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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%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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