Self-mutilation
(Self-injury; Self-harm)
by Rick Alan
Definition
Self-mutilation or self-injury is any form of self-harm inflicted on your body without the intent to commit suicide. Self-mutilation may be performed to release emotional pain, anger, or anxiety; to rebel against authority; to flirt with risk-taking; or to feel in control. In some cases, the behavior is outside your emotional control and related to a neurological or metabolic disorder.
The behavior is not considered socially appropriate. It is also not part of a religious custom or a form of art.
Causes
Self-mutilation is a severe impulse control disorder that is often associated with other psychiatric disorders, such as:
- Borderline personality disorder
- Depression
- Substance abuse, such as alcoholism or drug abuse
- Eating disorders, such as anorexia or bulimia
- Psychosis
- Antisocial personality disorders
- Post-traumatic stress disorder
Brain—Psychological Organ
Self-mutilation is often associated with psychiatric disorders that may be caused by chemical imbalances in the brain.
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It can also be associated with neurologic or metabolic disorders such as:
- Tourette syndrome —a neurological disorder
- Autism —a disorder that results in social, behavioral, and language problems
- Lesch-Nyhan syndrome —a genetic disorder
Risk Factors
Factor that increase your chance of developing this condition include:
- Childhood sexual, physical, or emotional abuse
- Violence or other abusive relationships in a child's home
- Post-traumatic stress disorder
- Being in prison
- Sex: female
- Age: adolescence
- Intellectual disability
- Autism
- Certain metabolic disorders
Symptoms
The symptoms of self-mutilation vary. The most common symptoms include:
- Cutting of skin with a sharp object
- Skin carving or burning
- Self-punching or scratching
- Needle sticking
- Head banging
- Eye pressing
- Finger, lips, or arm biting
- Pulling out one's hair
- Picking at one's skin
Rarely, in very severe cases, self-mutilation can include:
- Broken bones
- Amputation
- Castration
- Suicide
Diagnosis
Self-mutilation can be difficult to diagnose. People who self-mutilate often feel guilty and ashamed about their behavior. They may try to hide it. Physical harm caused by self-multilation may be the first sign noticed during an exam. To be diagnosed, symptoms should meet the following criteria:
- Excess concern with physically harming oneself
- Inability to resist harming oneself, resulting in tissue damage
- Increased tension before and a sense of relief after self-injury
- Having no suicidal intent in the self-mutilation
To make an accurate diagnosis, the psychologist or psychiatrist will assess other conditions, like personality or mood disorders, and whether there is suicidal intent.
Treatment
Treatment usually includes medical and psychological treatment, as well as medications.
Medical Treatment
A doctor will assess whether care needs to be provided right away to prevent further injury due to ingestion, wound, or other bodily harm.
Psychosocial Assessment
This assessment may be administered to assess a person’s mental capacity, level of distress, and presence of mental illness.
Psychologic Treatment
Psychologic treatment may be done either one-to-one or in a group setting. It is usually aimed at finding and treating the underlying emotional difficulty, trauma, or disorder. It may also include cognitive behavioral therapy.
Medications
Medications used include:
- Antidepressants
- Antipsychotics
- Mood regulators
- Anticonvulsants
Prevention
The best prevention is to get help as soon as possible for depression, trauma, emotional problems, or other disorders that may lead to self-mutilation.
RESOURCES:
American Psychological Association
http://www.apa.org
Mental Health America
http://www.mentalhealthamerica.net
CANADIAN RESOURCES:
Canadian Mental Health Center
http://www.cmha.ca
Canadian Psychological Association
http://www.cpa.ca
REFERENCES:
Diagnostic and Statistical Manual of Mental Disorder . 4th ed. Washington, DC: American Psychiatric Association; 2000.
National Collaborating Centre for Mental Health. Self-harm: the short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. National Institute for Health and Clinical Excellence website. Available at: http://www.nice.org.uk/nicemedia/pdf/CG016NICEguideline.pdf . Updated July 2004. Accessed February 20, 2013.
Self-injury in adolescents. American Academy of Child and Adolescent Psychiatry website. Available at: http://www.aacap.org/publications/factsfam/73.htm . Updated December 2009. Accessed February 20, 2013.
Slee N, Garnefski N, van der Leeden R, et al. Cognitive-behavioral intervention for self-harm: randomized controlled trial. Br J Psychiatry . 2008;192:202-211.
Taiminin T, Kallio-Soukainen K, Nokso-Koivisto H, Kaljonen A, Helenius H. Contagion of deliberate self-harm among adolescent inpatients. J Am Acad Child Adolesc Psychiatry . 1998;37:211.
Last reviewed March 2013 by Rimas Lukas, MD
Last Updated: 03/15/2013