The urge to hurt oneself

Repetitive self-mutilation, though not a serious problem in our country is something that needs to be understood.

Repetitive self-mutilation which is not an officially recognized mental disorder is a pattern of deliberately harming one-self without an intention of committing suicide. The most common ways of doing this are by cutting, burning or severely scratching one's skin, continuously picking at wounds or scabs, punching or slapping one's face, sticking needles into one's skin, breaking bones and swallowing glass or other harmful substances. Mental health professionals disagree as to whether such acts are a distinct syndrome or are symptoms of other mental disorders.

Like other problems involving impulsive control, repetitive self- mutilation appears to be a means by which some people relieve tension. Over time, they may become increasingly pre-occupied with this behaviour and harm themselves with increasing frequency and intensity.

How common is it?

Repetitive self-mutilation usually begins in late childhood, in the early teen years and appears to be more common among females. It is also a common symptom of borderline personality disorder and of certain schizophrenic disorders.

Repetitive self-mutilation typically begins at times of:

Among the traits often found in persons who harm themselves is a tendency towards perfectionism. Those who are prone to accidental injury, unhappy with their personal appearance or sexual organs or those who are unable to express their feelings in other ways are also likely candidates.

Individuals mutilate themselves as a way of avoiding suicide or as a form of self-castration, to vent their rage against themselves or others or as a way of dealing with sexual fears and conflicts.

Some may use their self-inflicted injuries to manipulate others into giving them more attention.

Psychiatrist Armado Favazza , MD of the University of Missouri, Colombia notes that those who mutilate themselves give many reasons for their behaviour, such as relieving tension, helping them overcome feelings of unreality, making them feel special or in control, to manipulate others, create a sense of excitement or help them express rage.

Others cannot simply resist the urge: “Cutting, burning and poking needles into my arms is a security for me because I know that if all else fails and leaves me emotionless and empty, the pain and the blood will always be there,” was what one sufferer wrote.

Individuals with this disorder often describe themselves as addicted to their acts. They may use several methods of physical injury, spend hours and days thinking about it and establish elaborate rituals for hurting themselves.

If you suspect that you or someone else close to you may have this problem, these are the questions that need to be asked:
Do you repeatedly injure yourself in some way?

Do you often think about hurting yourself?
Do you spend time planning ways of hurting yourself?
Do you touch or look at the scars afterwards?
Do you feel increased tension or anxiety before hurting yourself?
Do you feel pleasure or a sense of release during or after the act?
If the answer to any of these questions is 'yes', you or the person concerned should seek professional help.

Risks and complications

Repetitive self-mutilation can create wound infections or disfiguring scars. Some sufferers are embarrassed by the way they look and avoid going out in public. Some develop substance abuse problems. The greater risk is that of suicide, usually by drug overdose or by some other means other than wrist-slashing, another form of self-mutilation.

This is one of the most difficult psychiatric problems to treat and understand. Often individuals also suffer from other mental disorders, Treating these problems with psychotherapy, medication or both may help reduce or eliminate such episodes.

Impact on relationships

Self-mutilation is a solitary act that isolates individuals from others. If family members or friends discover what has been happening they are likely to be shocked and horrified and can find it very difficult to understand how persons they love and value could inflict pain on themselves. Family therapy can help in dealing with longstanding problems of communicating and coping in a family as well as with harmful behaviour.

Without treatment, repetitive self-mutilation may flare up and then ease or it may persist steadily for 10-15 years, if not longer. Self-mutilation in those who receive treatment for any other mental disorders may improve after therapy.