Treating Self-Harm in Children and Adolescents
What is considered self-harm?
Michigan State University College of Human Medicine Department of Pediatrics and Human Development Professor Donald Greydanus, M.D. defines deliberate self-harm (DSH) as “a behavior in which a person commits an act with the purpose of physically harming themselves with or without a real intent of suicide” in his article “Treating Self-Harm in Children and Adolescents: A Complex Conundrum for the Clinician.” He states that youths use a variety of DSH methods, with the most common being cutting, poisoning, overdosing, scratching, and biting.1 Research has shown that non-suicidal DSH in adolescents reflects upon underlying feelings of hopelessness and low self-esteem, with contributive factors including relationship statuses with peers and family. Over time, stress can build within an adolescent, and they may resort to self-harm when they have reached their personal threshold or when an uncontrollable impulse is “switched on.”1 Greydanus defines “switching on” as “the phenomenon of dissociation during the self-harm act and an uncontrollable need for more deliberate harm.”1 DSH provides relief for the child or adolescent, releasing inner tension and pain.
Why do youths perform self-harm acts?
Youths who perform DSH state that they feel intense efforts to avoid suicidal thoughts, self-anger or self-disgust, distress, and dissociation. Oftentimes, DSH is linked to a mental health disorder, such as depression, substance abuse, eating disorder, schizophrenia, or personality disorder; however, the type of DSH behavior does not predict the degree of underlying psychopathology.1 Still, all youths with DSH should be evaluated carefully for suicide risk. When the underlying factors of DSH are not addressed, the acts of self-harm can become repetitive and more severe over time. Depression and risk of suicide may also increase, as nearly five percent of patients who are taken to an emergency department for self-harm commit suicide within a period of nine years from the self-harming incident.
According to Greydanus, DSH is common in individuals with intellectual disability, occurring in 10 percent of children and adolescents with such, a conundrum that is difficult for clinicians to understand and therefore address.1 It is believed that it is part of overall aggressive behavior that is meant to be directed at themselves or others, resulting in self-harm. Oftentimes, self-harm within this population takes the form of skin-picking, head banging, and eye gouging.1
How is self-harm treated in children and adolescents?
Children and adolescents who exhibit DSH behaviors need to be evaluated by a clinician so that an individualized management strategy can be determined.1 Early intervention can help to prevent chronic DSH and suicide behavior that may worsen if left untreated.1 However, according to Greydanus, most youths with DSH hide their behaviors, with only 50 percent seeking professional help. Traditional interventions may include group therapy, school-based programs, hospitalization, art therapy, and psychopharmacological treatment for any underlying mental health disorders. Successful interventions incorporate positive coping mechanisms and problem solving skills that help the patient learn to reduce their overall stress level and improve communication skills. As part of the interventions, there should be a trusting relationship between the clinician and the youth as well as any possible support from family and friends.1 For youths with intellectual disabilities, management of DSH lies in behavior modification, which may include giving the patient preferred items, using helmets and other protective gear, and psychopharmacological agents.1
Greydanus states that deliberate self-harm is a common phenomenon that may begin in childhood and continue through adolescence and young adulthood if not treated properly. Linked to negative emotions and self-hate, DSH may also lead to eventual suicide. Therefore, research should focus on ways to improve methods of intervention as effective interventions will prevent repetitive DSH patterns and suicide.
 Greydanus, D.E. (2011, April 28). Treating Self-Harm in Children and Adolescents: A Complex Conundrum for the Clinician. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/display/article/10168/1852801
 Lloyd-Richardson EE, Perrine N, Dierker L, Kelley ML. Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychol Med. 2007;37:1183-1192.
 Madge N, Hewitt A, Hawton K, et al. Deliberate self-harm within an international community sample of young people: comparative findings from the Child & Adolescent Self-harm in Europe (CASE) Study. J Child Psychol Psychiatry. 2008;49:667-677.
 Klonsky ED, Muehlenkamp JJ. Self-injury: a research review for the practitioner. J Clin Psychol. 2007;63:1045-1056.
 Csorba J, Dinya E, Plener P, et al. Clinical diagnoses, characteristics of risk behaviour, differences between suicidal and non-suicidal subgroups of Hungarian adolescent outpatients practising self-injury. Eur Child Adolesc Psychiatry. 2009;18:309-320.
 Fortune S, Stewart A, Yadav V, Hawton K. Suicide in adolescents: using life charts to understand the suicidal process. J Affect Disord. 2007;100:199-210.
 Skegg K. Self-harm. Lancet. 2005;366:1471-1483.
 Tenneij NH, Koot HM. Incidence, types and characteristics of aggressive behavior in treatment facilities for adults with mild intellectual disability and severe challenging behavior. J Intellect Disabil Res. 2008;52(pt 2):114-124.
 Morey C, Corcoran P, Arensman E, Perry IJ. The prevalence of self-reported deliberate self harm in Irish adolescents. BMC Public Health. 2008;8:79.
 Yates TM, Tracy AJ, Luthar SS. Nonsuicidal self-injury among “privileged” youths: longitudinal and cross-sectional approaches to developmental process. J Consult Clin Psychol. 2008;76:52-62.
 Fortune S, Sinclair J, Hawton K. Adolescents’ views on preventing self-harm. A large community study. Soc Psychiatry Psychiatr Epidemiol. 2008;43:96-104. self-harm.