----

##  Self-Mutilation. ERIC/CASS Digest.                                           

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. The increased observance of these                 behaviors has left many mental health professionals calling for                 self-mutilation to have its own diagnosis in the Diagnostic and                 Statistical Manual of Mental Disorders (Zila & Kiselica, 2001). The             phenomenon is often difficult to define and easily                              misunderstood. DEFINITION OF SELF-MUTILATIONSeveral                       definitions of this phenomenon exist. In fact, researchers and                  mental health professionals have not agreed upon one term to                    identify the behavior. Self-harm, self-injury, and self-mutilation              are often used interchangeably. 
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; 2) stereotypic;             and 3) major. Superficial or moderate self-mutilation is seen in                individuals diagnosed with personality disorders (i.e. borderline               personality disorder). Stereotypic self-mutilation is often                     associated with mentally delayed individuals. 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 and                         dissociative. Self-mutilative behavior often stems from events that             occur in the first six years of a child's                                       development. 
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 parents and significant others.                   Disconnection leads to a sense of "mental disintegration." In this              case, self-mutilative behavior serves to center the                             person (Levenkron, 1998, p. 48). REASONS FOR SELF-MUTILATING                  BEHAVIORIndividuals who self-injure often have suffered sexual,             emotional, or physical abuse from someone with whom a significant               connection has been established such as a parent or sibling. This               often results in the literal or symbolic loss or disruption of the              relationship. 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. 
The person who                      self-harms often has difficulty experiencing feelings of anxiety,               anger, or sadness. Consequently, cutting or disfiguring the skin                serves as a coping mechanism. The injury is intended to assist the              individual in dissociating from immediate tension (Stanley,                     Gameroff, Michaelson & Mann, 2001). CHARACTERISTICS OF INDIVIDUALS            WHO SELF-MUTILATESelf-mutilating behavior has been studied in a             variety of racial, chronological, ethnic, gender, and socioeconomic             populations. However, the phenomenon appears most commonly                      associated with middle to upper class adolescent girls or young                 women. 
People who participate in self-injurious behavior are                  usually likeable, intelligent, and functional. At times of high                 stress, these individuals often report an inability to think, the               presence of unexpressable rage, and a sense of powerlessness. An                additional characteristic identified by researchers and therapists              is the inability to verbally express feelings. 
Some behaviors                 found in other populations have been mistaken for self-mutilation.              Individuals who have tattoos or piercing's are often falsely accused            of being self-mutilators. Although these practices have varying                 degrees of social acceptability, the behavior is not typical of                 self-mutilation. The majority of these persons tolerate pain for the            purpose of attaining a finished product like a piercing or tattoo.              This differs from the individual who self-mutilates for whom pain               experienced from cutting or damaging the skin is sought as an escape            from intolerable affect (Levenkron, 1998). COMMON MISCONCEPTIONS              OF SELF-MUTILATIONSuicide 
Stanley et al., (2001) report that              approximately 55%-85% of self-mutilators have made at least one                 attempt at suicide. Although suicide and self-mutilation appear to              possess the same intended goal of pain relief, the respective                   desired outcomes of each of these behaviors is not entirely                     similar. 
Those who cut or injure themselves seek to escape from               intense affect or achieve some level of focus. For most members of              this population, the sight of blood and intensity of pain from a                superficial wound accomplish the desired effect, dissociation or                management of affect. Following the act of cutting, these                       individuals usually report feeling better (Levenkron,                           1998). 
Motivation for committing suicide is not usually                       characterized in this manner. Feelings of hopelessness, despair, and            depression predominate. For these individuals, death is the intent.             Consequently, though the two behaviors possess similarities,                    suicidal ideation and self-mutilation may be considered distinctly              different in intent. 
