THE COMING OF AGE OF SELF-MUTILATION

Self-mutilation (SM), the deliberate, nonsuicidal destruction of one's own body tissue, occurs in such culturally sanctioned practices as ta ttooing; body piercing; and healing, spiritual, and order-preserving r ituals. As a symptom, it has typically been regarded as a manifestatio n of borderline behavior and misidentified as a suicide attempt. It ha s begun to attract mainstream media attention, and many more who suffe r from it are expected to seek treatment. This review suggests that SM can best be understood as a morbid self-help effort providing rapid b ut temporary relief hom feelings of depersonalization, guilt, rejectio n, and boredom as well as hallucinations, sexual preoccupations, and c haotic thoughts. Major SM includes infrequent acts such as eye enuclea tion and castration, commonly associated with psychosis and intoxicati on. Stereotypic SM includes such acts as head banging and self-biting most often accompanying Tourette's syndrome and severe mental retardat ion. Superficial/moderate SM includes compulsive acts such as trichoti llomania and skin picking and such episodic acts as skin-cutting and b urning, which evolve into an axis I syndrome of repetitive impulse dys control with protean symptoms.