Repetitive self-mutilation is the act of intentionally injuring one’s own body by cutting or burning it without intending to commit suicide. It is commonly done by adolescents to cope with stress and other concerns.
What Is Repetitive Self-Mutilation?
Repetitive self-mutilation 1, also known as self-harm, self-injury, or cutting, consists of behaviors such as self-cutting, burning, and intentional bruising, mainly used by adolescents to help them cope with stress, without any conscious wish to commit suicide or resulting in death. This type of self-injury is a painful way to cope with emotional pain, intense anger, and frustration. It may bring a momentary sense of calmness, the actions are usually followed by guilt, shame, and the return of painful emotions.
According to a 2005 study 2, 2(10), 28–37. )) , pathologic self-mutilation “may be defined as any self-directed, repetitive behavior that causes physical injury. It may also be defined as, the deliberate alteration or destruction of body tissue without conscious suicidal intent.” It has become a common problem among adolescents since the 1990s. Around 61.2% of psychiatrically hospitalized adolescents 3 exhibit self-cutting behavior, while approximately 4% of the general population show such behavior.
Understanding Repetitive Self-Mutilation
According to a 2017 research 4, “evidence focused on the psychological goals driving NSSI (non-suicidal self-injury) indicated that the conduct serves a range of interpersonal and intrapersonal roles that are not well understood” mutually exclusionary.” In general, the disorder begins with episodic self-harm and evolves to recurrent self-harm over a period of five to twenty incidents. The most prevalent form of self-mutilation is cutting one’s skin with razors or knives. Other methods of self-harm may include –
- Hitting
- Biting
- Bruising
- Scratching
- Picking or pulling hair or skin
- Burning self with cigarettes or lighters
- Amputating parts of the body.
Before this became a clinically approved mental health disorder, repetitive self-mutilation was often classified as a failed suicide attempt. This concept is no longer accepted. However, repetitive self-mutilation was not a specific diagnosis as recognized by the American Psychiatric Association but recognized as a feature of other psychiatric disorders. However, some researchers debate over the fact that the condition should receive a separate diagnosis. Additionally, self-mutilation or repetitive self-mutilation, should not be confused with current trends of tattoos and body piercing.
Read More About Cutting Here
Types Of Repetitive Self-Mutilation
As we have mentioned previously, DSM-IV 5 does not recognize repetitive self-mutilation as a separate disorder but defines it as a symptom of other mental health conditions. There are different types of self-mutilation, which includes multiple behaviors, from socially acceptable to the bizarre and distorted. The different types of self-mutilation are:
1. Severe
From the term itself, one can understand that this type of self-mutilation is defined by extensive body damage. A severe form of self-mutilation may involve activities such as eye enucleation, castration, or amputation. Acute psychotic states and intoxication from illegal substances, usually amphetamines, are the main causes of this rare type of self-mutilation which is not frequently repeated.
2. Stereotyped
This type of self-mutilation is self-directed physical injury, such as biting or head-banging, and is associated with mental retardation and developmental disorders. This type has a conventional and repetitive rhythm and exhibits in the clear context of a neurobiological insult.
3. Superficial
It is a moderate form of self-mutilation and is common in general psychiatric practice. This type of self-mutilation includes skin cutting, picking, or burning by nonpsychotic, nonmentally retarded patients. It is a repetitive behavior among patients with comorbid conditions, particularly personality disorders.
4. Socially Accepted
This type of self-mutilation includes tattoos, ear piercing, or culturally based behaviors, such as lip piercing or ear stretching prevalent in some African cultures.
