麻豆果冻传媒

For Release: September 27, 2010

STANFORD, Calif. - An alarming number of adolescents already battling eating disorders are also intentionally cutting themselves, and health-care providers may be failing to diagnose many instances of such self-injury, according to a new study from Stanford University School of Medicine and Lucile Packard Children鈥檚 Hospital.

The researchers found that 40.8 percent of patients with eating disorders in their study had documented incidents of intentionally harming themselves, most often by cutting and burning. What鈥檚 more, the study suggests that inadequate clinical screening might mean the count should be much higher. 鈥淭hese are very high numbers, but they鈥檙e still conservative estimates,鈥� said the study鈥檚 lead author Rebecka Peebles, MD, who was an instructor in pediatrics at Stanford when the research was conducted and is joining the faculty at Children鈥檚 Hospital of Philadelphia.

Peebles noted that clinicians aren鈥檛 routinely asking about this activity. 鈥淲e ask 97 percent of children 12 years and up if they smoke cigarettes; we need to get that good with screening for self-injurious behavior,鈥� she said. The study is to be published online Sept. 28 in the Journal of Adolescent Health. Its senior author is James Lock, MD, PhD, professor of psychiatry and behavioral sciences and of pediatrics. He is also psychiatric director of the Comprehensive Eating Disorders Program at Packard Children鈥檚 Hospital.

To conduct the study, the researchers examined the intake evaluation records of 1,432 patients, ages 10-21, who were admitted to the hospital鈥檚 eating disorders program from January 1997 through April 2008. Just over 90 percent of all the patients were female, three-quarters of them white, with a mean age of 15. Among the 40.8 percent identified to be physically harming themselves, the mean age was 16. Many of these patients had a history of binging and purging, and 85.2 percent of the self-injurers were cutting themselves. The researchers also discovered that slightly fewer than half the charts showed that health-care providers had asked patients if they intentionally injured themselves. If patients aren鈥檛 asked, they are unlikely to volunteer such information, said Peebles.

Those who were questioned tended to fit previously published profiles of a self-injurer: older, white, female, suffering from bulimia nervosa, or with a history of substance abuse. 鈥淭he question is, 鈥楢re we missing other kids who are not meeting this profile?鈥欌�� Peebles said. 鈥淭his is part of why we wanted to look at this. If you see an innocent-looking 12-year-old boy, you don't even think of asking about self-injurious behavior. We need to get much better about universal screening.鈥� Peebles noted that the profile itself might be flawed. If health-care workers only ask a certain type of patient about a behavior, the profile that emerges will necessarily reflect that bias, she said. The study did not examine the reasons behind such acts but Peebles said her clinical experience suggested patients 鈥渁re trying to feel pain.鈥�

鈥淧atients describe a feeling of release that comes when they cut or burn themselves,鈥� she said. 鈥淭hey'll cut with a razor or a scissor blade. Sometimes we鈥檝e even had kids who will take the tip of a paper clip and gouge holes. To burn themselves, they鈥檒l heat up a metal object and press it to their skin, or they鈥檒l use cigarettes.鈥� Physicians and other health-care providers at Packard鈥檚 Comprehensive Eating Disorders Program now question all new patients about self-injurious behavior. Studies have shown that between 13 and 40 percent of all adolescents engage in some form of self-injury, which is also associated with a higher risk of suicide.

鈥淚n clinical practice, kids are fairly open when you engage with them,鈥� Peebles said. 鈥淭hey'll come in wearing long sleeves, or hiding the marks on their inner thighs. But then when you ask them, they are usually willing to discuss the behavior.鈥� The study鈥檚 other author is Jenny Wilson, MD, who was a resident in pediatrics when the study was conducted.

The study was funded in part by the Stanford Child Health Research Program. Information about the Departments of Pediatrics and of Psychiatry and Behavioral Sciences, which also helped to support this study, is available at and .

Authors

Robert Dicks
(650) 497-8364
rdicks@stanfordchildrens.org