Self-mutilation





Self Mutilation 2259
Photo by: Mat Hayward

Definition

Self-mutilation, also called self-harm, self-injury or cutting, is the intentional destruction of tissue or alteration of the body done without the conscious wish to commit suicide , usually in an attempt to relieve tension.

Description

Self-mutilation has become an increasing problem among adolescents since the 1990s. Cutting one's skin with razors or knives is the most common pattern of self-mutilation. Other forms of self-harm include biting, hitting, or bruising oneself; picking or pulling at skin or hair; burning oneself with cigarettes, or amputating parts of the body. Self-mutilation can be episodic (infrequent) or repetitive. Episodic self-harm can progress to repetitive self-harm after as few as five or as many as 20 episodes.

Professional thinking about self-mutilation has evolved over the past 20 years. Before the 1990s, self-mutilation was often identified as a failed suicide attempt. This concept is no longer accepted. As of 2004 self-mutilation was not a specific diagnosis recognized by the American Psychiatric Association. Instead, it is recognized as a feature of other psychiatric disorders. Some researchers dispute this designation and feel self-mutilation should be a separate diagnosis. 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.

Demographics

It is estimated that one in every 100 individuals in the United States, or more than 2.5 million people, are self-mutilators. Girls are four times more likely to engage in self-harm than boys, with girls between the ages of 16 and 25 at highest risk, although many girls begin cutting in middle school (ages 12 or 13). At risk individuals also include those who have underlying psychiatric disorders. Up to half of individuals who are self-mutilators were sexually abused as children.

Causes and symptoms

It is not entirely clear why some individuals mutilate themselves. However, self-injury appears to give these people an immediate release from almost unbearable tension caused by anxiety , anger, or sadness. Some researchers ascribe this response to the release of certain chemicals in the body in response to pain . Like other addictive behaviors, self-mutilation gradually takes more and more destruction to achieve release. Some researchers separate self-mutilators into several groups, based on their psychological condition, motivation for harming themselves, and degree to which they practice self-injury.

The most common form of self-mutilation, and the one usually seen in adolescents, is impulsive self-mutilation consisting of superficial skin cutting and burning. Psychiatrists generally believe that this is a maladaptive form of self-help or self-preservation and is done to achieve release from almost unbearable psychic tension and to give the individual a feeling of control. It is often a feature of psychiatric disorders including the following:

  • borderline personality disorder
  • antisocial personality disorder
  • dissociative disorders
  • anorexia or bulimia
  • post traumatic stress syndrome
  • substance abuse
  • depression

Compulsive self-mutilation consists of repetitive hair pulling ( trichotillomania ), nail biting, and skin picking. It is often found in individuals with obsessive-compulsive disorder (OCD). Major self-mutilation is the least frequent form of self-harm. It involves infrequent episodes of destruction of large amounts of tissue, for example self-castration or self-amputation. Major self-mutilation occurs most often with psychotic or highly intoxicated individuals and occasionally with institutionalized mentally retarded individuals. It is also occasionally associated with autism , Tourette syndrome , and schizophrenia .

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 individual also shows signs of depression.

When to call the doctor

Parents and caregivers should consult a psychiatrist or psychotherapist with professional expertise in self-mutilation as soon as the behavior is discovered. Adolescents rarely do not outgrow this behavior. If left untreated, it can continue into adulthood.

Diagnosis

Self-mutilation is usually diagnosed by a psychiatrist or psychotherapist upon referral from a family member, physician, nurse, or social worker who has noticed scars, bruises , or other physical evidence of self-injury.

Treatment

Individuals 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 some specialized inpatient programs for self-mutilators exist. A number of different treatment approaches are used with self-mutilators, including individual therapy, family therapy , and group therapy. Therapies focus on teaching self-awareness, alternate coping skills, behavior modification, and improved communication skills . Techniques may

Self-inflicted lacerations on the arms of a teenage girl. (Photo Researchers, Inc.)
Self-inflicted lacerations on the arms of a teenage girl.
(Photo Researchers, Inc.)
include journaling, music and art therapy, and role-playing.

Underlying psychological disorders are also treated with medication and/or psychotherapy. 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. However, in October 2003, the United States Food and Drug Administration issued an advisory indicating that children being treated with selective serotonin re-uptake inhibitor antidepressants (SSRIs) for major depressive illness may be at higher risk for committing suicide. A similar warning was issued in the United Kingdom. Parents and physicians must weigh the benefits and risks of prescribing these medications for children on an individual basis.

