Thursday October 18, 2018

Can Pain Make You Feel Better ? Understanding Deliberate Self Harm Practices Among Adolescents

What do children and young adults do when the level of emotional pressure becomes increasingly high? According to studies, an increasing number of adolescents indulge in self harm to relieve stress.

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Societal pressure and lack of support often forces young adults to indulge in impulsive self-harm mechanisms like drug overdose and self cutting. Pixabay
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– by Dr. Rajeev Nagpal, Australia

  • Deliberate self harm (DSH), also known as self injury is the act of intentionally inflicting damage to the body
  • It has become a common practice among children and teenagers across the globe
  • DSH among teenagers can be attributed to lifestyle and technology changes, peer pressure and lack of support

Australia, September 1, 2017: Dr. Rajeev Nagpal expresses his opinion on the dangerous practice of self-harm increasingly affecting children and young adults across the world.

What is Deliberate Self-Harm (DSH)?

Self-harm is described as an expression of situational crisis or personal distress which leads to harming oneself. NICE clinical guidelines from the UK have defined it as self-poisoning or injury, irrespective of the apparent purpose of the act.

Deliberate Self Harm (DSH) is not a clinical condition but a response to a stressful situation in the life of a young child or adolescent. It can occur after long term stress like abuse or domestic violence or after an acute single event like the loss of a near one or failure in examinations. It is primarily a coping mechanism in which they try to release tension by trying to self-harm.

Self harm
Dr. Nagpal views self-harm not as a clinical condition, but as a coping mechanism adopted by children and young adults to vent their tension.

Already there are reports of Indian children losing their life after playing games like the blue whale challenge on the internet. It is time for the general population, including the parents of young children to understand the issues of this very complex condition called deliberate self-harm.

Public Health Issue

In recent years DSH has become a major public health issue in most developed countries. However, although less reported, this problem is a major under-recognized epidemic in low and middle –income countries like India, Nepal.

According to a retrospective study conducted at the Emergency department of CMC, Vellore, India from Jan 2011 to Dec 2013, among the total 1228 patients who were admitted, consumption of pesticides was the most common cause of DSH in men. Consumption of plant poisoning and drug overdose was more common in women.The study involved all population, therefore, the actual number of pediatric population was difficult to ascertain.

Other international studies have also revealed that adolescents, who experienced anxiety or low mood, were six times more at risk of self-harm in young adulthood compared to those without depression or anxiety disorders.

Approximately a million lives are lost to suicide annually, worldwide.

Deliberate self-harm (DSH) is the single most important risk factor for suicide and is associated with huge health service resource utilization. Deliberate self-poisoning in children continues to remain a significant part of the workload of emergency departments, especially in adolescents, even though fewer children need admission now as compared with earlier decades.

Presentation of DSH

Many young adults find it difficult to express their feelings. Some examples of self-harm behavior are:

  • Self-cutting or scratching
  • Burning or scalding
  • Poisoning with drugs like paracetamol, anti-depressants
  • Swallowing objects

Relatively little information is available about the characteristics and long-term outcome of children and adolescents aged under 15 years who present to general hospitals because of deliberate self-harm (DSH).

Depressive disorders in pediatrics fall in ranges from mood changes in response to persistent mood change accompanied by suicidal ideation or intent.

The difficulties faced by adolescents are getting more complex with lifestyle and technology changes globally. Peer pressure along with family expectations can aggravate this sense of worthlessness.

Deliberate self harm
Feelings of helplessness, stemming from a variety of social and cultural factors can force an adolescent to indulge in self-harm. Pixabay

Lack of support networks can lead them to opt for impulsive self-harm mechanisms like poisoning. Intentional overdose to commonly implicated drugs like Paracetamol in the UK, or organo- phosphorous compounds in Nepal and is a cause of grave concern.

How to Deal with this Issue

As young children are unable to deal very well with emotional stresses, they will need a supportive team to help them in understanding their feelings and the possible outcomes from them.

This requires a multidisciplinary team approach.

  • Understanding the issues by holding awareness sessions of this condition in schools and other organizations
  • Creating referral pathways that all school staff are aware of
  • Confidential telephone lines /NGOs dealing with mental health of adolescent’s
  • Government policies and procedures for treatment of acute cases in Accident and Emergency departments
  • Provision of developing CAMHS(Child and adolescent mental health services ) like services at state level in Indian government hospitals.
  • Increased research particularly in pediatrics and adolescent’s needs to be conducted at state and national level.

ALSO READ Suicide is Preventable: Alarming Effects of Self-harm on Families, Communities, Societies

Conclusion

DSH is an under-recognized, major public health problem in low and middle-income countries. National level medical protocols and increasing the awareness amongst the public and agencies dealing with such conditions can be the first step in saving millions of lives from the untimely death of the most vulnerable yet productive younger sections of the society.