Attention-seeking behavior 
Levenkron (1998)            reports that individuals who self-mutilate are often accused                    of "trying to gain attention." Although self-mutilation may be                  considered a means of communicating feelings, cutting and other                 self-harming behavior tends to be committed in privacy. In addition,            self-harming individuals will often conceal their wounds. Revealing             self-inflicted injuries will often encourage other individuals to               attempt to stop the behavior. Since cutting serves to dissociate the            individual from feelings, drawing attention to wounds is not                    typically desired. Those individuals who commit self-harm with the              intent of gaining attention are conceptualized differently from                 those who self-mutilate. 
Dangerousness to others 
Another                    reported misconception is that those individuals who commit                     self-harm are a danger to others. Although self-mutilation has been             identified as a characteristic of individuals suffering from a                  variety of diagnosed pathology, most of these individuals are                   functional and pose no threat to the safety of other                            persons. TREATMENT OF THE INDIVIDUAL WHO SELF-MUTILATESMethods            employed to treat those persons who self-mutilate range on a                    continuum from successful to ineffective. Those treatment methods               that have shown effectiveness in working with this population                   include: art therapy, activity therapy, individual counseling, and              support groups. An important skill of the professional working with             a self-harming individual is the ability to look at wounds without              grimacing or passing judgment (Levenkron, 1998). A setting that                 promotes the healthy expression of emotions, and counselor patience             and willingness to examine wounds is the common bond among these                progressive interventions (Levenkron, 1998; Zila & Kiselica,                    2001). CONCLUSIONResearch shows that self-mutilation has been             in existence far longer than the understanding and accurate                     conceptualization of the phenomenon. Therapeutic interventions have             improved substantially over the past two decades. However, further              study is imperative to insure that those who practice the behavior              continue to receive effective care. REFERENCESFavaro, A. &                Santonastaso, P. (2000). Self-injurious behavior in anorexia                    nervosa. The Journal of Nervous and Mental Disease, 188(8),                     537-542. 
Favazza, A.R. & Rosenthal, R. J. (1993). Diagnostic                  issues in self-mutilation. Hospital and Community Psychiatry, 44,               134-140. 
Levenkron, S. (1998). Cutting. New York, NY: W. W. Norton            and Company. 
Stanley, B., Gameroff, M. J., Michalsen, V., & Mann,             J. J. (2001). Are suicide attempters who self-mutilate a unique                 population? American Journal of Psychiatry, 158(3),                             427-432. 
Suyemoto, K. L. & MacDonald, M. L. (1995). Self-cutting              in female adolescents. Psychotherapy, 32(1), 162-171. 
Zila, L.                M. & Kiselica, M. S. (2001). Understanding and counseling                       self-mutilation in female adolescents and young adults. Journal of              Counseling & Development, 79, 46-52. 
----- Author:  Chris Simpson             is an assistant professor at San Francisco State University, San                Francisco, California. 
ERIC Digests are in the public domain and              may be freely reproduced and disseminated. 
This publication was               funded by the U.S. Department of Education, Office of Educational               Research and Improvement, Contract No. ED-99-CO-0014. Opinions                  expressed in this report do not necessarily reflect the positions of            the U.S. Department of Education, OERI, or ERIC/CASS.                        **Title:** Self-Mutilation. ERIC/CASS Digest.                                           **Document Type:** Information Analyses---ERIC Information Analysis Products (IAPs) (071); Information Analyses---ERIC Digests (Selected) in Full Text (073); **Available From:** ERIC Counseling and Student Services Clearinghouse, University of               North Carolina at Greensboro, 201 Ferguson Building, P.O. Box 26171,            Greensboro, NC 27402-6171. Tel: 336-334-4114; Tel:                              800-414-9769 (Toll Free); Fax: 336-334-4116; e-mail:                            [email protected]. For full text: http://ericcass.uncg.edu.                  **Descriptors:** Behavior Disorders,  Client Characteristics (Human Services),                    Clinical Diagnosis, Counseling Techniques, Emotional Disturbances,              Mental Health Workers,  Self Injurious Behavior                             **Identifiers:** ERIC Digests                                                                 
###
[Return to ERIC Digest Search Page]