Self-mutilation

Like acts of suicide, homicide, and the sexual abuse of children, self-mutilation is an example of human behavior at its most dysfunctional. Covering the entire spectrum of self-mutilation, from wrist-scratching to autocastration and self-inflicted eye removal, this is one of the few books since Karl Menninger's Man against Himself (1938) to comprehensively address this disturbing phenomenon. The book is divided into three sections that cover theory, research, and treatment. Part I focuses on the scope of the problem by reviewing the forms of self-mutilation behavior reported in the literature and analyzing its incidence as reported in a number of Western countries. In two particularly important chapters one theoretical, the other a review of the empirical literature including the authors' own research the book makes a crucial but difficult distinction between self-mutilative behavior and suicide attempts. The authors conclude that self-mutilation and suicide should be understood and treated as separate clinical problems. In Part II self-mutilation is described as it occurs in different clinical populations. Results from the authors' study of adolescent self-mutilators identifies key childhood and adolescent antecedents to the behavior. Another study by the authors provides the first empirical evidence for the frequently reported phenomenon of self-mutilative contagion. In addition, a detailed case example of a contagion episode illustrates how such "clusters" of self-mutilation develop. This section also offers extended discussion of the distinctive features of self-mutilation in borderline personalities, psychotics, retarded and autistic individuals. Several case examples map the idiosyncratic determinants of these behaviors for each specific group. Part III covers treatment. The authors present new and specific guidelines for the cognitive-behavioral, psychoanalytic, family, and group therapy of mutilators and identify the clinical strategies and responses likely to be counterproductive. The volume ends with a cogent discussion of how these modalities can be integrated into a comprehensive, multimodal treatment program. Designed for a broad range of mental health professionals, including psychologists, social workers, psychiatrists, nurses, and paraprofessionals, Self-Mutilation will be invaluable for those affiliated with psychiatric inpatient facilities, group homes, residential treatment centers, and schools. It is also a useful resource for researchers interested in self-destructive behaviors.