More Mental Health Care Urged for Kids Who Self-Harm

FRIDAY, May 25 (HealthDay News) — Doctors have long known that
some kids suffering severe emotional turmoil find relief in physical
pain — cutting or burning or sticking themselves with pins to achieve a
form of release.

But researchers now are questioning whether enough is being done to
reach out to these young people and help them before they do themselves
irreparable damage.

One study this year found that six of every 10 adolescents who went to
an emergency room for treatment after harming themselves were released
without receiving a mental health assessment or any follow-up mental
health care. The findings were reported in the February issue of the
Journal of the American Academy of Child Adolescent
Psychiatry
.

“Most young people who self-harm suffer from some underlying
psychological disorder,” said Jeffrey Bridge, a researcher with the Center
for Innovation in Pediatric Practice at Nationwide Children’s Hospital in
Columbus, Ohio, and the study’s lead author. “It’s critical to conduct a
mental health assessment in addition to the evaluation of their physical
health if we’re to get to the root of their problems.”

Between 8 and 10 percent of all adolescents are believed to engage in
some form of self-injurious behavior, Bridge said.

These children cut themselves with sharp edges, burn themselves with
matches, stick needles into their skin or under their nails, or perform
other acts of self-mutilation.

“I had one little boy that had one whole quarter of his head, he’d
pulled out all the hair,” said Mary Curran, executive director of Catholic
Family Services in Crestwood, Mo., and a psychologist who specializes in
self-harming behaviors.

Kids most often hurt themselves like this to deal with emotional
problems such as stress or depression.

“It helps them deal with their feelings,” Curran said. “It’s a
distraction for them. It’s usually to give them something else to think
about and something else to do with their hands.”

There are other reasons, too, said Dr. Stephanie Sims, a psychiatrist
with the University of Florida College of Medicine in Jacksonville. Some
hurt themselves to get attention, others because they’re angry with
themselves or because it helps them resist suicidal impulses. Some even
hurt themselves to feel the “high” that comes with the body’s release of
hormones in response to pain signals.

The best treatment for kids who self-harm is to deal with their
underlying emotional problems, experts say. “The key component of any
intervention would be treatment of the underlying psychopathology,” Bridge
said.

That’s why it is crucial that emergency rooms identify adolescents
engaging in self-harming behaviors and get them therapeutic help, he
said.

Once identified, kids can be treated using such psychotherapeutic
techniques as cognitive-behavioral therapy, Sims said. They also can
receive pharmaceutical help through medications such as antidepressants
and anti-anxiety drugs.

But unfortunately, Bridge said, the culture at most hospitals works
against kids getting help during those crucial interactions at emergency
rooms.

“Previous research indicates some hospitals and emergency departments
have no access to mental health professionals,” he said. “Also, staff will
often minimize the seriousness of self-harm, especially if patients have
presented in the recent past.”

That makes it all the more important that parents pay attention to
potential warning signs. These include:

  • Kids wearing unseasonably warm clothes that cover their bodies. “That
    could tip you off that there’s something on the child’s body that they’re
    trying to hide,” Sims said.
  • Unusual cuts, scrapes or bruises on an adolescent’s body.
  • Expressions of anxiety, depression or hopelessness.

“It can be difficult,” Curran said. “Kids are pretty sneaky about how
they do that. It’s very difficult for parents to catch it.”

Sims recommends that parents who think they see warning signs approach
their kids with “respectful curiosity.”

“Ask them what is cutting doing for them,” she suggested. “What do they
get out of it? Ask about suicide, but don’t assume that they are suicidal.
Let them know you want to help improve their coping skills so they don’t
have to use cutting as a way to deal with their emotions.”

More information

The KidsHealth website of the Nemours Foundation has more on cutting.

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