2. Definition and Description
Self mutilation is defined as intentional, non-
lethal, repetitive self bodily harm or disfigurement
that is considered socially unacceptable such as
cutting, carving, burning, scalding, punching
oneself, and breaking bones.
Self mutilation is a symptom of several mental disorders
such as: borderline personality, bipolar, major
depression, anxiety, schizophrenia, and PTSD and it is
not a mental disorder of it’s own.
The intent of these acts are not to cause death; it
usually begins in late childhood or early adolescence
and may continue for +10-15 years.
Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58).
Boston, MA: Pearson Custom Publishing.
3. Categories of Self-Mutilation
There are three types of self-mutilation behavior:
Major self- mutilation: extreme acts usually
associated with a psychotic state or acute
intoxication that cause considerable damage.
Stereotypic self-mutilation: repetitive, rhythmic self-
injurious behavior (such as head banging) carried
out by individuals who are autistic, mentally retarted,
and those with Tourette’s syndrome which has a
strong biological component.
Moderate or superficial self-mutilation: more
common form of self-mutilation which includes hair
pulling, skin scratching, picking, cutting, burning, and
carving.
Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58).
Boston, MA: Pearson Custom Publishing.
4. Categories of Self-Mutilation
Continued…
Moderate or superficial self-mutilation is then
further divided into three groups:
Compulsive self-mutilation:
repetitive, ritualistic, behavior that occurs several
times a day such as hair pulling and insults to the
skin.
Episodic self-mutilation: periodical behavior that
does not pre-occupy the individual. Is seen in
clients who have depression, anxiety, personality
disorders, and most commonly in borderline
personality disorder.
Repetitive self-mutilation: a major preoccupation
and consider it an addiction they can’t stop. Most
common in females and appears in late
childhood or early adolescence and continues for
many years.
Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58).
Boston, MA: Pearson Custom Publishing.
5. Prevalence
Is on the rise with young adolescents in middle school.
It is expected that 8 million Americans will have one
episode of self-mutilation.
Most common in young individuals and those who
have experienced childhood sexual abuse
Prevalence rates in urban and suburban schools were
almost the same with an average of 14.3% of students
having self-mutilated and females more likely of doing
so.
Skin cutting is the most common form of self-mutilation
followed by self-hitting.
Associating with others who self-mutilate is a risk factor
due to contagion
Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58).
Boston, MA: Pearson Custom Publishing.
6. Developmental Influences
Rootsof this behavior are thought to be in
unhappy early childhood experiences which
could have included trauma from physical or
sexual abuse, loss of a parent due to divorce,
witnessing family violence, or illness or surgery.
Thefeelings associated with such traumatic events
may then intensify in adolescence due to pubertal
changes occurring, which may cause further self-
loathing.
Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58).
Boston, MA: Pearson Custom Publishing.
7. Reasons for Self-Mutilation
It serves as an effective coping mechanism when
other strategies are not present when feeling intense
emotions.
Serves as a release of pressure and relieves tension.
The physical pain is the only control they feel they
have and is a way to refocus attention from
unbearable emotional pain that the individual has no
control over (i.e. sexual abuse).
It is a way for individuals to express emotional pain
that seems inexpressible in words.
Because self-mutilation may increase the levels of
endorphins, it can become addictive.
Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58).
Boston, MA: Pearson Custom Publishing.
8. Theoretical Views
Different theories seek to explain the origins and
dynamics of self-mutilation.
Biological Theories: explain that there are low levels
of serotonin in the brains of self-mutilators.
Additionally, that because endorphins are released
during self-mutilation, the person then associates a
pleasurable feeling with self-inflicted harm which
encourages them to continue.
Psychodynamic Theories: explain that real or
anticipated loss is a significant antecedent to self-
mutilation. It is suggested that when infant
development stages are disrupted, self-mutilative
behavior emerges when the person experiences a
loss later on in life and the pain triggers this behavior.
Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58).
