A 7-year-old girl scratching holes in herself

Case scenario

Emma is aged 7 years and lives with her mother and stepfather and her adored baby sister. She spends most weekends with her father who has moved back into the home of his elderly parents. Emma’s mother brought her in to the surgery and confided that she was at her wit’s end because Emma was recurrently scratching holes in herself.

It appeared that a kind of ritual had developed where Emma started to rub a small area of her skin harder and harder until she was able to penetrate the skin with her fingernail and dig out a small lump of flesh. She had about seven or eight scabbed holes on her trunk and limbs and even a couple medial to her scapula, where she hoped her mother wouldn’t see.