Wednesday January 24, 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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self harm
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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Next Story

Are bullied kids prone to suicidal behaviour?

Children who experienced severe peer victimisation were more than twice as likely to report depression or low moods at age 15, and three times more likely to report anxiety

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Victimization in early school days leads to anxiety. Pixabay
Victimization in early school days leads to anxiety. Pixabay
  • Children face most severe levels of victimization from the beginning of their schooling.
  • These kids develop significant symptoms of suicidal behaviour and anxiety.
  • Even after the victimization ends, it affects still pertains.

A study found that children who face bullying can be at a risk of developing mental health issues, suicidal thoughts and anxiety in their years. For the study, the team looked at 1,363 children who were followed until the age of 15 years.

About 59 percent of participants had experienced some peer victimisation in the first years of elementary school, although it generally declined as the children grew older.

“Our findings showed a general tendency, in about 15 percent of the children, of being exposed to the most severe levels of victimisation from the beginning of their education until the transition to high school,” said Marie-Claude Geoffroy, from the McGill University in Canada.

Also Read: Anxiety and depression genetic, says research

Even though victimization can end after school days, its affect still pertains. Pixabay
Even though victimization can end after school days, its affect still pertains. Pixabay

Findings

  • Children who experienced severe peer victimisation were more than twice as likely to report depression or low moods at age 15, and three times more likely to report anxiety.
  • This group of children were also 3.5 times more likely to report serious suicidal thoughts or attempt suicide.

“Those children were at greater risk of debilitating depressive/dysthymic symptoms or anxiety and of suicidality in adolescence than less severely victimised children, even after we accounted for a plethora of confounders assessed throughout childhood,” Geoffroy added.

Also read: List of 8 Food Items to Battle Depression and Anxiety

“Although peer victimisation starts to decrease by the end of childhood, individuals in the severe trajectory group were still being exposed to the highest level of victimisation in early adolescence,” Geoffroy noted.

Severe peer victimisation may contribute to the development of mental health problems in adolescence, thus, it is important to prevent victimisation early in the lifespan, the results suggest.

The study was published in journal CMAJ. (IANS)