-Nyhan Syndrome is a genetic condition that may lead to some horrific self injuries in children with this disorder. However, in most instances, children and adolescents usually have some sort of psychological distresses who engage in such self injuries. All children like adults are subjected to very powerful emotions with the ability to experience extreme fear and worries. Unlike adults, often children may not have learned a wide array of coping skills or social support to help them cope with such extreme emotions. Children and adolescents who engage in self injurious behaviors may have numerous scars on their bodies. They may also have evidences of other injuries, such as contusions or burnt marks. They may not be able to provide a good explanation for these wounds. More often, the person who self injures often does it in private and may keep their injuries hidden, especially with cutting and burning. They may wear long sleeves or have reluctance to wear shorts or any clothing that may expose scars from past injuries. In addition to these physical signs, the child may also have depression, mood swings, academic difficulties and relationship troubles with family and friends. For some, there may also be evidence of substance abuse issues and some extreme risk taking behaviors. The reason for these self cutting ultimately is complex, with numerous biological and environmental factors. As such, the treatment for such behavior in children is also complex and may include many modalities. The most important intervention is open communication between parents and their children. When parents first learn that their children are cutting, they may be quite stressed by it and take their children to emergency rooms. Unless the injuries are extremely serious, emergency room interventions are likely not the best initial treatment for the children. Parents should not fear that by discussing with their child, the behavior will be increased. Parents need to be direct with their children and let them know that they are there to talk and not force children to talk if they are not ready to do so. They should encourage this communication as being safe for their children and that they do not fear punishment from their parents. For more professional intervention, psychotherapy is often the first treatment of choice. Both individual and group psychotherapies can help children identify what troubles them. Psychotherapy can help children gain and increase their self respect and self esteem. Psychotherapy can help identify triggers for self injurious behavior and help them to develop other types of appropriate coping skills. For example, an often used intervention is a rubber band that the child will snap on their wrists when they have urges to cut. Medication, such as antidepressants, anti-anxiety medication and mood stabilizers, may be helpful if there are significant anxiety or depression that warrants such treatment. In some severe cases, brief inpatient psychiatric treatment may be necessary.The emotional health of children can be a strong determinant of their adult emotional health. Thus, it is important that there be early identification and treatment for such self injurious behavior by parents and guardians to ensure a successful outcome for their children.