Symptoms Of Repetitive Self-Mutilation
Symptoms of repetitive self-mutilation may include-
- Scars having a proper pattern
- Fresh cuts, bruises, scratches, bite marks, or other wounds
- Unnecessary rubbing an area to create a burn
- Staying close to sharp objects
- Wearing covered clothes, such as long sleeves or long pants, even in hot weather
- Frequent reports of accidental injury
- Troubles in interpersonal relationships
- Behavioral and emotional instability backed by impulsivity, and unpredictability
- Records of helplessness, worthlessness, or hopelessness
Causes Of Repetitive Self-Mutilation
The causes of repetitive self-mutilation are not entirely clear. However, people who suffer from this disorder appear to feel immediate relief from unbearable tension after inflicting self-injury. Such tensions are generally caused by anger, sadness, or anxiety. It is also believed that self-mutilation releases certain chemicals in the body in response to pain. Thus, in general, self-injury may result from:
- Poor coping skills, where an individual finds it difficult to cope in healthy ways with psychological pain
- Difficulty managing emotions, where a person finds it hard to express, regulate, or understand emotions. The amalgamation of emotions, such as the feelings of worthlessness, panic, loneliness, guilt, anger, rejection, or self-hatred, etc also triggers self-injury.
According to a 2005 study, 2, 2(10), 28–37. )), self-mutilation may also occur due to neurobiological contributions. These are divided into three categories as given below.
1. Serotonin System
Decreased serotonin levels have been linked to repetitive self-mutilation or disorders that often include self-mutilation. This behavior is often defined as impulsive with almost 50% of adolescents thinking about the act less than one hour before acting it out.
2. Opiate System
Apart from neurotransmitter serotonin and impulsivity, the opiate pathway is also involved in the etiology and treatment of self-mutilation. One-half to two-thirds of borderline patients with repetitive self-mutilation feels little or no pain connected to these behaviors. It is assumed that such patients have a high habituation level of endogenous opioids 6 due to recurrent exposure to physical or sexual abuse during their childhood. Another hypothesized concept is the change of endogenous opioids with both high and low levels occurring at separate times in the same patient along with dysphoria being associated with temporarily low levels. Yet another theory states the possibility of self-injury that may involve a form of addiction to endogenous opioids.
3. Dopamine System
In addition to serotonin and opioids, dopamine 7 is also associated with self-mutilation. Self-injurious behavior is also present in people with Lesch-Nyhan syndrome and, to a lesser extent, Tourette syndrome, both of which are illnesses characterized by dopaminergic activity dysregulation and dopamine receptor hypersensitivity.
Read More About Dopamine Here
Risk factors Of Repetitive Self-Mutilation
Self-mutilation is most common among teens and young adults, although it is equally common among people of different ages. The onset of this disorder is marked during the preteen or early teen years when emotions are more unpredictable and unstable. Additionally, certain factors may further increase the risk of repetitive self-mutilation such as:
- Staying around people or with friends who engage in repetitive self-mutilation.
- Traumatic life incidents, including negligence, sexual, physical, or emotional abuse, or other traumatic events. Growing up in an unstable family environment or staying socially isolated may also trigger self-mutilation.
- Repetitive self-mutilation is also common among people who are highly self-critical and poor problem-solvers. Additionally, the condition is also linked to certain mental health disorders, such as depression, borderline personality disorder 8 , anxiety disorders, etc.
People with this condition engage in self-injury when under the influence of alcohol or recreational drugs.
Read More About Anxiety Here
Diagnosis Of Repetitive Self-Mutilation
Self-mutilation is generally discovered by family members, friends, or by a doctor who is in charge of doing a routine medical examination. Through such routine checkups, the doctor may notice signs, such as scars or fresh injuries. However, there is no diagnostic test for self-injury. Diagnosis is done via a physical and psychological evaluation. A person may be referred to a mental health professional who has prior experience with treating repetitive self-mutilation.
Additionally, a mental health professional may also assess an individual with other mental health disorders associated with self-injury, such as depression or personality disorders. In such cases, the assessment may include additional tools, such as questionnaires or psychological tests.
Treatment Of Repetitive Self-Mutilation
There’s no particular way to treat repetitive self-mutilation. However, treatment of this condition is determined by the specific issues the person is facing along with other related mental health disorders he/she might have at the same time. If the self-injurious behavior is associated with other mental health disorders, the treatment is planned in a way to focus on that disorder along with self-mutilation. Treating repetitive self-mutilation takes time, hard work, and one’s willpower to recover. Here’s how the condition can be treated.
1. Psychotherapy
Also known as talk therapy or psychological counseling, psychotherapy can help a person the following way.
