Major – such as eye enucleation and castration, very rare, associated with psychosis and acute intoxication
Stereotypic – repetitive behavior that has relatively fixed pattern of expression, e.g. head banging, self-hitting, hand-biting. Associated with MR, PDD, Autism, Down’s Syndrome, Lesch-Nyhan Syndrome, and de Lange Syndrome, or Stereotypic Movement Disorder (Axis I)
Superficial/Minor - cutting, burning, interfering with wound healing, and scratching. Associated with borderline and antisocial personality disorders, adolescents, incarcerated men, and may be component of many psychiatric disorders. Also called “parasuicide”, “deliberate self-harm”, “cutters”
Favassa A, Rosenthal, Repetitive Self Mutilation, Psychiatric Annals. 1992; 22:2,
Favazza, A. R. (1996). Bodies Under Siege: Self-Mutilation and Body Modification in Culture and Psychiatry, 2nd ed. Baltimore: The Johns Hopkins University Press. S.I.B. Culturally Sanctioned Pathological Ritual Practices Suicidality Self-Mutilation Major Stereotypic Superficial/Moderate Compulsive (OCD spectrum) Impulsive (Impulse Control D/O) Episodic Repetitive
Compulsive self-harm part of OCD ritual involving obsessional thoughts; person tries to relieve tension and prevent bad things from happening by engaging in self-harm behaviors
Episodic self harm behavior is engaged infrequently by people who otherwise don’t think about it and don’t perceive themselves as “self-injurers”. Usually a symptom of some other disorder.
Repetitive self-harm is a switch to ruminating about self harm even when doing the act, identify as “self-mutilators”. Considered a “disease” itself. Reflex response to any sort of stress, positive or negative.
Endorphin Model – Pain resulting from SIB may elicit release of endogenous opioids (endorphins) which acts as an analgesic on opiate receptors like morphine or heroin. (Thompson et al. 1994). Little or no pain seen in many self-injurers which is termed “blunted nociception”.
Dopamine supersensitivity or hypersecretion of endorphins seen. Repetitive self-injurious actions my come under control of addictive reinforcers and these receptor effects.
Thompson, T., Hackerberg, T., Cerulti, D., Baker, D., Axtell, S. (1994), Opioid Antagonist Effects on Self-Injury in Adults with Mental Retardation. American Journal on Mental Retardation, 49: 85-102.
Naltrexone (opiate antagonist) found to be effective in about half the patients with stereotypic type of self injury.
May have therapeutic window in dosing.
No one has yet done a placebo-controlled double-blind crossover study that controls for type of behavior as well as psychiatric diagnosis.
Buzan, R. D., Thomas, M., Dubovsky, S. L., & Treadway, J. (1995). The use of opiate antagonists for recurrent self-injurious behavior. Journal of Neuropsychiatry and Clinical Neurosciences, 7(4), 437-444
Addiction Model – Used in more chronic cases to develop a sense of regaining control over one’s life in realistic way. Emphasizes techniques to build up time between having urges and acting upon urges.
Psychodynamic Therapy – help identify attachments
Aims of Therapy - tolerate greater intensities w/o resorting to self harm, develop ability to articulate emotions and needs, learn coping skills, problem solving, anger management, conflict resolution, and assertiveness training
Sexual Orientation – A longitudinal study of a cohort of 1037 individuals in New Zealand showed a strong, statistically significant link between same sex attraction and SIB. Men, more so than women, showed higher risks for self-harm with greater degree of same-sex attraction.
Skegg, Karen: Sexual Orientation and Self Harm in Men and Women. Am J Psychiatry 160:541-546, March 2003
Body Modification -piercings and tattoos may be rituals or practices.
Rituals reflect community tradition, underlying symbolism, healing, expressions of spirituality, social order marking
Practices may be fads, for ornamentation, and identification for a cultural group
Cultural Issues with S.I.B. Culturally sanctioned forms of SIB can be seen as rituals for country festivals, as government protests, and religious customs.
Cultural Issues with S.I.B. There is a recent rise in SIB in today’s society. Media exposure through musicians such Marilyn Manson, movies such as Girl Interrupted, and admissions of SIB from celebrities such as Johnny Depp and Angelina Jolie has increased social acceptance and awareness. In addition, the phenomenon of “Cutter Clubs” has further supported the concept of social remodeling.