MHM Magazine

Issue 3 | 2023 | MENTAL HEALTH MATTERS | 7 MHM There has been a significant increase in self-harm in the last decade among adolescents with the prevalence rates increasing due to the heightened levels of stress, anxiety, and depression within their age group. It’s one of those symptoms that create a sense of helplessness in parents, caregivers and teachers as well as healthcare professionals with self-harm amongst the commonest reason for referral to child and adolescent mental health services. Adolescent self-harm is a major public health concern, and prevention and treatment require universal measures aimed at youth in general and targeted interventions in those groups identified as high risk. The risk factors for self-harm include genetic vulnerability, psychiatric, psychological, familial, social and cultural factors. The effects of media and contagion play an important contemporary role. Self- harm often creates confusion among healthcare professionals, and it’s important for healthcare professionals to gain a better understanding of what self-harm is, the function and triggers of self-harm, and the assessment and management of adolescents who self- harm. WHAT IS SELF-HARM? Self-harm is defined as any form of intentional non-fatal self-poisoning or self-injury (such as cutting, taking an overdose, hanging, self-strangulation, restricting, etc.), regardless of motivation or the degree of intention to die. Only a small percentage of individuals who self-harm present to the hospital and this behaviour is largely hidden (from clinical services) at the community level. Fear of stigma, and reactions of parents, peers, and other adults are among the reasons that adolescents who self-harm, don’t seek help. HOW COMMON IS SELF-HARM? The age of onset is approximately 12 years, although there is a stronger association with puberty rather than chronological age. Self-harm is more common in adolescent females than males and community studies show a prevalence of 10% of adolescents reporting self-harm. The male: female ratio in 12–15-year-olds is 1:5-6. Presentation to the hospital only occurs in approximately one in eight adolescents who self-harm, with overdose being the commonest presentation. Research shows that fifty percent of adolescents who self-harm will use self-harm repeatedly. WHAT ARE THE FUNCTIONS OF SELF- HARM? The major purpose of self-harm appears to be affect regulation and management of distressing thoughts. When an adolescent feels overwhelmed by negative feelings, self-harm can be an effective, although maladaptive strategy to stop or reduce the negative thoughts and emotions. Experimental data support the affect regulating aspect of self-harm, as adolescents with self- harm demonstrated higher levels of physiological arousal during a stressful task compared to adolescents without self-harm. Self-harm is associated with a rapid decrease in heart rate. Self- harmmay also regulate emotions by increasing the affective experience, as they may have a subjective experience of being ‘emotionally numb’ or ‘empty’ Dr Alicia Porter Psychiatrist Johannesburg SELF-HARM ‘THE NEW ADOLESCENT MENTAL HEALTH PANDEMIC’