"There's a profile of patients who self-injure from the adult literature that's emerged," Peebles said. "There are higher incidences of self-injurious behavior in adults with eating disorders who binge eat or purge, have bulimia nervosa, have a history of abuse or have abused drugs."
The patients who did have documentation of screening were more likely to fit the profile, Peebles said, although she added other patients were screened who did not fit the profile.
Other experts said many clinicians don't know much about cutting other forms of self-injury.
"For a long time, professionals saw these as distinct issues and diagnoses, and for a long time there was a lack of research on cutting [and] self-injury," said Christopher Willard, a psychologist at Tufts University in Boston. "Nowadays, we see more cutting than we did in the past, which is unfortunate. But we also research it more thoroughly, so that hopefully this will mark a change in how we as professionals screen for these behaviors."
Willard said mental health practitioners often focus their attention on the symptoms of eating disorders and overlook other issues.
Peebles hopes the study will encourage more universal screening for self-injurious behaviors.
"We do know that self-injurious behaviors happen more in adolescents with other issues, such as mood disorders or drug abuse, and people with eating disorders often have the same symptoms, so it makes more sense to screen more universally," she said.
Clinicians also should pay special attention to these behaviors if an eating disorder seems to be improving.
"The eating disorder gets better, but cutting may go up, or if the cutting goes down, substance abuse may go up, et cetera," said Willard.
Danielle's doctors and counselors always have asked whether she wanted to hurt herself, and she's very glad they did.
She said she no longer has any desire to go back to that night when she took a razor to her legs in the shower.
"Now I just cry or yell or do whatever works without physically hurting myself," she said.