The identification and management of self-mutilating patients in primary care

Self-mutilation has been described as a complex group of behaviors resulting in the deliberate destruction of body tissue without conscious suicidal intent. Clinical reports suggest that many adults who engage in self-destructive behavior have childhood histories of trauma and disrupted parental care. Painless cutting after a period of depersonalization, followed by relaxation and repersonalization after bleeding, is the typical pattern reported. Complications include social rejection and condemnation as a response both to the behavior or the resulting disfigurement. The most serious complication of self-mutilation is death as a direct result of damage inflicted on the body or from a drug overdose. Primary care providers are in an excellent position to identify and intervene in self-injurious behavior. Establishing a trusting relationship appears to be the most critical component of assessing and treating the client who self-mutilates. Psychotherapy and psychotropic medications, though not specific to self-mutilation, remain the most compelling treatment options.