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 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 sexual abuse of children and media portrayals of cutting, are difficult to change. Parents should emphasize self-respect and respect for one's body. In general, 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.

Parental concerns

Parents should be alert to Internet sites and movies that promote and/or glorify self-mutilation as a way to cope with problems. Experts feel that some children may be induced to try this behavior as a coping mechanism because of the way it is presented in these media.

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.

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.

Selective serotonin reuptake inhibitors (SSRIs) —A class of antidepressants that work by blocking the reabsorption of serotonin in the brain, thus raising the levels of serotonin. SSRIs include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil).

See also Depressive disorders .

Resources

BOOKS

Milia, Diana. Self-Mutilation and Art Therapy. Herndon, VA: Kingsley Publishers, 2000.

Strong, Marilee, et al. A Bright Red Scream: Self-Mutilation and the Language of Pain. Collingdale, PA: DIANE Publishing Group, 2001.

Winkler, Kathleen. Cutting and Self-Mutilation: When Teens Injure Themselves. Berkeley Heights, NJ: Enslow Publisher, 2003.

PERIODICALS

"Self-cutting is almost epidemic in adolescents." Pediatric News 36 (September 2002): 29.

"Self-Injury." Brown University Child and Adolescent Behavior Letter –20 (March 2004): 14.

ORGANIZATIONS

American Academy of Child and Adolescent Psychiatry. –3615 Wisconsin Avenue, NW, Washington, DC 200163007. Web site: http://www.aacap.org.

American Psychiatric Association. 1400 K Street, NW, Washington, DC 20005. Web site: http://www.psych.org.

Focus Adolescent Services. Web site: http://www.focusas.com.

Tish Davidson, A.M. Rebecca J. Frey, PhD

User Contributions:

susan
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Aug 6, 2006 @ 8:08 am
Although your article is a good one, it talks mainly about teenagers. What about adults? Older adults. I have burned myself so serverly at times that it hasn't helped to the way it usually makes me fell. Whitch is a little better. And yes I am in therapy. But when I get so down I need some kind of relief, and it's getting to where it's not working anymore. So give me an article about that!
Si
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Aug 12, 2006 @ 9:21 pm
I've been a cutter for a number of years now. I havn't actually cut in over 3 months, but i still think about it all the time and the scars are a constant reminder. After awile, it's no longer a way to cope with feelings or anything of that sort, it becomes like a ciggerette, like and addiction. I've been tring to stop, and i've been doing it on my own. Without the help of ne professional. It started to scare me when the cuts would bleed more and more and leave deeper and darker scars... I knew i didn't want to die, and i know im taking that risk everytime i pick up ne thing i'd use to cut with. So now, yeah, i think about it all the time. But i know there's people out there that im hurting more than anyone has ever hurt me everytime i put it to my skin... And just bc i don't feel it at times, that doesn't mean my boyfriend, my friends, or my family can't feel it as well... and sometimes, people need to relise that... i know i did. And i know i may not over come it... but people need to know that a cutters not going to let any one in untill they find someone they can trust... and in our minds, you can't trust someone who thinks you're crazy... But people do need to know... because the pain helps you cope with... may stop then, but it'll come back, and it'll hurt twice as much...
chelsea k.
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Aug 23, 2006 @ 4:16 pm
my name is chelsea and i have been cutting for five years now.The worse time i cut i had to get 76 stiches in my right upper thigh.i been in an out of hospitals since i was 12 years old.im am on the road to recovery!its been 4 months since ive cut last and im very proud of myself.this is just someone letting others know it is hard to stop, but if you care enough about yourself and your family that cares about you. YOU CAN STOP!

