Thursday March 21, 2019

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

– 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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Next Story

The Mental Health ‘Epidemic’: About Six in Ten Teen Say, They Feel A Lot Of Pressure To Get Good Grades

The American Psychological Association found that almost one-third of teens say they feel sad or depressed and overwhelmed due to stress.

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Today, one in three teens between the ages of 13 and 18 has an anxiety disorder. Pixabay

Nineteen-year-old college student Margaret Pisacano can usually feel a panic attack coming on; her thoughts start to spiral, her breathing speeds up, and her heart races.

“It’s as if a tornado and a tsunami of emotions just like overcame your body and you couldn’t control anything,” Pisacano says. “It was like almost a total loss of control over any feeling or thinking in your body.”

The Arizona native, who attends college in Florida, was first diagnosed with general anxiety disorder in middle school. She is among millions of stressed-out members of Generation Z — the group of young people born roughly between 1995 and 2015, who are currently between 4 and 24 years old.

A report released Thursday by the American Psychological Association finds the rate of adolescents reporting symptoms of major depression increased 52 percent between 2005 and 2017 — from 8.7 percent to 13.2 percent — among youth from the ages of 12 and 17.

The increase was even higher — 63 percent from 2009 to 2017 — among young adults between the ages of 18 and 25.

The survey examined data from 611,880 adolescents and adults. The researchers did not find a similar increase in adults older than 26.

Today, one in three teens between the ages of 13 and 18 has an anxiety disorder.

“The current rate of anxiety is 31 percent in adolescents,” says Dr. Elena Mikalsen, head of the Psychology Section at the Children’s Hospital of San Antonio in Texas. “It’s an epidemic. It’s a mental health emergency.”

Margaret Pisacano, 19, focuses on where she is in the moment to deal with anxiety about how her past affects her present, or how her present affects her future. (Photo courtesy of Margaret Pisacano)
Margaret Pisacano, 19, focuses on where she is in the moment to deal with anxiety about how her past affects her present, or how her present affects her future. (Photo courtesy of Margaret Pisacano). VOA

Everyone gets anxious some of the time, but that anxiety is usually temporary. However, for a person with an anxiety disorder, the feeling doesn’t go away and can worsen over time to the point where it might trigger headaches, chronic pain, stomach issues, immune system suppression and disrupted sleep.

School and the pressure to get good grades appears to be the leading source of stress for many young people.

“We see all of our anxiety referrals very clearly as soon as the school year starts, almost like from the first week and until the school year ends and then we see none of them in the summer,” says Mikalsen. “The worst is the end of May when all of the teens get their grades…they’re just panicking terribly. We hospitalize kids for all kinds of medical issues because they get their grades and their immune system just collapses. The highest rate of suicide is in April and May when they’re having finals, when they’re having exams.”

The American Psychological Association found that almost one-third of teens say they feel sad or depressed and overwhelmed due to stress.

Claire Taylor, a 17-year-old high school junior in Massachusetts, was diagnosed with generalized anxiety a couple of years ago, but didn’t have her first panic attack until she started visiting colleges ahead of her scheduled high school graduation next year.

“For my whole life, college has kind of been my end goal…It kind of hit me that college is not the end, and that there’s more after that,” Taylor says. “I’m really not sure what I want to go to college for and so just the whole prospect kind of freaked me out…I was shaking and crying and I couldn’t quite articulate why until after the fact.”

College-related anxiety is rising, according to a 2017 report from the Higher Education Research Institute at UCLA. The institute surveyed 8,264 incoming first-year students at 30 U.S. colleges and universities and found that 39 percent reported frequently feeling anxious, but fewer than half of those students say they sought personal counseling in college.

Tarek Saoud, 22, began suffering from panic attacks after he went to college and felt the mounting pressure to set a course for success in life.

“I tried switching my (college) majors a few times, but I really did not like anything,” he says. “Not being able to find something was a big issue for me…Where I grew up here in Northern Virginia, it’s very expected to be either a businessman, a lawyer, a doctor, a scientist, something like along those lines. Those are what is seen as successful.”

