Deliberate self-harm peaks at adolescence
Deliberate self-harm (DSH)
Deliberate self-harm peaks at adolescence and is generally low in childhood. Suicidal ideation is relatively common in adolescence with 10–20 per cent experiencing such thoughts over the past year. DSH is generally uncommon in early childhood and is more common in boys. After the age of 12, DSH is f ive times more common in girls than boys. Self-poisoning is the common form among girls (Shaffer et al. 1996). Common features found in the background of children attempting DSH include broken homes, discordant family life with psychosocial conflict. Parental psychiatric disorder and substance abuse/alcohol abuse are more common. A history of sexual abuse or physical abuse may be present. Roughly one fifth of the children will have made a previous attempt at DSH (Shaffer 1974).
All children who self-harm should have a full psychiatric assessment. Children who commit DSH may be seen in Accident and Emergency departments or be admitted to an inpatient ward where they can be seen once the toxic effects of an overdose have been dealt with. As DSH commonly involves adolescents, clear protocols need to be in place to meet the needs of these children so that they do not fall into the gaps between the medical and mental health services for children and those for adults. Factors indicating the suicide risk of children following an incident of DSH are shown in Table 18.2. Most children who self-harm should be offered followup after assessment.