Conference looks at warning signs and diagnostic therapies

By:  Christine Zeindler

“A child born today will live to be about 80 years old on average. But the challenge is getting them through 16, 17, 18, 19 – the most hazardous time in their lives. A kid with a car, a kid with a gun, a kid with a bottle – any one of these combinations is much more of a risk than a terror attack or the flu.” These poignant words from journalist Timothy Egan’s New York Times OpEd were an appropriate backdrop for a recent conference on “Self-Injury and Suicide in Youth Conference” that was held in Montreal last month. Here, educators, therapists, nurses, psychologists and other child-care professionals were united to learn the latest diagnostic techniques, trends and therapies about teens in crisis. The event was hosted by the McGill Division of Child Psychiatry comprising of the Montreal Children’s Hospital, the Douglas Mental Health University Institute and the Sir Mortimer B. Davis Jewish General Hospital. Dr. Eric Fombonne, director of Psychiatry at The Montreal Children’s of the MUHC, was the chairperson. 

The featured guest speaker, Dr. Barbara Stanley, from the Department of Psychology, City University of New York discussed how self-injury and suicide in preteens and teens are linked and on the rise. "In the past couple of years what seems to be happening is there is now an increase in suicide rates in adolescents after it had been going down."

She defined self-injury as a deliberate and repetitive destruction of one’s own body.  How does a self-inflicted cut on the arm lead to a full-blown suicide attempt? According to Dr. Stanley, self-injurious behaviours, such as cutting, burning, hitting one self, are distinct from suicidal behaviour. Self-injury most often occurs in individuals who have major depression or who have been previously diagnosed with borderline personality disorder (BPD), a mental health condition characterized by emotional and behavioural instability. These individuals inflict harm on themselves in an attempt to reduce emotional tension and to regain control. This is often a quick remedy to ease stress and sooth the individual. Whereas self-injurers use harm to feel better, individuals who truly attempt suicide seek an end to all feelings.

While suicidal and self-injury behaviours are distinct, it is possible for one person to have both. Between 55 and 85 percent of self-injurers have attempted suicide at least once. For some, especially those with BPD, suicide attempts serve a similar emotional release as self-injury episodes; these individuals feel relieved afterward. This is alarming given the rate of suicide success since, according to Dr. Stanley, up to 11 percent of teen suiciders will eventually die. How then can caregivers, family members and friends tell the difference between self-mutilation and suicide? Dr. Stanley says parents should treat self-mutilation as a suicide warning sign. "If a kid is repeatedly self-injuring, they need help."

Help for those who mutilate themselves and those who attempt suicide is similar and can involve therapy, medication or a combination of both. Types of therapy include cognitive behavior therapy .It focuses on decreasing negative actions, family therapy, and psychoeducation. In addition, the new approach of dialectic behavioural therapy is being introduced to these patients. This treatment balances validation and acceptance of a patient’s situation, while challenging them to modify their behaviour and learn new coping skills. It has been particularly useful for BPD and suicidal multi-problem adolescents.

There is hope for many of these teens. In many cases these behaviours run a natural course of five to ten years, with the exception of adolescents who progress to nmore seriopus deprerssion

Side bar: Risk factors for Self-Injury Behaviour (Ref. The Centre for Suicide Prevention: CMHA)
Risk or predisposing factors for self-injury behaviour may include:

• Drug and alcohol abuse
• Eating disorders
• Signs of depression
• Inability to express feelings
• Feelings of worthlessness
• Sense of abandonment
• Disruption or lack of supportive relationships
  

Signs of self-injury
People who injure themselves often try to keep their behavior secret and thus it may be difficult to spot.
Ref. mayoclinic.com [1]
Signs of self-injury may include:

• Scars, such as from burns or cuts
• Cuts, scratches or other wounds
• Bruises
• Broken bones
• Keeping sharp objects on hand
• Spending a great deal of time alone
• Wearing long sleeves or long pants even in hot weather
• Claiming to have frequent accidents or mishaps