- To recognize and control underlying issues
- To learn skills fostering better stress management
- To learn how to regulate one’s emotions
- To learn how to boost self-image
- Help develop skills to enhance relationships and social skills
- Help develop sound problem-solving skills
There are different types of individual psychotherapy that may be helpful, such as:
A. Cognitive-Behavioral Therapy (CBT)
CBT helps one identify harmful, negative beliefs and behaviors and substitute them with sound, adaptive ones. A 2011 study 9 states that cognitive behavior therapy (CBT) is efficacious in the critical treatment of depression and may provide a viable alternative to antidepressant medications (ADM) for even more seriously depressed unipolar patients when implemented in a competent fashion. CBT may also prove to be useful in adjunct to medication treatment for bipolar patients, although the studies are few and not wholly consistent. CBT does appear to have a lasting effect, thereby protecting the patients against succeeding relapse and recurrence, following the end of active treatment, something that cannot be said for medications.
B. Dialectical Behavior Therapy
A type of CBT that helps to develop behavioral skills to tolerate distress, manage or regulate emotions better along with enhancing relationships with others. A clinical trial 10 examined two groups: girls (aged 18–45 years) with parasuicidal borderline personality disorder (PBPD) who were treated with DBT and females with PBPD who were not treated with DBT underwent treatment as usual in the community. It was found that there was a notable reduction in the frequency and medical risk of parasuicidal behavior among patients who received DBT compared to ones who received usual treatment. DBT effectively retained patients in therapy. Additionally, the number of days of inpatient psychiatric hospitalization had reduced significantly as well.
C. Mindfulness-Based Therapies
This form of therapy enables one to live in the present moment to appropriately understand the thoughts and actions of those around the person to reduce his/her anxiety and depression for a better well-being. A 2018 study 11 states that the most widely examined Mindfulness-Based Interventions (MBI) to treat psychiatric disorders is mindfulness-based cognitive therapy (MBCT). There is noteworthy evidence confirming the use of MBCT to decrease the risk of depressive relapse. A meta-analysis found that MBCT reduced the risk for relapse and recurrence of the major depressive disorder compared with treatment as usual (TAU) or placebo control groups. The relapse rate among MBCT+TAU patients was 32% relative to 60% for the TAU control group. Moreover, MBCT has been as effective as a maintenance antidepressant medication in preventing major depressive disorder relapse
2. Medications
There are no medicines to specifically treat self-injuring behavior. However, if one is diagnosed with a mental health disorder, such as depression or an anxiety disorder, the doctor may prescribe antidepressants or other medicines to treat the underlying disorder associated with self-mutilation.
3. Psychiatric Hospitalization
If the condition becomes severe, the doctor may recommend admission to the hospital for psychiatric care. Hospitalization can provide a safe environment and more-intensive treatment until one gets through the crisis.
Coping Strategies For Repetitive Self-Mutilation
Here are a few lifestyle changes and home remedies through which a person can battle the condition. These are:
- The person must make sure to stick to the treatment plan
- He/she must recognize the underlying factor that triggers the condition, thereby making plans to soothe or distract oneself along with getting support
- The concerned person should not hesitate or shy away from asking for help
- He/she must engage in physical activities, relaxation, and eat healthily
- The patient must avoid alcohol and recreational drugs
How To Support Your Loved One With Repetitive Self-Mutilation
If your loved one needs help in coping and support, consider the tips below:
1. Learn about the Disorder
Learn more about the disorder to better understand and help your loved one during critical situations. Know the strategies to manage the condition after talking to the therapist.
2. Avoid Judging or Criticizing
Instead of criticizing, yelling, threats or accusations, offer support, praise his/her efforts to express emotions, and try to spend positive time together.
3. Care No Matter What
Make it clear to the person that you are always there to take care of him/her under any circumstance. Remind the person that he/she is not alone and he/she can express his/her feelings anytime.
4. Support the Treatment Plan
Help your loved one to take prescribed medicines and stress the significance of keeping therapy appointments.
5. Share Coping Strategy Ideas
Your loved one may also benefit from hearing about self-help tactics used when feeling distressed.
