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Introduction

Suyemoto and MacDonald (1995) reported that the incidence of self-mutilation occurred in
adolescents and young adults between the ages of 15 and 35 at an estimated 1,800 individuals
out of 100,000. The incidence among inpatient adolescents was an estimated 40%. Self-
mutilation has been most commonly seen as a diagnostic indicator for Borderline Personality
Disorder, a characteristic of Stereotypic Movement Disorder (associated with autism and mental
retardation) and attributed to Factitious Disorders. However, practitioners have more recently
observed self-harming behavior among those individuals diagnosed with bipolar disorder,
obsessive-compulsive disorder, eating disorders, multiple personality disorder, borderline
personality disorder, schizophrenia, and most recently, with adolescents and young adults.

Definition of Self-Mutilation

Some researchers have categorized self-mutilation as a form of self-injury. Self-injury is
characterized as any sort of self-harm that involves inflicting injury or pain on one's own body.
In addition to self-mutilation, examples of self-injury include: hair pulling, picking the skin,
excessive or dangerous use of mind-altering substances such as alcohol, and eating disorders.

Favazza and Rosenthal (1993) identify pathological self-mutilation as the deliberate alteration or
destruction of body tissue without conscious suicidal intent. A common example of self-
mutilating behavior is cutting the skin with a knife or razor until pain is felt or blood has been
drawn. Burning the skin with an iron, or more commonly with the ignited end of a cigarette, is
also a form of self-mutilation.

Self-mutilating behavior does exist within a variety of populations. For the purpose of accurate
identification, three different types of self-mutilation have been identified:
1.Superficial or moderate self-mutilation is seen in individuals diagnosed with personality
disorders (i.e. borderline personality disorder).
2. Stereotypic self-mutilation is often associated with mentally delayed individuals.
3.Major self-mutilation, more rarely documented than the two previously mentioned categories,
involves the amputation of the limbs or genitals. This category is most commonly associated
with pathology (Favazza& Rosenthal, 1993). The remaining portion of this digest will focus on
superficial or moderate self-mutilation.

Additionally, self-injurious behavior may be divided into two dimensions:

Nondissociative self-mutilators usually experience a childhood in which they are required to
provide nurturing and support for parents or caretakers. If a child experiences this reversal of
dependence during formative years, that child perceives that she can only feel anger toward self,
but never toward others. This child experiences rage, but cannot express that rage toward anyone
but him or herself. Consequently, self-mutilation will later be used as a means to express anger.

Dissociative self-mutilation occurs when a child feels a lack of warmth or caring, or cruelty by
parents or caretakers. A child in this situation feels disconnected in his/her relationships with

At times of high stress. and this may make it more difficult for them to respond to their children in positive. Although these practices have varying degrees of social acceptability. consistent. ODD. and supportive ways. 48). or sadness. However. the behavior is not typical of self- mutilation. have difficulty making friends. intelligent. The person who self-harms often has difficulty experiencing feelings of anxiety. This often results in the literal or symbolic loss or disruption of the relationship. gender. p. emotional. cutting or disfiguring the skin serves as a coping mechanism. anger. Some behaviors found in other populations have been mistaken for self-mutilation. Michaelson& Mann. They are more likely than other children to bully and to be bullied. the presence of unexpressable rage. the phenomenon appears most commonly associated with middle to upper class adolescent girls or young women. and functional. People who participate in self-injurious behavior are usually likeable. Consequently. Sidebar: Children with ADHD. Disconnection leads to a sense of "mental disintegration. chronological. The behavior of superficial self-mutilation has been described as an attempt to escape from intolerable or painful feelings relating to the trauma of abuse. or physical abuse from someone with whom a significant connection has been established such as a parent or sibling. and lag behind their peers in psychosocial development. Individuals who have tattoos or piercing's are often falsely accused of being self-mutilators.parents and significant others. self-mutilative behavior serves to center the person (Levenkron. Reasons for Self-Mutilating Behavior Individuals who self-injure often have suffered sexual. They frequently experience school problems. An additional characteristic identified by researchers and therapists is the inability to verbally express feelings. The majority of these persons tolerate pain for the purpose of attaining a finished product like a piercing or tattoo. 2001)." In this case. Gameroff. Characteristics of Individuals Who Self-Mutilate Self-mutilating behavior has been studied in a variety of racial. and a sense of powerlessness. This differs from the individual who self-mutilates for whom . and socioeconomic populations. Parents of children with behavior problems experience highly elevated levels of child-rearing stress. and other behavioral disorders are particularly vulnerable to low self-esteem. ethnic. 1998. these individuals often report an inability to think. The injury is intended to assist the individual in dissociating from immediate tension (Stanley.

such as scarring and social isolation. The books involve writing exercises that help them understand why they injure themselves and the results of their behavior. Alderman publish books with exercises designed to help self- mutilators overcome the need to harm. 1998). A variety of treatments are described below: „   Psychologists such as Dr. The people are asked to consider their motivation to self-mutilate. Treatment: Treatment for self-mutilating patients takes a number of different forms. A combination of treatments may provide the most effective manner to treat this disease. .pain experienced from cutting or damaging the skin is sought as an escape from intolerable affect (Levenkron. and its positive and negative consequences.

Preliminary research has found decreased serotonergic activity in self-mutilators. Illinois. people can experience the relief of self-mutilation without actually performing the act on themselves. and adhering to several ground rules. SAFE involves self-mutilators enrolling themselves in the program. An effective therapist will help an individual identify the feelings and emotions associated with self-mutilation. therapy should focus on learning to use positive behaviors as an alternative to self-mutilation. obsessive-compulsive disorder. Patients: -must have a "heartfelt motivation to stop" -have the right to voluntarily withdraw at any time -must sign a "no-self-harm contract" before being admitted to the program -are discouraged from exhibiting or discussing scars with other patients to prevent contagion -must refer to their behavior as self-injury to control "war stories" -must complete written assignments that focus on the negative consequences of self-injury and the benefits of staying free of self-harm -are expected to develop and practice at least five alternatives to self-mutilation   A new therapy uses psychophysiological responses to an image or memory of an event to simulate responses experienced during the actual execution of self-mutilation. The content of guided imagery has been demonstrated to effect the psychophysiological response. medications that alleviate symptoms of anxiety. . and hence selective serotonin re-uptake inhibitors such as fluoxetine and sertraline are often used.    Effective medical treatment should involve a combination of psychotherapy and possibly medication. depression. Furthermore. and sleep-impairment are often popular. Through imagery. „ Self-Abuse Finally Ends is a program located in Berwyn. Although there is no specific drug of choice to treat self-mutilation.