Self-Harm Showing Up in Elementary Schools: Study

MONDAY, June 11, 2012 (HealthDay News) -- When young people purposely hurt themselves it's disturbing at any age, but a new study suggests that kids in elementary school cut and otherwise injure themselves at about the same rate as older children.

"One of our main messages is: This happens earlier than you think. And then it's: How are kids at different ages doing this and what do you need to look for?" said study author Benjamin Hankin, an associate professor of psychology at the University of Denver.

Appearing online June 11 and in the July print issue of Pediatrics, the study included youths aged 7 to 16 from the Denver area and central New Jersey.

Of the 665 participants, 53 children (8 percent) in third, sixth and ninth grades admitted to doing what's known as "nonsuicidal self-injury" at least once. Among third graders, 7.6 percent had intentionally hurt themselves, compared to 4 percent of sixth graders and 12.7 percent of ninth graders.

All kids were taking part in a larger study of social, emotional and mental health development. "During this nonsuicidal self-injury interview, we were talking to the child separately, without the parent present," Hankin explained.

Cutting, burning and head banging are self-injury methods, along with inserting sharp objects into skin or nails, skin picking, biting, or pulling hair to cause pain.

"The older adolescents in our study -- basically ninth graders -- were engaging in cutting and burning," Hankin said. "The boys, and especially the younger kids, were actually doing more head banging."

By ninth grade, girls were three times more likely to self-injure than boys, the study found.

"Of those who engaged in nonsuicidal self-injury-- about a third of them did it once and didn't do it again," Hankin said. "Of course that means the rest of them, 66 percent, go on and repeat."

It's possible that, at least initially, some kids try self-injury as a form of imitation.

"There's some emerging evidence of that imitation, copycat, 'peer-contagion' effect," Hankin said. "But there is not really strong, excellent scientific data for that yet." He said some kids may try it once and decide, "Nope, it's not for me."

A March 2011 Pediatrics study found that a variety of YouTube videos posted by teens engaging in self-injury had together attracted more than 2 million views.

In the current study, 1.5 percent of participants had self-injured at least five times that year. Repeaters tend to feel depressed, anxious, angry or consumed with negative feelings or thoughts, the study authors found.

"What maintains the behavior usually is that it works," said Alec Miller, chief of child & adolescent psychology at the Montefiore Medical Center/Albert Einstein College of Medicine in New York City. "At least from what we understand with adolescents and adults, the primary reason people do it is for emotional regulation effects. It helps relieve emotional pain for many children."

Self-injury is considered a risk factor for eventual suicidal thoughts and behaviors. And there can also be physical consequences, such as infection or worse.

"Usually, people who do those kinds of things, they're not wanting to die," Hankin said. "Most of these individuals have a decent sense of how far they can go without causing really significant medical damage. But sometimes they accidentally hit an artery or do other things and the accumulation gets them into medical problems."

Miller recommends a form of treatment called dialectical behavior therapy, in which kids who self-injure learn a variety of coping skills, such as mindfulness -- noticing emotions and the urge to do self-harm -- and emotional regulation.

"What's very important is distress-tolerance skills," Miller said. "Can we teach them replacement behaviors in lieu of self-injuring? Can you distract yourself, can you soothe yourself, can you weigh the pros and cons of the act before you do it?"

When parents come to suspect that their children are self-injuring, it's difficult.

Miller advises parents to "ask questions gently and assertively." Parents should "ask what's going on and whether they're feeling stressed and is that a way that they're coping." If so, the children should be asked if they would "like to learn some other ways of managing their distress," Miller added.

"The worst thing you can do is be judgmental and angry, even though I understand that parents -- in their fear and horror -- might come [across] that way," he said. "So the parents have to be very careful; otherwise, the kid will go further underground and conceal it more."

Study author Hankin said, "If you have a concern, talk with a pediatrician. That pediatrician can confidentially ask things and make appropriate referrals for mental health specialists."

Because the study involved children in relatively well-off families, the results might not apply to the general population, the researchers noted.

More information

The American Academy of Child & Adolescent Psychiatry has more facts on self-injury.