by Anne Chung

Created on: January 31, 2007   Last Updated: April 18, 2007

Self-Mutilation: Overview of Cutting

Self mutilation is described as deliberate destruction or alteration of one's own body tissue without the conscious intent of suicide. However, it may be misidentified as a suicide attempt (Favazza 1998). Self mutilation is not listed as a separate disorder in the DSM-IV, but appears as a symptom of other diagnoses (Favazza 1993). Self mutilation can be divided into pathological and socially or culturally accepted. Examples of non-pathological self mutilation include ear piercing, tattoos, and healing and spiritual rituals. Pathological self mutilation can further be divided into three types: severe, stereotyped, and superficial or moderate. Severe self-mutilation is usually irreversible damage to the body done in psychotic or intoxicated states, including eye enucleation, castration, and amputation. Stereotyped self-mutilation is usually seen in mental retardation and developmental disorders and include head banging and biting. Superficial or moderate self-mutilation is often seen in personality disorders with non-psychotic, non-mentally retarded patients and includes trichotillomania skin cutting, burning, and picking (Favazza 1998).

Self-mutilation is associated with several psychiatric conditions. It is often seen in type II cluster B traits such as borderline, narcissistic, and histrionic personality disorders. The described "deliberate self-harm syndrome" includes self-mutilation, eating disorders, and alcohol and substance abuse. Self-mutilators may also suffer from depression and schizophrenia. Many self-mutilators describe themselves as isolated and disconnected from the world and may also have a history of physical or sexual abuse.

Self-mutilation is seen in 70-80% of patients with borderline personality disorder (Bohus 2000). A US study showed that of all attempted suicide and self-inflicted injury ED visits, 20% were due to cutting or piercing (Doshi 2005).

There are several theories on the causes of self-mutilation. A previous study from Japan studied reasons for cutting. Patients were divided into groups based on psychiatric diagnosis. Cutting was seen as a way of seeking sympathy in the hysteria group. Cutting was seen as a preparation trial for suicide in the depressed group. Self conflict or conflict with parents were the motivation for cutting in the adolescent behavioral disorder group (Takeuchi 1986). A popular website for self-mutilators posts personal quotes from visitors. Self-mutilators describe these

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