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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.

Causes

Self-mutilation may be caused by associated psychological problems. Self-mutilation may be done to release emotional pain, anger, or anxiety. It may also be done to rebel against authority, flirt with risk-taking, or feel in control. In some cases, the behavior is outside your emotional control, and related to a neurological or metabolic disorder.

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

Self-mutilation is more common in females and adolescents. Other factors that may increase your chance of self-mutilation 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 thinking about 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_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Self_Injury_In_Adolescents_73.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.



Last reviewed May 2014 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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