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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 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_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 July 2013 by Rimas Lukas, MD; 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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