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Wednesday, May 28th, 2008

| CWK Producer

At thirteen, Melissa Gerjoi tried to kill herself.

“I just wanted to do something, something that would just totally stop everything,” Melissa, now 19, recounts.

She later realized she didn’t want to die; she wanted to get rid of the pain.

 “For some reason, when I’d get depressed, I would just take a razor and I’d cut little slits in my arm,” she says. “And I don’t know why I did it, and I don’t know why it was any consolation whatsoever.”

It was after her father died in a car crash that Melissa started cutting herself. It was her way of coping.

 “Sometimes kids are engaging in this behavior as a way of converting their intense emotional pain into the more tolerable physical pain,” explains Dr. Leslie Apfelbaum, a child psychologist.

According to a study by the Centers for Disease Control, in the year 2005, nearly half a million people were treated in emergency rooms for self-inflicted wounds. More of them were teenagers than any other age group.  Experts say most aren’t trying to die, they’re crying out for help.

 “We actually call it suicidal gestures,” says Dr. Apfelbaum.  “…a way of asking for help without actually doing something too harmful.”

A change in behavior, as well as long sleeves and baggy clothes to hide scars, are clues your child may be hurting themselves.  Professional therapy can help unlock the emotional pain.

Family support and time away at boarding school helped Melissa pull her life back together and stop the vicious cycle of self-inflicted pain.

 “I sort of stopped my life and went on and started a new one,” she says.  “I mean, I totally turned around and changed into a different person.”

Tips for Parents

Self-Injury May Be Path to Suicide

What exactly constitutes self-injury?  According to the American Academy of Child & Adolescent Psychiatry (AACAP), self-injury is the act of deliberately destroying body tissue – at times to change a way of feeling.  Lately it has become a popular among adolescents, and its forms may include the following:

• Carving
• Scratching
• Branding
• Marking
• Picking and pulling skin and hair
• Burning
• Cutting
• Biting
• Head banging
• Bruising
• Hitting
• Excessive tattooing
• Excessive body piercing

The AACAP says that teens engage in self-mutilation in order to take risks, to rebel, to reject their parents’ values, to state their individuality or merely to be accepted by their peers.  Others, however, may injure themselves out of desperation or anger, to seek attention, to show their hopelessness and worthlessness or because they have suicidal thoughts.  Some young children may resort to self-injurious acts from time to time but often grow out of it.  Children with mental retardation and/or autism may also show these behaviors, which may persist into adulthood.  And children who have been abused or abandoned may self-mutilate.

The Self-Harm Alliance cites the following factors that may contribute to a teen’s reasons for self-harming:

• Loss of a loved one
• Physical abuse, such as domestic violence
• Sexual abuse, such as rape or child abuse
• Verbal abuse, such as bullying
• Childhood neglect from one or both parents
• Physical Illness or disability
• Loss of freedom
• Relationship problems

If your child or adolescent is engaging in self-harm, the AACAP says it is important to talk to your child about respecting and valuing his or her body.  You can also help your teen to avoid hurting himself or herself by teaching him or her the following skills:

• To accept reality and find ways to make the present moment more tolerable
• To identify feelings and talk them out rather than acting on them
• To distract himself or herself from feelings of self-harm (counting to 10, waiting 15 minutes, saying “NO!” or “STOP!,” practicing breathing exercises, journaling, drawing, thinking about positive images, using ice and rubber bands, etc.)
• To stop, think and evaluate the pros and cons of self-injury
• To soothe himself or herself in a positive, non-injurious way
• To practice positive stress management
• To develop better social skills

You should have your child evaluated by a mental health professional to identify and treat the underlying causes of self-injury.  A child and adolescent psychiatrist can also diagnose and treat any serious psychiatric disorders that may accompany your child’s self-injurious behavior.

The most severe cases of self-injury result in suicide.  The CDC estimates about 32,000 people commit suicide every year in the United States.  It is the third leading cause of death for 15- to 24-year-old.  The National Association of School Psychologists cites the following signs indicating that your child’s self-injurious behavior may be escalating to suicide: 

• Suicide notes:  These notes are a very real sign of danger and should be taken seriously.
• Threats:  Threats may be direct statements (“I want to die” or “I am going to kill myself”) or, unfortunately, indirect comments (“The world would be better without me” and “Nobody will miss me anyway”).  Among teens, indirect clues could be offered through joking or through comments in school assignments, particularly creative writing or artwork. 
• “Masked” depression:  Sometimes risk-taking behaviors can include acts of aggression, gunplay and alcohol or substance abuse.
• Final arrangements:  This behavior may take many forms, such as giving away prized possessions like jewelry, clothing, journals or pictures.
• Continued efforts to hurt oneself:  Common self-destructive behaviors include running into traffic, jumping from heights and scratching, cutting or marking the body.
• Changes in physical habits and appearance:  Changes include an inability to sleep or sleeping all of the time, sudden weight gain or loss and disinterest in appearance or hygiene.

If one or more of these signs occurs, talk to your child about your concerns and seek professional help when the concerns persist.  With support from family and professional treatment, your child can heal and return to a more healthy path of development.

As a parent, you can help prevent teen suicide in the following ways, according to PROMINA Health System:

• Know the warning signs and when to get a professional assessment.
• Learn who your child is, how he or she feels and what he or she thinks by being more involved in his or her life.
• Improve and enhance adult supervision and socialization and monitor the feelings, thoughts and behaviors of your child.
• Emphasize honest communication and sharing.
• Emphasize honest cooperation with authority and systems, such as school, church, work or rules at home. 

References

• American Academy of Child & Adolescent Psychiatry
• Centers for Disease Control and Prevention
• National Association of School Psychologists
• PROMINA Health System
• Self-Harm Alliance

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