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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 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:
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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It can also be associated with neurologic or metabolic disorders such as:

Risk Factors

Factor that increase your chance of developing this condition include:

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:

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.

Revision Information

  • Reviewer: Rimas Lukas, MD
  • Review Date: 03/2013 -
  • Update Date: 00/31/2013 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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