tera
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Aug 24, 2006 @ 1:01 am
hi, my name is tera and i am 17 years old. from the time i was about 14 until i was 16 i was a cutter. EVERYTHING seems so great when i would cut, then when i was done i felt soooo bad/sad/angry at myself for doing it. What i'm getting at is the feeling you get from cutting, sort of like a high, only lasts for awhile. Please find other things in life that can get you that same feeling! like God, or friends, or music, or talking, or singing, or dancing, or camping, or reading, or drawing, or jumping! ANYTHING! i knwo you can do it! i just knwo you can! if i can stop...i knwo you can! i luv you and if you need to talk i am here 24/7 terajo89@hotmail.com add me on msn or e-mail! i will talk and listen! you can TRUST me. I've been there done that!
Steve
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Aug 30, 2006 @ 4:16 pm
I have been cutting for quite sometime. I can not control my emotions and I feel the need to cut. It mostly happens at night when I can not sleep. My mind races and I feel a need to focus on something else. I don't think sucide should be an option for anybody. All my relationships have been failures to some degree. I can't stand being alone, but it seems that is the only way from hurting myself and other people.
motherhater
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Sep 23, 2006 @ 9:21 pm
i have not cut for 6 months 1 week and 1 day! and makes me so furious. i know about all the bad things, infections death and what not but i still want to despratly i have been told it takes over 25 years for the urge to stop. i would rather die cutting then be in hel* for one more day!
Danna
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Dec 31, 2006 @ 9:21 pm
hi my name is Dana and i`m a cutter for a year .I`m 14 and i know that i better stop but i can`t do it because every time when i think at people who hurt me all my whole life i think that i should better die ...i want despratly to stop but i can`t do this ... i hate myself for doing this but in the same time i love myslef for doing something that i really can .... my whole life was controled by my parents , i was beated treated like a rubbish by whole society .... now i don`t have either a mom because he left us ....i ca`t stop this i have to , i know this very well ... but i really can`t .... and either i would stop .... i know that the scars will still remain even in my soul ....
Lex
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Jul 24, 2007 @ 9:21 pm
My name is Lex and I've been a cutter since I was eleven. I've been cutting on and off since the 8th grade and I'm about to start my junior year in high school. I have a very busy schedule and I only get a little bit of sleep at most. Cutting makes me really really tired so it almost instantly puts me to sleep when I'm thinking about all the things I have to do the next day. My parents ignore me and know that I cut but they don't really care. I don't trust any of my friends to tell them and I've become so distant with everyone that I don't think any of them would care. It's sad really when the only thing you have to live for is your next practice or appointment.
Suzanna
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Jul 26, 2007 @ 12:00 am
I Have Been A Cutter For 6 Years Now And I Know It's Bad But I Can't Stop I Have # Sharps In My Room Can SomeOne Help Me??
Daniel
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Dec 14, 2007 @ 12:00 am
You can call me crazy if you want too.
I'm nineteen years old and severly depressed.
I've lost interest in everything
I find ways to hurt myself
I cut and I'm seeing a therapist.
I have this sick urge to cut myself.
I can't stop these suicidal thoughts.
I hope I get better.
Somebody help me
I wish I never ever caught
I have scarred my soul
I wish I never gave in
helphelphelp
Alicia
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Oct 15, 2014 @ 5:05 am
I thought my daughter had Alopecia in the 5th grade, I took her to the Dermatologist they took a pencil eraser size punch biopsy of one of her many bald spots that she was currently doing comb over's and pinning with bobby pin's, and stitched her head with three stiches. We returned they gave me the diagnosis privately that she had Trichotillomania, I couldn't believe it why would my daughter pull her own hair out? I left with her slides and report in hand, went to work the next day sent the slides only to one of the Dermatopathologist I work for to look at them, my doctor I worked for knew they were my daughter's slides and said she needs to see her Pediatrician and to bring the report, and the she would also send me a report concurring, that it is TRICHOTILOMANIA and what they wanted me to do. I should never of revealed to my daughter that the biopsy showed he was pulling her own hair out, because I truly do not know if her brain really acknowledged that she was doing that,because it was a slow process until I confronted her, then it manifested out of control and within a few weeks as I was getting all her doctors lined up and scheduled she had managed to pull out nearly every single solitary strand of hair on her head. Contined...
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Oct 15, 2014 @ 5:05 am
I thought my daughter had Alopecia in the 5th grade, I took her to the Dermatologist they took a pencil eraser size punch biopsy of one of her many bald spots that she was currently doing comb over's and pinning with bobby pin's, and stitched her head with three stiches. We returned they gave me the diagnosis privately that she had Trichotillomania, I couldn't believe it why would my daughter pull her own hair out? I left with her slides and report in hand, went to work the next day sent the slides only to one of the Dermatopathologist I work for to look at them, my doctor I worked for knew they were my daughter's slides and said she needs to see her Pediatrician and to bring the report, and the she would also send me a report concurring, that it is TRICHOTILOMANIA and what they wanted me to do. I should never of revealed to my daughter that the biopsy showed he was pulling her own hair out, because I truly do not know if her brain really acknowledged that she was doing that,because it was a slow process until I confronted her, then it manifested out of control and within a few weeks as I was getting all her doctors lined up and scheduled she had managed to pull out nearly every single solitary strand of hair on her head. Contined...