Tarek Saoud, now 22, in a photo taken at Ohio State University on the day he decided which college to attend. (Photo courtesy of Tarek Saoud)
Tarek Saoud, now 22, in a photo taken at Ohio State University on the day he decided which college to attend. (Photo courtesy of Tarek Saoud). VOA

Getting an appointment at the on-campus mental health center proved almost impossible, according to Saoud, who recounts a near-suicide attempt that was interrupted by a concerned friend who came looking for him.

“I’d been thinking about suicide for months at that point…there’s this big ledge I was sitting on with this big fall under it. I was just kind of sitting there thinking about, ‘Could I do this right now? Like, do I have everything in order? Did I forget anything that would get anyone in trouble and what not?’ Not like sad about it, just getting my things in order,” he says.

“I kind of felt crazy in my own head,” Saoud says. “When I was getting anxiety, super-irrational thoughts were running through my head all the time. Things like, ‘You’re never going to be happy, things are never going to get better’…It’s really easy to mask whatever inner issues are going on by being a super social, outgoing person, drinking a lot.”

He left school in Ohio during his sophomore year in college, returning home to Northern Virginia where he was eventually diagnosed with anxiety and clinical depression.

There are two new stressors impacting young people that are perhaps a sign of the times. Mikalsen says more of her patients are concerned about school shootings and the lockdown drills they practice at school.

“I’ve been a psychologist for about twenty years and this is the first year that I now have patients who have Post Traumatic Stress Disorder from school lockdowns,” she says. “Before, it was you hide and now the hiding is not working, so now it’s attack the shooter and everybody’s like, ‘I can’t attack anybody. I’m too scared.’ And they’re supposed to be climbing on desks and throwing things and they’re practicing that in the classroom.”

Graphic: Pew Research Center
Graphic: Pew Research Center. VOA

The way their parents use social media is also causing stress for some teens.

“There is a problem happening right now with parents wanting to videotape their children and take pictures of their children in vulnerable moments. Like when kids are really stressed out, like when they’re anxious, when they’re upset,” says Mikalsen. “There’s a general lack of boundaries now because we’re all on social media…and I think it’s become a really big problem for kids that their information is just shared out there everywhere with everybody, causing stress and anxiety.”

Saoud says learning to express his feelings has helped get his anxiety under control, but not all young people feel free to be candid about their mental health.

“I don’t think a lot of my friends know because I don’t talk about it that often,” says Pisacano, the 19-year-old Florida college student. “It feels like they don’t want to hear me talk about it almost. It’s almost like I want to shield them from discomfort. I’m not uncomfortable talking about my mental health issues, but I think my friends are uncomfortable that I’m mentally ill.”

Taylor, the 17-year-old Massachusetts high school student, feels that she has generally accepted her anxiety as a fact of life. But she does feel regret when her mental illness stops her from doing things she would otherwise enjoy, like an exchange trip to Spain that she passed on due to her fear of flying.

“Even though I had a lot of great friends on the trip, I was still too afraid,” she says, “so in that sense, like I wish that my anxiety either manifested itself differently, or that I didn’t have anxiety, because I think it would have been really fun to go on the trip and it would have been an experience that I would remember forever, but usually I just kind of accept it as part of who I am.”

Also Read: New Zealand Government Puts Immediate Ban on Guns Used in Mosque Attack

Saoud is attending community college for now and intends to transfer to a four-year college soon. Still on medication and seeing a psychologist, he doesn’t say he’s ‘cured,’ but feels there’s been a huge improvement over when he hit bottom.

“Sometimes I get in my head about the future and I think, ‘Where’s the point?’…but those are the times that I really sit down with myself and think about what I have achieved, what I want to achieve, how much I have to be grateful for,” Saoud says. “I’d like to say I’m hopeful. I really do believe that I have a lot of potential for the future.” (VOA)