Boston, MA: Pearson Custom Publishing.
9. Theoretical Views Continued…
Cognitive Behavioral Theory: explains that self-
mutilation is strengthened through positive and
negative reinforcements in the individuals life . It
suggest that the behaviors is a symptom that can be
corrected but are not concerned with the underlying
issue.
Narrative Theory: explains that individuals who self-
mutilate are seeking a way to re-enact the childhood
trauma they once experienced to prove that they are
incapable of self-protection because they were not
protected as children.
Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58).
Boston, MA: Pearson Custom Publishing.
10. Treatment Options and
Considerations
There are various treatment options for individuals
who self-mutilate, however, not one single one is
more effective than another.
Such option are:
Medication
Dialectical Behavior Therapy
Manual Assisted Cognitive-Behavior Therapy
Cognitive Analytic Therapy
Narrative Therapy
Group Therapy
Impatient Treatment
Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58).
Boston, MA: Pearson Custom Publishing.
11. Treatment Options
Continued…
Manual Assisted Cognitive-Behavior Therapy: This
therapy incorporates many of the principles that DBT
has but is normally given in no more than six sessions.
Can be very practical because it can be given to
patients via bibliotherapy.
Cognitive Analytic Therapy: used with repeat self-
mutilators and can be done in one session. It’s focus is
on helping the client understand self-mutilation
behavior, teaching problem-solving focus, help the
client find alternatives to dealing with stress, and
analysis of reciprocal role relationships.
Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58).
Boston, MA: Pearson Custom Publishing.
12. Treatment Options
Medication: SSRIs such as Prozac, Paxil, and Luvox
are used to reduce self-mutilation in individuals and is
most successful in conjunction with other forms of
treatment. Therefore, it should never be used as a form
of absolute treatment.
Dialectical Behavioral Therapy: An outpatient
program that includes weekly individual and group
therapy for the duration of a year that includes
instruction in mindfulness, interpersonal
effectiveness, emotional regulation, and distress
tolerance that will carry over successfully in the
individuals world outside of treatment.
Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58).
Boston, MA: Pearson Custom Publishing.
13. Treatment Options
Continued…
NarrativeTherapy: sees symptoms of self
mutilation as “stories”, in which the problem is
located outside the individual. Three stages:
Outer: The counselor inquires about the context of
the client’s life with no focus on the self-mutilation.
Middle: The counselor inquires about the client’s
trauma and symptoms and encourages client to
build a support system.
Inner: The counselor focuses on identifying the
aspects of the client that were internalized as a
way to cope with the trauma or abuse.
Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58).
Boston, MA: Pearson Custom Publishing.
14. Treatment Options
Continued…
Group Therapy: used simultaneously with individual
therapy. It allows the client to feel that they are not
alone in this problem. However, caution should be
used with self-mutilation groups because of
contagion and members becoming too involved in
the other patients’ recovery which can become
counterproductive.
Inpatient Treatment: usually for those who are not
benefiting from outpatient therapy and their behavior
is escalating.
Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58).
Boston, MA: Pearson Custom Publishing.
15. Dos
Counselor Dos for working with clients who self-
mutilate are:
Show that you care
Show concern for the injury and offer compassion
Help client recognize and understand the function and
origin of the behavior
Help client learn other ways of expressing difficult
feelings or memories and to ask for support
Encourage client to create and strengthen support
systems
Encourage and acknowledge any gains made by the
client, no matter how small
Encourage patients to seek help online with individuals
also struggling with this behavior because it might
encourage disclosure of feelings and emotions which
can be healthy.
Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA:
Pearson Custom Publishing.
Richardson, B. G., Surmitis, K.A., & Hyldahl, R. S. (2012). Minimizing social contagion in adolescents who self-injure:
Considerations for group work, residential treatment, and the internet. Journal Of Mental Health
Counseling, 34(2), 121-132.
