A survey of self-mutilation from forensic medicine viewpoint

Currently little research exists examining self-mutilation (SM) in samples of forensic referrals. The present study provides a comprehensive review on the frequency, etiology, and morphologic characteristics of self-inflicted injuries in a sample of outpatients' forensic referrals.

In a prospective cross-sectional study, during 3 years, we examined 9874 outpatients' forensic referrals and found 1248 SM cases in Ghouchan (an urban and suburban area of Iran).

Based on forensic medical examinations, it was found that 12.6% of all outpatients' forensic referrals had engaged in SM behavior at sometime. Males had significantly higher rates of SM than females (76.9 vs. 23.1%, respectively). The mean age was found to be significantly lower in patients with SM (23.6 +/- 8.5) than patients without SM (40.0 +/- 10.5) (P < 0.001). Rate of being single and unemployed was higher in the SM group (58.2, 56.1%, respectively) than in the group without SM (19.1, 22.8%, respectively). Superficial cuts and scratches were found to be the most common type of SM (79.5%), followed by bruises (10.8%), burns (3.4%), deep cuts (3.2%), fractures (0.6%), and other miscellaneous injuries (2.5%). Upper extremities including forearms, wrists, and arms opposite the dominant hand were the most common areas of injury.

Nonsuicidal self-injury, the deliberate-direct destruction of body tissue without suicidal intent is a relatively common event in forensic referrals. It is very important to distinguish between this and other types from forensic point of view. Forensic practitioners must be expert and trained for this purpose.