Mental Illness in Children – Clinical Case 1

A 15-year-old boy is brought to the ED for crisis assessment. He appears shy and quiet. He presents with multiple, superficial cuts on both of his arms and has been cutting himself for a year. He told his parents about the self-harm 3 weeks earlier. He said he cuts himself when his mood is low and that he doesn’t want to die. However, he has persisted with cutting himself and the cuts are now becoming deeper.

He reports intrusive thoughts of suicide with a recent increase in frequency and intensity, and he is being bullied at school. Despite these symptoms, his functioning is not impaired; he is doing well in school, is insightful for his age and states that cutting helps him cope with stress and alleviates feelings of loneliness. He describes dips in his mood that seem to be triggered by stressful situations, and he is not sleeping well. Family history reveals depression on the maternal side. He has so far abstained from substance use and shows no signs of intoxication. He has a good relationship with his parents, who describe him as a good kid.