Non suicidal self-injury (NSSI, referred to as 'self injury' in this article) means intentionally hurting one's skin or body without the intent of suicide. Self injury is considered a risk factor for suicidal thoughts and a precursor to more serious psychopathology. It seems likely that NSSI will become an official psychiatric diagnosis in the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders
Traditionally, we have thought of self injury as a teen phenomenon. Before this study, published recently in the journal Pediatrics
, there was no research reporting rates of self injury in children younger than age 11.
For this study, researchers interviewed 665 children and youth in the third, sixth and ninth grades (ages seven to 16) about self injury. They found that, overall, eight percent of children and youth had engaged in self injury (nine percent of girls and seven percent of boys). The rates were highest in older kids (13 percent in Grade 9) but younger ones also reported self injury (eight percent in Grade 3 and four percent in Grade 6).
Overall, 1.5 percent of children and youth met some criteria for the proposed DSM-5 definition of NSSI because they: 1) engaged in self injury at least five times in the previous year; 2) engaged in self injury for a purpose, and 3) had high levels of distress.
Girls were more likely across all age groups to intentionally harm themselves. In Grade 9, girls were almost four times more likely than boys of the same grade to do this (19 percent versus five percent). Girls reported carving and cutting more often, while boys reported hitting themselves mostly.
People who use self harm are often doing it as a way to express negative emotions. According to Toronto's Hospital for Sick Children
, "They may have low self-esteem, feel depressed or anxious, feel ashamed or guilty about something in their lives, experience loneliness or lack of control, or even feel numb."
"Knowing that a substantial percentage of youth overall report engaging in NSSI suggests it is a mental health outcome that needs medical evaluation, especially as NSSI might be a precursor for suicidal behaviours. Hospital emergency rooms discharge nearly 60 percent of patients who report self harm without a mental health evaluation.... Early identification of NSSI engagement could help prevent negative physical and mental health outcomes," say the Pediatrics researchers in their paper.
If your child is engaging in self injury, here are some tips on what to do, from the Hospital for Sick Children
-Stay calm and avoid judging your child, even if you are upset.
-Understand that your child is not self-harming to get attention but rather to manage her emotions.
-Talk to your child and try to understand what is prompting her behaviour.
-Try to remove the temptation of self-harm, if possible, by encouraging your child to avoid situations in which she could harm herself.
-Help your child think about why she is harming herself by asking if she can do anything about the cause or if something else needs to change.
-Make a list of people your child can talk to such as you or your partner, other relatives, a teacher, or friends of the family.
-Depending on your child's age, encourage journaling, breathing exercises, or physical activity as a way to relieve stress and anxiety.
-If your child's behaviour is not changing or if you suspect she might be depressed, ask your doctor for advice. Depression and anxiety can be treated in many ways.