Question regarding teen self-injury and mandatory reporting.

[KidsHappen]

As many of you know my teen dd had an episode of self-injury back in Dec. As far as I know there have been no further episodes but she does have scars. She has an appt. on Friday with our regular family dr. and I know that he will ask questions. I am concerned about him thinking that there might be abuse and I know that dr.s are mandatory reporters. I trust my family dr. and I have no problem being frank with him. I also understand that they will probably want to talk my dd alone but I know that she will not be very communitive with him. She does not want to discuss this and she is not going to answer his questions. What is the best way to handle this situation? I obviously don't want to involve the law or child services or put our family through any additional (and unnecessary) trauma. Should I call him and talk to him ahead of time? I have talked to my psychiatrist about this situation and I will consult her tomorrow. Her advise so far has been that as long as the behavior does not continue to not put pressure on my dd to talk about it until she is ready. I would especially appreciate input from anyone who has direct experience with this kind of situation from any POV.

[Amy in Orlando]

((())) I'm sorry you're going through this at all. I'd probably call both doctors as early as you can and have them get in touch with each other before the appointment. I think if the family doctor gets all the background and knows that you're actively involved in helping your doctor it should be fine. If you can't get the doctors to connect, I'd reschedule the appointment until such a date that they had talked to each other.

[Alice]

I'm a pediatrician. I would imagine that if I saw your daughter and knew your family well I wouldn't feel like I had to report abuse. Self-injury scars should appear different than typical abuse scars. (Sorry that this sounds so blunt, I can't think of a way to phrase it gentler.) I would be more concerned if I thought the parents weren't aware and so the teen had noone involved in helping her.

 

It is always extremely helpful to have a parent call and talk ahead of an appointment if there is this kind of thing to discuss. And it's always extremely helpful to hear from psychiatrists, although that happens very very rarely as psychiatrists are restricted by confidentiality on what they can discuss with us. The patient (not the parent) has to give them the ok to talk to us, and so we hardly ever get info from them. From your post, I wasn't sure if your daughter had seen the psychiatrist or not. If not, I'm not sure how helpful it would be to talk to the psychiatrist.

 

We're also pretty used to uncommunicative teens. :)

 

I would definitely call your family doctor ahead of the appointment and give him the heads-up.

[Danestress]

I should think that you could sigh a waiver allowing the Psychologist to talk to the Pediatrician directly - letting him/her know about the situation and the treatment plan.

[TCoppock]

I'm sorry you have had to deal with this. Although I have not been through this situation I think it would be helpful to call your child's pediatrician and let him know what has happened. I would make it clear that this is being taken care of by the psychiatrist too. You don't want to add stress to your DD by having the Dr ask probing questions. I always think that the more information you can provide to the DR the better they are able to treat you.

[KidsHappen]

I called the dr. and talked to him ahead of time. He spent about an hour with us at the appt. and talked to both of us extensively about teen self-injury and her particular expression of this. Her problem is possibly OCD related. She is also having a lot of anxiety, panic-attacks and insomnia that could either be related to this or perhaps in addition to it. The best option would be an SSRI but my dd is adamant about not taking that class of medication. He talked to her about why she didn't want to take it and that her concern was not supported by the facts but she still doesn't want to take it. So, we are going to try a different medication. I did tell him that I was very concerned and stressed about this but neither he nor my psychiatrist are as alarmed about it as I thought they would be so maybe I am over-reacting. He said that it is actually not uncommon in this generation. He said that some teens use it as a way to distract themselves from difficult emotions that they may be having. It would be easier to figure out if she was more willing to discuss it but she doesn't seem to be ready to do that. I am somewhat relieved to have discussed it with him and I am so glad that I was out of the hospital and able to deal with it. Of course I will follow-up with both my him and my psychiatrist.

[Chris in VA]

(((Kidshappen)))

 

My ds16 has had multiple problems, which started with substances and progresses to severe cutting, then more severe addiction, so I've been there. Your Dr. is right, cutting and self-injury is extremely common now among teens. In fact, my son's counselor actually expects kids he sees to cut.

Just to tell you, a person does not need to be ready to talk in order to start treatment. While I totally understand your desire to make sure she is ready, and to honor her decision not to talk, I feel I need to say that self-injury is rarely isolated, and rarely occurs just once. I'm so glad you are following up with your psychiatrist.

If I were you (and I'm not--I totally view you as capable of making a loving decision, just offering here), I would find a counselor for your daughter--someone who specializes in self-injury AND kids. It's pretty common for doctors to recommend meds, but they don't do so lightly, so that's your clue that this is very serious. Self injurious behavior is hard to remediate. The sooner one gets into treatment, the more likely it will be successful.

I don't want to alarm or scare you, and of course, the temptation is to speak to you thru the lens of my own experience with ds, but I really wish we had done more, earlier, for ds.

 

Hang in there. I'll be praying for your daughter--it's hard enough to be a teen nowadays, without mental illness being in the picture, so I have a lot of compassion for those dear ones going thru these tough trials. And for you, too, as I have a ton of compassion for the parents!