Report this comment as inappropriate
Oct 15, 2014 @ 5:05 am
I thought my daughter had Alopecia in the 5th grade, I took her to the Dermatologist they took a pencil eraser size punch biopsy of one of her many bald spots that she was currently doing comb over's and pinning with bobby pin's, and stitched her head with three stiches. We returned they gave me the diagnosis privately that she had Trichotillomania, I couldn't believe it why would my daughter pull her own hair out? I left with her slides and report in hand, went to work the next day sent the slides only to one of the Dermatopathologist I work for to look at them, my doctor I worked for knew they were my daughter's slides and said she needs to see her Pediatrician and to bring the report, and the she would also send me a report concurring, that it is TRICHOTILOMANIA and what they wanted me to do. I should never of revealed to my daughter that the biopsy showed he was pulling her own hair out, because I truly do not know if her brain really acknowledged that she was doing that,because it was a slow process until I confronted her, then it manifested out of control and within a few weeks as I was getting all her doctors lined up and scheduled she had managed to pull out nearly every single solitary strand of hair on her head. Contined...
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Oct 15, 2014 @ 6:06 am
Continued.I got her into a Psychiatric Nurse Practitioner that excepted insurance, almost no one excepts insurance, she started her on Geodon 10 MG and increased every month and we stabilized at 60MG, the hair pulling stopped, no nail biting or any nervous twitches. So the summer or the end of 7th grade my daughter does not want to take the Geodon anymore she tells me in so many words/she says she feels better, we communicate this w/her NP of Psychiatry she agrees to wean her off the medication, but tells my daughter if you feel any mood changes it is ok but to let her know right away.So now at this point my daughter my has totally weaned off the Geodon but still takes her ADD medication, a couple months go by and I see her less and less, she is sleeping all he time,it is the dead of summer and these are not summer clothes she has on,she seems more and more distant from me.Continued ..
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Oct 15, 2014 @ 6:06 am
Continued.I gave her a journal some time ago for her to only share with me, if she did something wrong and confessed the truth in the journal, it is equal to confessing the truth and requesting help to me, the rule is NO matter what is in the journal she can NOT get in trouble, because I believe teens have a lot going on it there lives they need a safe house a place they can ask for help without getting in trouble or the fear of getting in trouble and I am not allowed to share any information revealed in the book it is top secret and only between my daughter and what ever parent she passes the book to, my husband knows about the book and the rules..Continued..
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Oct 15, 2014 @ 6:06 am
Continued.. I wrote the rules on the hard bind of the book, and that you pass the book under the pillow of one another, and that everything in the book is confidential unless of course medical attention is necessary, but getting in trouble with your parents while passing the book is not a option if you are the adult receiving the book, you can not discipline you may only offer advice and tell them what consequences what may come of there action's and then left them make the decisions way than to be the parent receiving the information, So the only time I ever received the book from my daughter was a few months after the stop of Geodon, it appeared under my pillow at bed time, I pulled it out from under my pillow told my husband she passed me the book,Continued..
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Oct 15, 2014 @ 6:06 am
, he said read it, I said I cant I have to read it in privacy, Ill ready it when I get up for work, so I did, and the tears flowed right down my cheeks as I read that my 13 year old was so sad that was she trying to find the most efficient way to kill herself, and that cutting has helped her pressure a little, but a little that is all. I confronted my daughter after school that day and asked her to take her jacket off and she said she did not want to, I said I need to see what you have done to yourself and she started to cry, as she removed the jacket, now I know why she started to cry, because once I got a eyeful of her entire right arm from the wrist to the top of the elbow, there were hundreds of cuts, Continued..
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Oct 15, 2014 @ 6:06 am
I cried instantly and she thought she was in trouble, and I quickly rebutted she was not in trouble, just that I was devastated at what I was seeing that's all. On my way to work that morning I had already called the NP of Psychiatry to find out what to do, she said to put her back on the low dose of Geodon and to bring her right back in so I did and 50 MG of Zoloft was added. Zoloft addition was a a 360 for my daughter, continued...
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Oct 15, 2014 @ 6:06 am
... , she was a totally different kid, now she is outgoing.
"Learning about mental illness through the eye's of my child, how could that be, she is perfect"
Alicia Merrill

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