16. Don’ts
Counselor Don’ts when working with clients who
self-mutilate
Encouraging detailed verbal descriptions of the
self-mutilation rather than focusing on the
underlying emotional issues
Suggesting substitute behaviors that “re-enact” the
feeling of cutting
Encouraging techniques that release anger such
as punching objects, rather than encouraging
verbal expression.
Hypnosis
Reinforcing the behavior by being the clients
“hero” and excessively going above and beyond
to try to maintain the clients safety .
Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58).
Boston, MA: Pearson Custom Publishing.
17. Issues of Diversity
Self-mutilation is known to cross the lines of
culture, race, and socioeconomic status
It is suggested that females self-mutilate at higher rates
than males across all age levels
Individuals who are more likely to come forth and admit to
self-mutilation behaviors are female, bisexual, or
questioning their sexual orientation
Persons with Disabilities
Self-mutilation is a common behavior among individuals with
developmental disabilities (stereotypic type)
The degree of developmental impairment is related to the level
of risk that individual has to self-mutilate, with individuals who
have a more severe disability likely to show more self-mutilation
behavior.
Treatment for individuals who have developmental disabilities
and self-mutilate are preferred to be medication and behavior
modification programs
Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58).
Boston, MA: Pearson Custom Publishing.
18. Assessment
There is no particular profile associated with
people who self-mutilate nor is there one specific
assessment test designed to test for self-mutilation
Self- report inventories are more common
Observation and direct questioning are the best
ways to assess an individuals level of self-
mutilation behavior
When self-mutilation behavior is
acknowledged, then it is important for the
counselor to follow up with more in depth
questioning
Counselors should refer patients to a physician to
treat any possible infections to sight
Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58).
Boston, MA: Pearson Custom Publishing.
19. Counselor Issues
It is difficult for counselors to accept the possibility that they may not be
able to stop their client from engaging in self-mutilation behavior.
Counselors should refrain from excessive sympathy for the behavior
because it can reinforce it and should focus on the emotions behind
the behavior instead
Counselors should not overreact to non- suicidal self- mutilation and
should refrain from seeking unnecessary medical intervention.
Counselors need to be aware of the commitment required to work with
this population
Counselors should caution not letting their frustration become an
impediment in the therapeutic process
Counselors should use good judgment and realize when they must
make a referral to a more qualified professional.
When pertaining to adolescents, counselors need to determine whether
the injury is severe enough to breach confidentiality and inform the
adolescent’s parents.
Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58). Boston, MA:
Pearson Custom Publishing.
Hoffman, R. M., & Kress, V. E. (2010). Adolescent nonsuicidal self-injury: Minimizing client and counselor risk
and enhancing client care. Journal of Mental Health Counseling, 32(4), 342-347.
20. Ethical Concerns
Counselors should always provide informed consent
that covers the clients limits of confidentiality; which
should include duty to protect.
It is important for counselors not to overreact to self-
mutilation behavior due to their own level of fear
and seek extreme measures (i.e. hospitalization)
It is also important that counselors to not disregard
such behavior either and make the appropriate
referral if the situation is beyond their level of
competence.
Counselors should aim at seeking supervision from
another mental health professional who is
experienced when working with clients who self-
mutilate
Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.), Pearson custom education (pp. 33-58).
Boston, MA: Pearson Custom Publishing.
21. References
Bauman, S. (2008). Self-mutilation. In N. Danner (Ed.),
Pearson custom education (pp. 33-58). Boston,
MA: Pearson Custom Publishing.
Hoffman, R. M., & Kress, V. E. (2010). Adolescent
nonsuicidal self-injury: Minimizing client and
counselor risk and enhancing client care. Journal
of Mental Health Counseling, 32(4), 342-347.
Richardson, B. G., Surmitis, K.A., & Hyldahl, R. S. (2012).
Minimizing social contagion in adolescents who
self-injure: Considerations for group work,
residential treatment, and the internet. Journal Of
Mental Health Counseling, 34(2), 121-132.
