November 19, 2014 - 5:00 AM
TORONTO - There is a troubling trend among some tweens and teens, says a new report that points to a sharp rise in self-harming behaviour such as attempted suicides and cutting.
The report, from the Canadian Institute for Health Information, compares hospitalizations for self-harm induced injuries over a five-year period, from 2009-10 to 2013-14.
While the numbers are not enormous, the increases in percentage terms are very high — a 90 per cent jump in self-cutting hospitalizations among girls aged 10 to 17, for example. Experts note that self-cutting injuries serious enough to merit a hospital stay would be a fraction of the actual total of girls who practise cutting.
"It has increased quite dramatically. And these are really just the cases where the girls are hospitalized because of the cutting, which means it's pretty severe," said Juliana Wu, manager for decision support and registries at the Canadian Institute for Health Information.
"There's probably a lot of other cases out there where they're cutting themselves (but) it's not severe enough to require treatment or they can hide themselves in secret. And those cases won't be accounted for in here."
Dr. Kathleen Pajer, chief of psychiatry at the Children's Hospital of Eastern Ontario in Ottawa, says the numbers reflect what people in her profession across North America are seeing — a surge in cases of kids hurting themselves.
These activities break down into two groups, she suggests: children who are trying to commit suicide, and children who are inflicting pain on themselves as a coping strategy for dealing with emotional distress.
Both appear to be on the rise from the CIHI numbers. For instance, there were 1,136 youths hospitalized for self-poisoning — attempting to overdose on prescription drugs — in 2009-10. In 2013-14, the number was 2,140.
But Pajer says she and others see a lot of teenagers — and preteens — who are using self-inflicted pain to try to cope with emotions that overwhelm them. Their goal is not to kill themselves, but to find psychological relief.
Most are girls, and in girls the most common form of self-harm is cutting. Boys are more likely to resort to burning or slamming their head or fist into a wall.
There were 202 hospitalizations for cutting and piercing type self-harm injuries in 2013-14, compared to 113 in 2009-10. The figures are drawn from all provinces except Quebec.
The report said there has been an 85 per cent increase in the number of children aged 10 to 17 who get admitted to hospital because of incidents involving self-harm. But again, the cases that result in hospitalization would make up a small portion of total cases.
Dr. Susan MacKenzie of Toronto's Centre for Addiction and Mental Health said in her practice, she sees a lot of kids who cut themselves.
"There's a huge population of young people who use self-harm — cutting, burning, ... even quite reckless and destructive substance use that we see that is more of a means of coping ... for the emotional distress," she said.
The idea — using physical pain to distract from emotional pain — may seem perverse or self-defeating to those equipped with better coping skills. But both MacKenzie and Pajer said that some kids who don't have a lot of coping mechanisms report a sense of relief from the practice.
"These behaviours, we have to remember, serve a purpose in the moment," MacKenzie said.
"They sound very destructive and you might think: There's so much potential damage and they might take it too far and there could be such negative consequences. But they have a really hard time seeing that in the moment. And in the moment, there's a lot of relief that comes from it."
Pajer said there appears to be a contagion factor at play. "You hear about it, you see it in school and then you go on the Internet and learn how to do it. And learn how to hide it."
Pajer, who has been practising for 30 years, said it used to be that if she was asked to see a patient who had self harmed, she could safely assume it would be someone with a serious mental health problem — major depression, psychosis, maybe bipolar or maybe borderline personality disorders. But today, that's not the case.
"When you go into a room now and you talk to these kids, you do not have a clear-cut disorder that comes up. It's not as if 'I get depressed and then I start harming myself.'... Instead it seems (to be): 'I feel things very intensely because I'm a kid... and I don't know what to do with these intense feelings. And somehow I've heard about causing myself pain.'"
"The conclusion we're all coming to is: This is less about a psychiatric disorder than it is about poor emotional regulation," Pajer said.
It can be tough treating kids who become ensnared in using self harm to regulate their emotions, she acknowledged. "When you get the kids for whom it's really become a cycle, it's almost like an addiction. And it's just as hard to treat as an addiction."
MacKenzie agreed. "It takes a while to help them see that long-term, these methods aren't sustainable and will cause more damage."
News from © The Canadian Press, 2014