The psychological, psychiatric and psychophysiological correlates of self-mutilation
Creators: name: Haines, J
Publisher: name: University Of Tasmania
Year: 2023

description: Type III self-mutilation is defined as deliberately inflicted and often repetitive low lethality sell-injurious behaviour, of a socially unacceptable nature, performed in the absence of conscious suicidal intent and at a tithe of psychological crisis. It includes such behaviours as self-cutting, self-burning, skin-abrading, self-hitting and wound excoriation. The behaviour is believed to reflect severe psychopathology and alteration or extinction of the behaviour is problematic. This investigation examined aspects of self-mutilative behaviour in a male incarcerated population. Comparisons were made with two control groups: a group of male prisoners with no history of self-mutilation and a normal control group with no history of self-mutilation or criminal incarceration. Three studies were conducted. The first study examined those variables reported in the literature to be concomitants of self-mutilative behaviour. As stated, self-mutilation is said to reflect excessive psychopathology. However, incarceration also is associated with elevated symptom levels. It was necessary to determine if a pattern of psychopathology existed that effectively distinguished the self-mutilators from non-mutilating prisoners as well as individuals with no history of self-mutilation or incarceration. A distinctive pattern of symptomatology emerged. Self-mutilators evidenced a wide range of elevated scores on general measures of psychological/psychiatric symptoms, particularly depression and hostility. Aspects of hostility that distinguished self-mutilators from other groups included the urge to act out hostile feelings, critical feelings towards others, paranoid feelings of hostility and guilt. Self-mutilators demonstrated substantial problems with substance abuse, particularly alcohol. A pattern of passive-aggressive, schizoid and avoidant personality styles distinguished self-mutilators from other groups. Consideration also was made to some factors which may have led to these elevated scores and have been associated with self-mutilation in the literature. Generally, the family backgrounds of self-mutilators were unremarkable. Although a history of sexual abuse did not differentiate the groups, there was some evidence that the self-mutilators experienced more severe physical punishment during childhood than control groups. The patterns of these factors differed substantially from results reported in the literature. It was concluded that the occurrence of self-mutilative behaviour be viewed as the primary consideration in understanding the behaviour with differing patterns of psychopathology being understood as secondary and treated symptomatically. As a consequence of this conclusion, the following question needed to be addressed. If self-mutilative behaviour is not necessarily a symptom of a disorder, then what is it? The second study was based on the notion that the act of self-mutilation is an effective, although maladaptive, strategy for coping with stress. It was hypothesised that self-mutilators would have deficient skills in coping and problem-solving. These deficits would leave self-mutilators vulnerable to the adoption of self-mutilative behaviour as a coping strategy. Examination of the inherent resources which enable an individual to cope adequately and effectively with stress demonstrated a depressed score for self-mutilators on the scale measuring self-worth, a positive approach to others and a general optimism about life. In addition, assessment of the strategies used to cope with real problems demonstrated that self-mutilators engaged in more problem avoidance behaviours. Self-mutilators also recorded less perceived control over problem-solving options. Consideration also was given to a range of attitudes or beliefs that predispose an individual to distress. Self-mutilators endorsed a range of irrational beliefs that indicated they generally experienced feelings of little control over life events and a desire to avoid problem situations. However, while these deficits existed for this sample, many aspects of their coping and problem-solving repertoires were adequate. The results suggested that there was a property of selfmutilation that recommended its use to those who engaged in the behaviour. The consistent theme in the literature suggested that this property was tension reduction. There is much agreement in the literature with regard to the consequences of the behaviour. Self-mutilation is used as a means of alleviating unpleasant psychological states. In brief, the phenomenology of an episode of self-cutting, for example, involves increasing tension and distress as a result of a precipitating factor such as an adverse life event. Negative affect escalates until a state of depersonalisation is experienced. At this point the individual will engage in painless cutting. On the sight of blood, repersonalisation occurs and tension is reduced. Clinical reports of this process resulted in the development of the tension reduction model of self-mutilation. The model postulates that self-mutilation operates as a drive reduction mechanism. The reduction of tension following an act of self-mutilation is reinforcing, increasing the likelihood that when experiencing a similar negative psychological state, the self-mutilator will repeat the behaviour to gain relief. The third study tested the tension reduction model of self-mutilation to determine if the behaviour was being maintained by its reinforcing qualities. Self-mutilators' psychophysiological and subjective responses during a visualised self-mutilative act were investigated. Arousal to three imaged control events (neutral, accidental injury and aggression) were examined for differences between self-mutilating prisoner, prisoner control and normal control groups. Imagery scripts were presented in four stages: scene setting, approach, incident, and consequence. Results demonstrated a decrease in psychophysiological and subjective response during imagery of the act of self-mutilation. A lag between psychophysiological and psychological response to the self-mutilative act was demonstrated. Patterns of response elicited during self-mutilation imagery were markedly different to those during control imagery. Results were consistent with reports indicating that self-mutilative behaviour is maintained by the reinforcing tension reducing qualities of the act. The implications of the results of this research to the management of self-mutilative behaviour are discussed.