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Self-Injurious Behavior

Diane Tanaka MD and Solomon Behar, MD
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Sol and Diane Tanaka, Associate Professor of Clinical Pediatrics at CHLA, discuss how to identify and manage pediatric patients with self-injurious behavior. 

  • Self-injury is the deliberate destruction of body tissue done with the intent not to kill oneself.

  • The behavior most commonly takes the form of skin-cutting, scratching and burning. Other methods used to self-injure include head banging, pinching, biting, rubbing with an eraser and inserting objects under the skin. 

  • Approximately 30 to 70% of youth that engage in self-injury have also attempted suicide.

  • Self-injury typically begins in early adolescence so it is important to start screening youth as young as 12. If there is a preteen child with a known history of depression, consider asking about such behaviors as early as 10 or 11. It is also helpful to ask the patient if his or her friends engage in such behaviors as peer relationships hold an important influence. 

    • Examples of ways to ask about self-injurious behaviors: 

      • "How do you manage your emotions (anger, sadness, distress)?"

      •  "Have you ever hurt yourself just to help you with the feelings?”

      • “Have you felt so numb, you thought you would cut yourself or hurt yourself to see if you could feel something?".

  • Given that this is often a hidden and/or secretive behavior, it is important to examine the patient in a gown.

    • If you see such a scar, consider saying something such as "some of my patients that I've seen these same types of scars on have created these themselves by using a sharp object to help handle the way they're feeling."

  • Therapy is foundational to the management of self-injurious behavior. Dialectical behavioral therapy is the preferred type of therapy. Cognitive behavioral therapy also works well especially if there is a component of OCD. For patients engaging in self-injury who do not respond to therapies, adjunctive pharmacotherapy such as selective serotonin reuptake inhibitors can be of benefit. 

  • Patients can be taught new skills and behaviors to replace self-injury as means to cope with distress. Journaling or listening to music can be helpful. Another behavior to suggest, is to use an ice cube when the patient feels the need to cut.

 

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Hippo Peds RAP June 2021 Written Summary 199 KB - PDF

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