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.

Risk Factors

Self-mutilation is more common in females and adolescents. Other factors that may increase your chance of self-mutilation include:

• Childhood sexual, physical, or emotional abuse
• Violence or other abusive relationships in a child’s home
• Being in prison
• Intellectual disability
• Psychiatric disorders, such as:
  • Psychosis
  • Borderline personality disorder
  • Depression
  • Antisocial personality disorders
  • Post-traumatic stress disorder
• Certain metabolic disorders
• Substance abuse, such as alcoholism or drug abuse
• Eating disorders, such as anorexia or bulimia

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

• Tourette syndrome
• Autism
• Lesch-Nyhan syndrome

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

Certain behavioral symptoms can be signs of self-multilation. These may include:

• 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:

• Broken bones
• Amputation
• Castration
• Eye damage
• Suicide

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.

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.

Mental Health America http://www.mentalhealthamerica.net

Canadian Psychological Association http://www.cpa.ca

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 July 2013. Accessed November 11, 2014.

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.