2. Definition and Description
Self mutilation is defined as intentional, non-lethal, repetitive
self bodily harm or disfigurement that is considered socially
unacceptable such as cutting, carving, burning, scalding,
punching oneself, and breaking bones.
Self mutilation is a symptom of mental disorders such as:
borderline personality, bipolar, major depression, anxiety,
schizophrenia, and PTSD and it is not a mental disorder of it’s own.
Self mutilation acts are not to cause death; it usually begins in late
childhood or early adolescence and may continue for 10-15 years
after acts.
3. Classification in North
American Nursing Diagnosis
(NANDA)
SELF MUTILATION
SELF MUTILATION RELATED TO
1. borderline personality disorder
2. major depression
3. Eating disorder (anorexia nervosa)
4. Anxiety disorder,
5. schizophrenia
6. Post Trauma Stress Disorder
4. Etiology of Self-Mutilation
Social and Behavioral Considerations
2004 Study by Nock and Prinstein (89 adolescent inpatients surveyed)
To stop bad feelings (immediate relief)
To feel something, even if it was pain
To punish yourself
To relieve feeling numb or empty
To feel relaxed
Way of coping with intense internal emotions, or
even preventing suicide.
Social modeling – 82% of responders say at least
one friend self-injured in the last 12 months
5. Risk Factors of Self-Mutilation
History of physical or sexual abuse
Family neglect
Comorbid conditions such as depression, eating
disorders, personality disorders (BPD, antisocial,
histrionic), PTSD, and anxiety disorders
Alcoholism and illicit drug use
Female sex
6. Prevalence
Is on the rise with young adolescents in middle school.
It is expected that 8 million Americans will have one episode of self-
mutilation.
Most common in have history childhood sexual abuse
Prevalence rates in urban and suburban
Skin cutting is the most common form of self-mutilation
More common in females than males
More common in singles than married
Prevalent in all races and economic groups
Often associated with eating disorders(anorexia nervosa)and BPD and
prison
Found in homes in which communication is indirect and at times violent .
Found with a family history of mood disorders and other forms of addiction
7. Categories of Self-Mutilation
There are three types of self-mutilation behavior:
Major self- mutilation: extreme acts usually associated with a
psychotic state or acute intoxication that cause considerable
damage.
Stereotypic self-mutilation: repetitive, rhythmic self-injurious
behavior (such as head banging) carried out by individuals who
are autistic, mentally retarted, and those with Tourette’s
syndrome which has a strong biological component.
Moderate or superficial self-mutilation: more common form of
self-mutilation which includes hair pulling, skin scratching,
picking, cutting, burning, and carving.
8. (Moderate or superficial ) Self-Mutilation
Moderate or superficial self-mutilation is then further divided
into three groups:
Compulsive self-mutilation: repetitive, ritualistic, behavior that
occurs several times a day such as hair pulling and cut to the skin.
Episodic self-mutilation: periodical behavior that does not
preoccupation the individual. Is seen in clients who have
depression, anxiety, personality disorders, and most commonly in
borderline personality disorder.
Repetitive self-mutilation: a major preoccupation and consider it
an addiction they can’t stop. Most common in females and
appears in late childhood or early adolescence and continues for
many years.
9. Bauman, S. (2008). Self-mutilation. In N. Danner
(Ed.), Pearson custom education (pp. 33-58).
Boston, MA: Pearson Custom Publishing.
10. Theoretical Views
Biological Theories: explain that there are low levels of serotonin in the
brains of self-mutilators.
Psychodynamic Theories: explain that real or anticipated loss is a
significant antecedent to self-mutilation.
Cognitive Behavioral Theory: explains that self-mutilation is strengthened
through positive and negative reinforcements in the individuals life .
Narrative Theory: explains that individuals who self-mutilate are seeking a
way to re-enact the childhood trauma they once experienced to prove that
they are incapable of self-protection because they were not protected as
children
11. Most common methods to self mutilation
Cutting: Scratches with sharp objects
Branding: Burning self with a hot object or friction
burn=rubbing a pencil or eraser on skin
Picking at skin or re-opening wounds
Hair pulling
Hitting
12. There are various treatment options for individuals who
self-mutilate, however, not one single one is more
effective than another.
Such option are:
Medication
Dialectical Behavior Therapy
Manual Assisted Cognitive-Behavior Therapy
Cognitive Analytic Therapy
Narrative Therapy
Group Therapy
Impatient Treatment
Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58).
Boston, MA: Pearson Custom Publishing.
13. Treatment
Manual Assisted Cognitive-Behavior Therapy: This therapy is
normally given in no more than six sessions. Can be very
practical because it can be given to patients via bibliotherapy.
Cognitive Analytic Therapy: used with repeat self-mutilators and
can be done in one session. It’s focus is on helping the client
understand self-mutilation behavior, teaching problem-solving
focus, help the client find alternatives to dealing with stress,
and analysis of reciprocal role relationships.
14. Treatment
Medication: SSRIs such as Prozac, Paxil, and Luvox are used
to reduce self-mutilation in individuals and is most successful in
conjunction with other forms of treatment.
Dialectical Behavioral Therapy: An outpatient program that
includes weekly individual and group therapy for the duration of
a year that includes instruction in mindfulness, interpersonal
effectiveness, emotional regulation, and distress tolerance.
15. Treatment Options
Narrative Therapy: sees symptoms of self mutilation as
“stories”, in which the problem is located outside the
individual. Three stages:
Outer: The counselor inquires about the context of the client’s
life with no focus on the self-mutilation.
Middle: The counselor inquires about the client’s trauma and
symptoms and encourages client to build a support system.
Inner: The counselor focuses on identifying the aspects of the
client that were internalized as a way to cope with the trauma or
abuse.
Group Therapy: used simultaneously with individual therapy. It
allows the client to feel that they are not alone in this problem.
Inpatient Treatment: usually for those who are not benefiting from
outpatient therapy.
16. Assessment
Self- report are more common
Assessment to child past life .
Assessment to any psychiatric disorder
Assessment to psychiatric family history.
Observation and direct questioning are the best ways to
assess an individuals level of self-mutilation behavior
When self-mutilation behavior is acknowledged, then it is
important for the counselor to follow up with more in depth
questioning
Counselors should refer patients to a physician to treat any
possible infections to sight
17. Nursing intervention
Monitor the patient behavior for anxiety status .
Determine emotional and situational triggers.
Help client recognize and understand the function and origin of the
behavior
Provide support for the recognition of feelings ,reality testing
impulse control.
Use therapeutic holding some might need special restraints
(helmets , mittens , special padding )
Use play and art therapy (swinging , drawing , singing).
18. References
Bauman, S. Self-mutilation. In N. Danner (Ed.), Pearson
custom education (pp. 33-58). Boston, MA: Pearson Custom
Publishing. (2008).
Varcarolis ,E, ,manual psychiatric nursing care
planning,4thed ,saunder , USA 2011
