What is Self-Injury, Self-Mutilation, Self-Harm?

Definition

Self-mutilation is a general term for a variety of forms of intentional self-harm without the wish to die. Cutting one's skin with razors or knives is the most common pattern of self-mutilation. Others include biting, hitting, or bruising oneself; picking or pulling at skin or hair; burning oneself with lighted cigarettes, or amputating parts of the body.

Description

Self-mutilation has become a major public health concern as its incidence appears to have risen since the early 1990s. One source estimates that 0.75% of the general American population practices self-mutilation. The incidence of self-mutilation is highest among teenage females, patients diagnosed with borderline personality disorder, and patients diagnosed with one of the dissociative disorders. Over half of self-mutilators were sexually abused as children, and many also suffer from eating disorders.

Self-mutilation should not be confused with current fads for tattoos and body piercing. In some cases, however, it may be difficult to distinguish between an interest in these fads and the first indications of a disorder.

The relationship of self-mutilation to suicide is still debated even though statistics show that nearly 50% of individuals who injure themselves also attempt suicide at some point in their lives. Many researchers think that suicide attempts reflect feelings of rejection or hopelessness, while self-mutilation results from feelings of shame or a need to relieve tension.

Causes and symptoms

Several different theories have been proposed to explain self-mutilation:

• self-mutilation is an outlet for strong negative emotions, especially anger or shame, that the person is afraid to express in words or discuss with others.
• self-mutilation represents anger at someone else directed against the self.
• self-mutilation relieves unbearable tension or anxiety Many self-mutilators do report feeling relief after an episode of self-cutting or other injury.
• self-mutilation is a technique for triggering the body's biochemical responses to pain. Stress and trauma release endorphins, which are the body's natural pain-killing substances
• self-mutilation is a way of stopping a dissociative episode. Dissociation is a process in which the mind splits off, or dissociates, certain memories and thoughts that are too painful to keep in conscious awareness. Some people report that they feel "numb" or "dead" when they dissociate, and self-injury allows them to feel "alive."
• self-mutilation is a symbolic acting-out of the larger culture's mistreatment of women. This theory is sometimes offered to explain why the great majority (about 75%) of self-mutilators are girls and women

The symptoms of self-mutilation typically include wearing long-sleeved or baggy clothing, even in hot weather; and an unusual need for privacy. Self-mutilators are often hesitant to change their clothes or undress around others. In most cases the person has also shown signs of depression.

Diagnosis

Self-mutilation is usually diagnosed by a psychiatrist or psychotherapist. A family practitioner or nurse who notices scars, bruises, or other physical evidence of self-injury may refer the person to a specialist for evaluation.

Treatment

Persons who mutilate themselves should seek treatment from a therapist with some specialized training and experience with this behavior. Most self-mutilators are treated as outpatients, although there are some inpatient programs, such as S.A.F.E., for adolescent females. A number of different treatment approaches are used with self-mutilators, including psychodynamic psychotherapy, group therapy, journaling, and behavioral therapy.

Although there are no medications specifically for self-mutilation, antidepressants are often given, particularly if the patient meets the diagnostic criteria for a depressive disorder.

Alternative treatment

Mindfulness training, which is a form of meditation, has been used to teach self-mutilators to observe and identify their feelings in order to have some control over them.

Prognosis

Prevention

Some society-wide factors that influence self-mutilation, such as the high rate of sexual abuse of children and media stereotypes of women, are difficult to change. In general, however, young people who have learned to express themselves in words or through art and other creative activities are less likely to deal with painful feelings by injuring their bodies.

Resources:

Books:

• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association, 1994.
• Eisendrath, Stuart J., M.D., and Jonathan E. Lichtmacher, M.D. "Psychiatric Disorders." In Current Medical Diagnosis & Treatment 2001 40th ed. n, ed. L. M. Tierney, Jr., MD, et al. New York: Lange Medical Books/McGraw-Hill, 2001.
• Pipher, Mary, PhD. Reviving Ophelia: Saving the Selves of Adolescent Girls. New York: Ballantine Books, 1994.

Organizations:

• American Psychiatric Association. 1400 K Street, NW. Washington, DC 20005. (202) 682-6220. http://www.psych.org.
• Focus Adolescent Services. (877) 362-8727. http://www.focusas.com.
• National Institute of Mental Health. 5600 Fishers Lane, Rockville, MD 20857. (301) 443-4513. Fax: (301) 443-4513. http://www.nimh.nih.gov.

continue: Causes, Symptoms, Risk Factors

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Reviewed: 04/2006