Intentional self-injury among teenagers with eating disorders is occurring at a much higher rate than most health care professionals are aware of, according to a study carried out by researchers from Stanford University School of Medicine and Lucile Packard Children’s Hospital which has been published in the latest issue of the Journal of Adolescent Health. The authors found that 4 in every 10 teenagers with an eating disorder had harmed themselves deliberately. If screening is not thorough, which the researchers say is likely, the number of people intentionally harming themselves may be even higher.
Lead author, Rebecka Peebles, MD., said:
These are very high numbers, but they’re still conservative estimates.
Dr. Peebles adds that self-harm is not routinely asked about by clinicians. If 97% of 12-year-olds are asked whether they consume tobacco products, surely screening for self-harm should occur too, she added.
James Lock, MD, PhD, professor of psychiatry and behavioral sciences and of pediatrics, also psychiatric director of the Comprehensive Eating Disorders Program at Packard Children’s Hospital, and team assessed data on the intake evaluation records of 1,432 youngsters aged 10 to 21 years who were admitted to the eating disorders program run by the hospital from January 1997 until April 2008.
The majority of the patients were girls (90%), about 75% of them were Caucasian, with an average age of 15 years. 40.8% of them were found to be harming themselves. Those harming themselves had an average age of 16, most of them were cutting themselves. A considerable number of patients intentionally hurting themselves had a history of binging and purging.
The investigators report that less than half of all patients were being asked by health care providers whether they had deliberately harmed themselves. Dr. Peebles said that self-harm is not the kind of information a patient volunteers without being asked.
Health care professionals tended only to question patients with eating disorders about self-harm if they fitted typical profiles, such as being older, female, Caucasian, with bulimia nervosa, and/or a history of substance abuse.
Dr. Peebles said:
The question is, Are we missing other kids who are not meeting this profile?. This is part of why we wanted to look at this. If you see an innocent-looking 12-year-old boy, you don’t even think of asking about self-injurious behavior. We need to get much better about universal screening.
If health-care staff ask only certain types of patients about a behavior, the emerging profile will only add to that bias – a self-perpetuating flawed system.
Even though this study did not set out to determine why patients intentionally harm themselves, Dr. Peebles believes the patient is “trying to feel pain”.
Dr. Peebles said:
Patients describe a feeling of release that comes when they cut or burn themselves. They’ll cut with a razor or a scissor blade. Sometimes we’ve even had kids who will take the tip of a paper clip and gouge holes. To burn themselves, they’ll heat up a metal object and press it to their skin, or they’ll use cigarettes.
Dr. Peebles added:
In clinical practice, kids are fairly open when you engage with them,” Peebles said. “They’ll come in wearing long sleeves, or hiding the marks on their inner thighs. But then when you ask them, they are usually willing to discuss the behavior.
Source: Stanford School of Medicine
Written by Christian Nordqvist