self-mutilation

Self-Mutilation 

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

The prognosis depends on the presence and severity of other emotional disorders, and a history of sexual abuse and/or suicide attempts. In general, teenagers without a history of abuse or other disorders have a good prognosis. Patients diagnosed with borderline personality disorder and/or a history of attempted suicide are considered to have the worst 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.

Key terms

Borderline personality disorder (BPD) — A pattern of behavior characterized by impulsive acts, intense but chaotic relationships with others, identity problems, and emotional instability.

Dissociation — The splitting off of certain mental processes from conscious awareness.

Dissociative disorders — A group of mental disorders in which dissociation is a prominent symptom. Patients with dissociative disorders have a high rate of self-mutilation.

Endorphins — Pain-killing substances produced in the human body and released by stress or trauma. Some researchers think that people who mutilate themselves are trying to trigger the release of endorphins.

Resources

Books

Eisendrath, Stuart J., M.D., and Jonathan E. Lichtmacher, M.D. "Psychiatric Disorders." In Current Medical Diagnosis & Treatment 2001, edited by L. M. Tierney, Jr., MD, et al., 40th ed. N. New York: Lange Medical Books/McGraw-Hill, 2001.

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.

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self-mutilation,

n the act of deliberately causing injury to oneself.

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self-mutilation

the animal damages itself by biting or by violent and persistent scratching or rubbing, e.g. cattle with pseudorabies, sheep with pseudorabies. A degree of injury beyond self-trauma.

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self-mutilation

Neurology The physical abuse of a person's body by its owner, often over a psychogenic substrate; SM is also an integral component of certain hereditary conditions–eg, Lesch-Nyhan syndrome, Cornelia de Lange syndrome, attributed to neurotransmitter imbalances Psychiatry Auto-destruction, perpetuated in various guises by ± 1:1500 population; most SM is psychogenic in origin, and may be related to physical confinement, deprivation, depression, often related to childhood experiences; SM may be a form of self-cleansing to cauterize the 'pain of living'