Why are More Kids Hurting Themselves?

Learn the “Why” and what to watch for.

Growing up — feeling comfortable in our own bodies, knowing well our own thoughts and feelings — has never been easy, but many child advocates say that this long, arduous process has become even more difficult, what with the pressures of school and social media.

Now a 15-year study of emergency room visits seems to confirm suspicions that the emotional suffering of girls and young women, especially while traversing those tough middle school years, is getting worse.

ER visits for incidents of self-harm by 10- to 24-year-old females unexpectedly spiked after 2008, according to data gathered by the Centers for Disease Control and Prevention.

In fact, the number of girls and young women admitted to emergency rooms for nonfatal self-inflicted injuries grew by 8.4 percent annually between 2009 and 2015. In comparison, the number of emergency room visits for nonfatal self-inflicted injuries in males of the same age range has remained stable.

University of Miami Health System clinical psychologist Claudia A. Ranaldo and Dr. Samantha Saltz, physician in the department of Psychiatry and Behavioral Sciences have witnessed this surge with female patients but are not sure to what it can be attributed.

“I’ve seen quite a bit,” Dr. Saltz says, “but I don’t know if it’s because there are more cases or if it’s because young women are seeking more treatment. Physicians, teachers, and professionals all are encouraging youth in need to seek mental health care.”

Most patients come to the Dialectical Behavior Therapy Program for Adolescents, where Dr. Ranaldo serves as clinical director, after being reported by school or pediatrician, sometimes parents, yet “typically parents aren’t aware,” Dr. Ranaldo adds.

Most kids don’t show their parents what they’re doing, but their friends or peers may know or suspect something.

Dr. Samantha Saltz

Ingesting pills or poisons was the most popular method used by girls and young women admitted to emergency rooms for self-harm, though some were also treated for injuring themselves with sharp objects. In line with the national data, Dr.s Saltz and Ranaldo have also noticed an uptick in middle schoolers who cut or burn themselves.

Between 2001 and 2005, 10- to 14-year-old girls rarely needed emergency room care for self-harm. After 2009, however, their rates of emergency room visits began to match the rates of young women between 20 and 24 — or about 318 per 100,000 women.

Such behavior is particularly worrisome because self-inflicted injury is one of the strongest risk factors for suicide, the second leading cause of death among those aged 10 to 24. Girls’ suicide rate has doubled in the past decade, hitting a 40-year high in 2015, according to the CDC. (Teen boys’ rate has increased by more than 30 percent.)

While not all those who self-harm are suicidal, “it’s still a big concern,” Dr. Ranaldo adds.

“No matter what, the child needs to be seen right away.” The program she runs uses an evidence-based treatment called Dialectical Behavior Therapy for Adolescents, or DBT-A, which helps teens handle stress, improve relationships, and manage emotions. Using private and group therapy, the treatment teaches mindfulness, acceptance, and cognitive-behavioral skills – and how to apply them in real-life situations.

Like many other experts, Dr.s Ranaldo and Saltz point to social media and smartphones as potential culprits in the rise of self-harm by teens.

By 2015, 73 percent of teens had smartphones, with easy access to each other and to the infinite world of the web. Research has shown that teens who spend five or more hours a day online were 71 percent more likely to have at least one suicide risk factor when compared to teens who spend only one hour a day online. Screen time not only cuts back on face-to-face social interaction and interferes with sleep, but it also can make teens more vulnerable to cyberbullying.

You can now be bullied 24/7. You can’t escape the playground. You’re vulnerable all the time.

Dr. Samantha Saltz

When a case of self-injury is discovered, it often proves devastating for parents, who tend to blame themselves.

But both Dr.s Ranaldo and Saltz say there are ways to ensure parental peace of mind:

• Ask your teen if she is self-harming. Some teens will answer honestly. They want to tell someone.
• Check the teen’s internet searches. Include phone, tablet, or any other device she has access to. Web searches can be telling.
• Observe if she’s covering up more than usual. In South Florida, wearing long sleeves and long pants in hot weather could be suspicious. Teens tend to self-injure in “invisible” parts of the body such as upper forearms, upper thighs and stomach.
• Keep in mind that a teen may not show signs of depression, such as fatigue, trouble concentrating, feelings of hopelessness and worthlessness, and persistent sad or empty feelings. Instead the teen may be experiencing anxiety symptoms that lead her to self-harm, as self-injury may dull her emotional pain or release tension. (Signs of anxiety include nervousness, restlessness, feelings of panic or dread, digestive problems, and difficulty focusing.) Ranaldo and Saltz have noticed more girls reporting and exhibiting anxiety.
• Give your child support and understanding. Assure them that, with the right professional help, together you can find alternative ways to help her cope with the emotions that drive her behavior.
• Seek professional help if you suspect something. Telling her to stop or threatening doesn’t work. “Make sure the child gets help,” Dr. Ranaldo says. “This is definitely treatable.”

In Their Words

Tags: adolescent health, behavioral health, Claudia A. Ranaldo, Dialectical Behavior Therapy for Adolescents, Dr. Samantha Saltz, mental health, self harm, teens