Why are my teen patients self-cutting?

Social media rise makes teens more vulnerable.

I must be a terrible doctor. That was one possibility I thought of to account for the six teenage patients of mine who over a recent three-month period presented to emergency rooms for depression and suicidal thinking. They were all between 14 and 16. The four who were girls had been actively selfmutilating, colloquially known as “cutting.” Four of the six teens were admitted to an in-patient psychiatric ward as significant and immediate “dangers to themselves.” In other words, the psychiatrist in the emergency room deemed them suicide risks.

I’ve been in practice for 40 years. I’d guess over those decades I averaged about two or so hospital admissions a year. I’ve been extremely fortunate that none of the children and teens I’ve actively managed have ever killed themselves. I’ve always felt I’ve been on the overly cautious side in sending these kids to ERs for evaluations. But I know I’ve also been just lucky — as when that wayward, distraught boy I knew gave the loaded gun he held to his head to his mother, and hadn’t pulled the trigger.

So six emergencies in three months was unusual for me. Besides questioning my abilities, I had been noticing for a while how children’s coping had changed. I had wondered if it was just my experience until I read about a study that appeared in the Journal of the American Medical Association last November. The researchers looked at national rates of self-inflicted injuries (primarily poisoning and self-mutilation) between ages 10 and 24 that were evaluated in ERs from 2001 to 2015.

The overall rate for ER visits for selfharm rose 51%. But more striking than this increase was who was doing the bulk of the overdosing and cutting, and when it got really out of control. Rates of self-harm for boys and young adults have not changed much. But the rates for girls 10 to 14 increased by 166% and for those 15 to 19 by 62%. Overall poisonings only rose by 19% over this period, but injury from sharp objects went up by 152%. Notably the vast bulk of the increase in cutting started in 2009. Since then, cutting by younger girls has increased by 18.8% a year!

The researchers were understandably cautious in speculating upon the reasons for this disturbing trend, which they said needed further study. I am not bound by the same constraints. We cannot wait to address this mounting epidemic. There are many factors that go into making a national psychiatric disorder epidemic, and studying it is an enormous challenge. But I am especially struck by the 2009 start of the major increase in teenage girls’ self-harm.

Facebook became available to children age 13 or over in 2006. MySpace was one of the most popular social media sites between 2005 and 2008, when it was overtaken by Facebook. Instagram went online in 2010 and Snapchat in 2011. Teenagers are probably the greatest users of social media and are certainly the most ill equipped to limit its dangers to their emotions, self-image and self-esteem. Many are getting quite depressed and suicidal, and they cut to relieve their stress.

Google “how to cut yourself ” and check out the first five website citations. The Internet has created these special communities of interest. The irony of our concerns about our children killing themselves (teenage suicide rates continue to creep up) is that talk of depression and suicide is constantly in the air these days on high school and middle school campuses.

Of course, many other factors are creating this unhappy atmosphere. Parents can’t change the social, economic and political conditions of our country overnight. However, they can ask their teenagers to turn over their cell phones, iPads and laptops at 9 p.m. Parents also can work at disengaging themselves from their own online activities — especially around dinner time, so they can eat a meal with their kids and without electronics.

I’ve been lucky, as I said, in that not one of my patients has committed suicide yet. But unless we take a close look and change our electronic habits, I fear my luck will run out.

Dr. Lawrence Diller, an assistant clinical professor at the University of California-San Francisco, practices behavioral pediatrics and family therapy in Walnut Creek, Calif.