Dr. Rajeev Nagpal  is a Pediatrician and MHID (Masters OF Health and International Development-Flinders University, Adelaide, Australia) 

 


 

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Why Not Everyone Can Travel the World

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Once you leave the comfort and the certainty you have at home, you are exposed to all kinds of experiences,

Many people desire to experience how life feels beyond their borders by traveling to as many countries as the possible, but just a few ever manage to realize their dream of traveling. Several factors may be responsible for this, considering that traveling is expensive and will require to have some time on your hand that you can afford you to spend for the travels.

However, most people don’t have either the money to take care of their traveling expenses or the time to travel. But for some people, they have both the time and the money, but still, they are unable to travel. In order to try and understand this group of people, here are some of the possible reasons why not everyone may be ready to travel the world-:

Traveling may be uncomfortable

Leaving the comfort of your home to explore lands you may have never set foot it may not be the easiest thing in the world. It requires you to be tough mentally and physically so that you are well prepped and ready to deal with both the physical and mental challenges you are likely to face.

Travel
When some people think about the prospects of going through these experiences, they find it easy to take the easy decision.

Once you leave the comfort and the certainty you have at home, you are exposed to all kinds of experiences, including dealing with randy roommates, rude people in public spaces, sleeping in crappy hostels, eating foods you have never eaten before, and a whole horde of new experiences. When some people think about the prospects of going through these experiences, they find it easy to take the easy decision which is to stick to the places they already know and never bother to travel the world.

Travelling will take you out of your comfort zone

The possibility of having to do and experience things you have never done before or which you don’t know how to do is another turn of that make some people to not bother about traveling. The human mind is designed to keep the body safe from any harm, both real and perceived. When it comes to traveling, there are so many unknowns that come into play and the natural way to react to this is to avoid any experience you might have not experience so that the body is not faced with any kind of harm. Consequently, the mind will find more comfort in remaining and doing the things it is used with instead of trying to venture out to find out new things happening in other parts of the world. In such a case, it holds true that better deal with the devil you know than the angel you don’t.

travel
Consequently, the mind will find more comfort in remaining and doing the things it is used with instead of trying to venture out.

Traveling turns you into a different person

Change is a constant factor of life, and when it comes to traveling, it becomes even more pronounced. This is because you will be moving from one place to another, sampling one experience after the other. You will also be meeting different kinds of people, some whom you will like and others who will completely piss you off.

If you are traveling alone, you learn to be independent very first and if before you the travel you didn’t like the prospects of doing things on your own and taking charge or your own life, you find that you will be a completely changed person. There are some people who are truly scared about the prospects of such change, and instead of having to go through such in the name of traveling, they would rather stick to what they knew and just be as they have always been.

Fear and anxiety

When you leave for a trip abroad, like visiting Canada, the moment you fill the Canada ETA form and you are granted permission to get into the country, it will immediately dawn on you that you are now on your own and you have all the responsibility for taking care of yourself. At such moments, you can’t help but feel anxious about the unknown. If it is a destination you have never visited and you have probably heard about some bad stuff about it, the fear grows even bigger and you start to wonder why you had to take the trip in the first place.

travel
If you are traveling alone, you learn to be independent very first.

It is this fear of the unknown that is stopping millions of people around the world from traveling, even though they have the time and the money to travel. Some people will be constantly worried about their relatives back at home, while some will get depressed over uncertainties such as falling sick while away and much more. To them, home is always the best and there is no need to bother self to try travel to see other places. You can check out this link if you need more information about entry requirements to Canada, now that we have mentioned it.

Misinformation about certain destinations

Some people are also afraid to travel to certain destinations about some myths or wrong information they got about such places. For example, most people are afraid of traveling to certain countries in African and South America due to conflicts and high crime rates respectively. If you have never been to Kenya and you had that though it has some of the best Safari packages in the world, there are constant fights among communities due to politics, you will not be heading to Kenya simply because you don’t want to be caught in the middle of the conflict. Or, if you were thinking about going to Brazil, but you hear about the rampant violence by gangs on the streets, I guess you will also be changing your mind about taking your trip there.

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It is also possible that some people may be afraid to travel to new places due to bad experiences

Bad experience from past travels

It is also possible that some people may be afraid to travel to new places due to bad experiences they might have received while traveling in the past. There are so many things that can go wrong during trips and all of them are potential turn-offs from future travels. For example, losing your flight multiple times during the same trip can be disheartening. Also getting sick, injured or robbed during a trip may make you decide to never go for another trip again.