Radiologists identify and treat teenage self-injury

September 07, 2010

OAK BROOK, Ill. - Using ultrasound and a minimally-invasive procedure, radiologists can identify and treat patients who engage in a disturbing self-injury behavior known as self-embedding, according to a new study published in the online edition and October print issue of the journal Radiology.

"This is a new way for radiologists to impact public and mental health," said the study's senior author, William E. Shiels II, D.O., chairman of the Department of Radiology at Nationwide Children's Hospital in Columbus, Ohio, and president of The Children's Radiological Institute. "Radiologists can be in a position to interrupt a cycle of self-harm with effective, early diagnosis and referral for appropriate behavioral health and foreign body removal."

Self-injury, or self-harm, refers to a variety of behaviors in which a person intentionally inflicts harm to his or her body without suicidal intent. It is a disturbing trend among adolescents, particularly girls. Prevalence is unknown because many cases go unreported, but recent studies have reported that one in five high school students has practiced deliberate self-injury at least once. More common forms of self-injury include cutting of the skin, burning, bruising, hair pulling, breaking bones or swallowing toxic substances. In cases of self-embedding, objects are used to puncture the skin or are embedded into the wound after cutting.

Dr. Shiels and colleagues studied 21 episodes of self-embedding behavior in 11 teenagers, including nine girls and two boys, age 14 to 18. Objects had been present for time periods between 2 days and an unknown number of years. Using ultrasound and/or fluoroscopic guidance, interventional pediatric radiologists removed 68 of the 76 embedded foreign objects found in the patients. The embedded objects included metal, glass, wood, plastic, graphite, crayon and stone. The objects were embedded during injuries to the arms, ankles, feet, hands and neck. One 18-year-old patient with repetitive behavior had self-embedded 35 objects over two years time, including staples, a comb tooth, a fork tine, a cotter pin and nail polish wands.

Ultrasound guidance allowed the researchers to detect the presence and location of wood, crayons and plastic objects, not detectable on x-ray examinations. Removal was performed through small incisions in the skin that left little or no scarring and was successful in all cases. There was one incident of fragmentation, but all fragments were removed.

"Early detection and removal of these foreign bodies are key steps for these teenagers to engage in effective therapy and interrupt their cycle of self-harm, so they can recover and grow as healthy and successful adults with good coping skills," Dr. Shiels said.

Radiological Society of North America

Treating Self-Injury: A Practical Guide
by Barent W. Walsh PhD (Author)

Uniquely practical and comprehensive, this timely guide addresses a problem that is on the rise, particularly among adolescents and young adults. Practitioners gain a wealth of knowledge about the variety and causes of self-injurious behavior and how to recognize it in people at risk, ranging from those who do not have psychiatric diagnoses to those with eating or mood disorders, posttraumatic stress disorder, personality disorders, or psychoses. Illustrated with detailed case examples, clear guidelines are presented for assessing clients and conducting evidence-based interventions using replacement skills training, cognitive-behavioral therapy, exposure treatment, psychopharmacology, and family- and school-based strategies. Reproducible clinical materials are included....

The Tender Cut: Inside the Hidden World of Self-Injury
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Helping Teens Who Cut: Understanding and Ending Self-Injury
by Michael Hollander PhD (Author)

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Alone

Willow, a 23 year-old artist, has secluded herself for so long for the sake of keeping her art true to who she is. A bad relationship with her mother, and being turned away by friends while in high school, has caused Willow to do the unthinkable and she turns to a knife for the only comfort she knows.

Being a cutter for almost half her life, Willow doesn't know any other way to deal with her emotions. Although she is a successful artist, she still feels a sense of emptiness and loathing inside. She knows that she needs to learn to love herself again, but she doesn't even know where to begin...

Scars That Wound, Scars That Heal: A Journey Out of Self Injury (Live Free)
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This is Jackie's story of repeated self-injury and how relationships with those who came alongside hertogether with a deeper understanding of God's love and patiencebrought her to a place of hope and healing.The Live Free series for teens and young adults tackles real questions about real lifequestions about sex, family problems, relationships, body image, and the future. You’ll discover firsthand stories of teens and their personal struggles, journeys, and spiritual healing that comes with real freedom. Each chapter includes Scriptures, journaling prompts, tips for supporting the person seeking help, and questions designed for personal reflection or small group discussion.

A Bright Red Scream: Self-Mutilation and the Language of Pain
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by Jerusha Clark (Author), Earl R. Henslin (Contributor)

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This book explores the complex issue of cutting without offering any pat or simple fixes. It examines the psychology of, the feelings of anger and despair behind it, and the counseling resources that can help.

This book is a great tool to help those who engage in cutting, pastors who want to learn more, or those who need to understand someone who practices self injury.

Slices: A Memoir-in-progress

In "Slices," Violet Wilson looks back at her first years away from home, first at college, then after dropping out, as she struggles to make sense of her urges to cut herself. She doesn't offer neatly wrapped-up explanations of her motivations; the vignettes focus on what she thought and how she felt in the moment. The few dispassionate memories of childhood abuse are not served up as "A-ha!" explanations, since that's not how it felt at the time. There is a lot of confusion, a lot of shame, and a lot of failed attempts to connect. But there are also some patient friends, a couple of morbidly comic moments in a mental hospital and at a funeral, and, by the end, a tiny smidgen of hope that Violet will find her way.