Diagnostic issues in self-mutilation

Hosp Community Psychiatry. 1993 Feb;44(2):134-40. doi: 10.1176/ps.44.2.134.


Objective: Pathological self-mutilation--the deliberate alteration or destruction of body tissue without conscious suicidal intent--was examined both as a symptom of mental disorders and as a distinct syndrome.

Methods: Data from more than 250 articles and books were reviewed, as well as data obtained by the authors from their extensive clinical experience in treating self-mutilating patients.

Results and conclusions: The diverse behaviors that constitute pathological self-mutilation can be categorized into three basic types: major--infrequent acts that result in significant tissue damage, usually associated with psychoses and acute intoxications; stereotypic--fixed, rhythmic behavior seemingly devoid of symbolism, commonly associated with mental retardation; and superficial or moderate--behavior such as skin cutting, burning, and scratching associated with a variety of mental disorders. The authors propose that a syndrome of repetitive superficial or moderate self-mutilation should be regarded as an axis I impulse disorder. In most cases, the syndrome coexists with character pathology.

Publication types

  • Review

MeSH terms

  • Humans
  • Impulsive Behavior / classification
  • Impulsive Behavior / diagnosis*
  • Impulsive Behavior / psychology
  • Personality Disorders / classification
  • Personality Disorders / diagnosis*
  • Personality Disorders / psychology
  • Psychotic Disorders / classification
  • Psychotic Disorders / diagnosis*
  • Psychotic Disorders / psychology
  • Self Mutilation / classification
  • Self Mutilation / diagnosis*
  • Self Mutilation / psychology