6. Find Support
Consider communicating with people who’ve gone through the same experience. Confide your experiences with trusted family members or friends. You can also join a local support group for parents, family members, or friends.
7. Care About Yourself
Apart from taking care of your loved ones, make sure to take care of yourself and take some time out to indulge in your hobbies.
Help Is Available
Repetitive self-mutilation is a growing condition among adolescents and adults, associated with other forms of mental impairment. Over the years, the interest revolving around this condition has grown to a great extent leading to an ongoing debate about its separate diagnosis on its own. Repetitive self-mutilation, however, is a manageable condition. Encouraging the sufferer to express his/her feelings, providing a sound environment, offering professional treatment, and persistent care can help one overcome this condition with time.
Repetitive Self-Mutilation At A Glance
- Repetitive self-mutilation is the act of deliberately harming one’s own body, without any intention of suicidal attempt.
- People who suffer from this disorder appear to feel immediate relief from unbearable tension after inflicting self-injury.
- Self-mutilation is most common among teens and young adults.
- People with this condition engage in self-injury when under the influence of alcohol or recreational drugs.
- Treating repetitive self-mutilation takes time, hard work, and one’s willpower to recover.
- Repetitive self-mutilation is a growing condition among adolescents and adults, associated with other forms of mental impairment.
- Favazza, A. R. (1992). Repetitive self-mutilation. Psychiatric Annals, 22(2), 60–63. https://doi.org/10.3928/0048-5713-19920201-06 [↩]
- Smith B. D. (2005). Self-mutilation and pharmacotherapy. Psychiatry (Edgmont (Pa. : Township[↩][↩]
- DiClemente, R. J., Ponton, L. E., & Hartley, D. (1991). Prevalence and correlates of cutting behavior: risk for HIV transmission. Journal of the American Academy of Child and Adolescent Psychiatry, 30(5), 735–739. [↩]
- Cipriano, A., Cella, S., & Cotrufo, P. (2017). Nonsuicidal Self-injury: A Systematic Review. Frontiers in psychology, 8, 1946. https://doi.org/10.3389/fpsyg.2017.01946 [↩]
- Bell, C. C. (1994). DSM-IV: Diagnostic and statistical manual of mental disorders. JAMA Network | Home of JAMA and the Specialty Journals of the American Medical Association. https://jamanetwork.com/journals/jama/article-abstract/379036 [↩]
- Bresin, Konrad & Gordon, Kathryn. (2013). Endogenous Opioids and Nonsuicidal Self-injury: A Mechanism of Affect Regulation.. Neuroscience and biobehavioral reviews. 37. 10.1016/j.neubiorev.2013.01.020. [↩]
- Breese GR, Criswell HE, Duncan GE, Mueller RA. Dopamine deficiency in self-injurious behavior. Psychopharmacol Bull. 1989;25(3):353-7. Erratum in: Psychopharmacol Bull 1990;26(3):296. PMID: 2697009. [↩]
- Fowler JC, Hilsenroth MJ, Nolan E. Exploring the inner world of self-mutilating borderline patients: a Rorschach investigation. Bull Menninger Clin. 2000 Summer;64(3):365-85. PMID: 10998813. [↩]
- Driessen, E., & Hollon, S. D. (2010). Cognitive behavioral therapy for mood disorders: efficacy, moderators and mediators. The Psychiatric clinics of North America, 33(3), 537–555. https://doi.org/10.1016/j.psc.2010.04.005 [↩]
- Panos PT, Jackson JW, Hasan O, Panos A. Meta-Analysis and Systematic Review Assessing the Efficacy of Dialectical Behavior Therapy (DBT). Res Soc Work Pract. 2014 Mar;24(2):213-223. doi: 10.1177/1049731513503047. Epub 2013 Sep 19. PMID: 30853773; PMCID: PMC6405261. [↩]
- Shapero, B. G., Greenberg, J., Pedrelli, P., de Jong, M., & Desbordes, G. (2018). Mindfulness-Based Interventions in Psychiatry. Focus (American Psychiatric Publishing), 16(1), 32–39. https://doi.org/10.1176/appi.focus.20170039 [↩]
