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June 20, 2012 — Children as young as 7 years report cutting, burning, hitting, or otherwise harming themselves, although their intent is not to commit suicide, new research shows.

A community-based study of 655 children suggests that young children engage in nonsuicidal self-injury (NNSI) at a rate similar to that seen during early adolescence.

"There has been a lot of research on cutting, burning, or harming yourself without wanting to die in high school kids and young adults, and only 3 or 4 in middle schoolers, but no one has studied this in younger children," Benjamin L. Hankin, PhD, associate professor of psychology at the University of Denver, in Colorado, who is a coauthor of the study, told Medscape Medical News.

We wanted to provide some basic descriptive information on how many young children are engaging in self-harming behavior and how they were doing it so that we can get the help and attention these kids need," Dr. Hankin said.

The researchers interviewed 665 children aged 7 to 16 years using the Self-Injurious Thoughts and Behaviors Interview. The children were in grades 3, 6, and 9 and were from the greater metropolitan Denver area and central New Jersey.

"Because this is a general community sample, you can get a good sense of how many kids overall are doing this without that number being biased, so these were all ordinary public schools in 2 geographical areas that are broadly representative of the United States," Dr. Hankin noted.

The study showed that overall, 53 (8.0%) of the children interviewed reported engaging in NSSI during their lifetime. Of that number, 17 youngsters reported that they had self-harmed 1 time only; the remaining 36 children reported that they had self-harmed multiple times.

Girls in the 9th grade appeared to be at greatest risk of engaging in NSSI, hurting themselves 3 times more often than their male peers.

Most (63.6%) of the girls who reported self-injury said that they cut or carved their skin. Among boys reporting self-injury, 55% said they hit themselves.

Most 3rd (60%) and 6th (50%) graders also reported hitting themselves, but among children in the 9th grade, cutting and carving skin was reported by 70.4%.

Other methods used to self-harm, which included biting, pulling hair to cause pain, running into walls, and throwing the body into sharp objects, were reported by 18.9% of the study sample.

"One thing that makes this study unique is that we assessed NSSI across different ages and found that 8% of the youth in our sample reported this behavior," Dr. Hankin said.

"It is commonly thought that NSSI is characteristic of adolescence, but our results show that younger kids engage in this kind of behavior as well," he said. "We didn't know that kids in elementary school were engaging in this."

Dr. Hankin said that the information from this study will be useful to inform the new version of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is expected out next year.

"They have proposed 'nonsuicidal self-injury' as a new psychiatric disorder, and we are trying to paint a picture of what it looks like and how many people have it, because this has not been done before," he said.

Red Flag

Commenting on the findings for Medscape Medical News, Michael A. Scharf, MD, assistant professor in psychiatry and pediatrics and Chief Psychiatrist, Child and Adolescent Mental Health Program, at the University of Rochester Medical Center, in New York, described the study as "novel."

"This is of interest to clinicians who routinely think of these behaviors occurring in older children and adolescents, as it helps to underscore the importance of inquiring about such behaviors when working with younger patients, whether it be in primary care or mental health settings," Dr. Scharf said.

Identifying such behaviors should prompt further assessment of the clinical significance of the self-injury and the factors leading to it, because NSSI can be considered a risk factor for psychopathology, further self-injury, or even future suicidality, he suggested.

"The authors appropriately underscored the importance of asking open-ended questions about self-injury as part of the assessment, rather than asking directly, because a significant number of youth who engaged in NSSI did not endorse using the most common methods," Dr. Scharf added.

The study was supported by the National Institute of Mental Health and the National Institutes of Health. Dr. Barrocas, Dr. Hankin, and Dr. Scharf have disclosed no relevant financial relationships.

Pediatrics. 2012;130:1-7. Full article


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