Self-mutilation

(Self-injury; Self-harm)
  • 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 done 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.
  • Causes

    Self-mutilation may be caused by associated psychological problems.
    Brain—Psychological Organ
    Brain
    Self-mutilation is often associated with psychiatric disorders that may be caused by chemical imbalances in the brain.
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  • Risk Factors

    Factor that increase your chance of developing this condition include:
    It can also be associated with neurologic or metabolic disorders such as:
  • 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
    • Wearing long sleeves or pants, even in hot weather
    • Claiming to have frequent accidents
    • Relationship difficulties
    • Behavioral and emotional difficulties
    Rarely, in very severe cases, self-mutilation can include:
  • 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-mutilation 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, such as personality or mood disorders, and whether there is suicidal intent. A psychosocial assessment may also be given to assess a person’s mental capacity, level of distress, and presence of mental illness.
  • 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 treat or prevent further injury.
    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

    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 July 29, 2013.

    Self-injury in adolescents. American Academy of Child and Adolescent Psychiatry website. Available at: http://www.aacap.org/AACAP/Families%5Fand%5FYouth/Facts%5Ffor%5FFamilies/Facts%5Ffor%5FFamilies%5FPages/Self%5FInjury%5FIn%5FAdolescents%5F73.aspx. Updated December 2009. Accessed July 29, 2013.

    Slee N, Garnefski N, et al. Cognitive-behavioral intervention for self-harm: randomized controlled trial. Br J Psychiatry. 2008;192:202-211.

    Taiminin T, Kallio-Soukainen K, et al. Contagion of deliberate self-harm among adolescent inpatients. J Am Acad Child Adolesc Psychiatry. 1998;37:211.

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