Self-inflicted patient burns: suicide versus mutilation

Though suicide by burning is well-described, little information is available regarding patients who mutilate themselves by burning without suicidal intent. We reviewed 31 patients admitted from 1980 to 1991 with self-inflicted burns to describe differences between self-mutilation and attempted suicide (AS). In 16 patients who had mutilated themselves, mean burn size was 1.6% TBSA (range 0.3% to 9.0% TBSA) compared with 35.4% TBSA in the 15 patients who had attempted suicide (range 11.5% to 90% TBSA; p < 0.0001). Twelve of 15 patients who had attempted suicide used flammable liquids for self-immolation, whereas patients who had mutilated themselves often used techniques that they could control, including scalding, chemicals, and contact injuries. Most patients in both groups and previous histories of psychiatric disorders. Self-mutilators had a high incidence of personality disorders (56%), whereas the AS group more frequently suffered from depression (47%). Nine (56%) patients who had mutilated themselves had previous self-inflicted burns, compared with only one patient in the AS group. Mean lengths of stay, number of surgeries, and hospital and physician charges were higher for the AS group. Case examples of both types of injuries are presented. Burn care professionals should be familiar with syndrome of self-mutilation by burning. Patients often present with puzzling injuries and require psychiatric treatment in addition to burn care.