The focus of this research database is on how stress affects women's health,

and options for treatment using mind-body therapies. 

If you are not a health care professional, see new "Medical Glossary" below.  

To obtain full summaries of the articles, see "How to Get Abstracts" below. 

9809120 JA

Of almost 1000 randomly selected, stratified US adults, the prevalence of self-injury in the general population, male and female, was 4%, and was 21% in a psychiatric clinic group. There was a strong correlation with childhood sexual or physical abuse. The practice reportedly reduced anger at self and others, fear, emptiness, hurt, loneliness and sadness.

1998 Am J Orthopsychiatry 68;4:609-20

Briere, J. and Gil, E.

9612442 R,T

Review of diagnosis, symptoms, etiology and treatment. Self-mutilation refers to the "deliberate, direct destruction or alteration of body tissue without conscious suicidal intent", and is a "self-help effort providing rapid but temporary relief from feelings of depersonalization, guilt, rejection, boredom, hallucinations, sexual preoccupations, and chaotic thoughts."

1998 J Nerv Ment Dis 186;5:259-68

Favazza, A. R.

9172240 R,T

Self-cutters describe a period of depersonalization leading to painless cutting, followed by relaxation and repersonalization after bleeding. Complications include social rejection due to the behavior as well as the resulting disfigurement. Primary care providers can identify and intervene by establishing a trusting relationship.

1997 Nurse Pract 22;5:151-3, 159-65

Dallam, S. J.

2711856 JA

"Data are presented on 240 female habitual self-mutilators. The typical subject is a 28-year-old Caucasian who first deliberately harmed herself at age 14. Skin cutting is her usual practice, but she has used other methods such as skin burning and self-hitting, and she has injured herself on at least 50 occasions. Her decision to self-mutilate is impulsive and results in temporary relief from symptoms such as racing thoughts, depersonalization, and marked anxiety. She now has or has had an eating disorder, and may be concerned about her drinking. She has been a heavy utilizer of medical and mental health services, although treatment generally has been unsatisfactory. In desperation over her inability to control her self-mutilative behavior this typical subject has attempted suicide by a drug overdose."

1989 Acta Psychiatr Scand 79;3:283-9

Favazza, A. R. and Conterio, K.

2644160 R

Discusses self-mutilation as the "deliberate destruction or alteration of body tissue without conscious suicidal intent" as a purposeful act of self-help, via interviews with patients.

1989 Hosp Community Psychiatry 40;2:137-45

Favazza, A. R.

9740977 R,T

Review of literature and presentation of six possible etiologic models and treatments for this disorder.

1998 Clin Psychol Rev 18;5:531-54

Suyemoto, K. L.

9029348 JA

Studies in male self-cutters showed they had less perceived control over their options, and used avoidance as a coping behavior.

1997 J Clin Psychol 53;2:177-86

Haines, J. and Williams, C. L.

11901779 R,T

Deliberate self-harm may be seen as a temporary escape from an intolerable situation or psychic or physical pain, a way of communicating distress or anger, or a way to try to influence the behavior of others. Many DSH patients have decreased problem-solving skills, so they can' t think of an alternative solution. 60-70% are significantly depressed, and 20% have an alcohol dependency. 25% of suicide victims presented with an episode of DSH in the previous year.

2002 Practitioner 246;1632:164-6, 169-72

Sinclair, J. M. and Hawton, K.

7754789 R

Review of self-injurious behavior in a sample of 54 female psychiatric inpatients, in relation to impulsivity, eating disorders, personality and schizophrenia.

1995 Acta Psychiatr Scand 91;1:57-68

Herpertz, S.

9245269 JA

Interviews with four female teens who self-injure reveal that they consider this an adaptive alternative to suicide. Issues of communication and control are discussed.

1996 J Adolesc 19;2:111-9

Solomon, Y. and Farrand, J.

11452679 R

Severe self-mutilation may occur when a person in under the delusional belief that a part of the body is causing trouble, is deformed, or needs to be sacrificed. Causes may include guilt, religious guilt, self-punishment, and gender dissatisfaction. An abrupt change in appearance (ie shaved head) may precede the injurious act.

2001 Int J Clin Pract 55;5:317-9

Parrott, H. J. and Murray, B. J.

2729432 JA

Case report of three women who began cutting themselves after rape with subsequent post traumatic stress disorder. One of the women had been a bright, outgoing college student with no previous psych history, who had been threatened with death if she told anyone, and used cutting as a way to release unbearable tension due to rape-related flashbacks.

1989 Am J Psychiatry 146;6:789-90

Greenspan, G. S. and Samuel, S. E.

11060002 JA

Following the death of Diana, princess of Wales, there was an increase in female deliberate self-harm of 65.1% in the following week, and increase in female suicides age 25-44 by 45.1% in the following month. Etiology was felt to be "amplification of personal losses or exacerbation of existing distress."

2000 Br J Psychiatry 177;463-6

Hawton, K., Harriss, L., Simkin, S., Juszczak, E., Appleby, L., McDonnell, R., Amos, T., Kiernan, K., and Parrott, H.

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2609364 JA

Discusses the correlation between eating disorders and self-mutilation, as a manifestation of an impulse control disorder.

1989 Suicide Life Threat Behav 19;4:352-61

Favazza, A. R., DeRosear, L., and Conterio, K.

10972574 JA

Of 236 patients with anorexia, over 60% reported some form of self-injurious behavior, including skin cutting/burning, hair pulling or severe nail biting, classified as either impulsive or compulsive. Childhood sexual abuse or anxiety significantly predicted impulsive self-injury, whereas obsessionality and younger age were associated with compulsive self-injury. Those with both impulsive and compulsive components had a 72% drop-out rate in treatment.

2000 J Nerv Ment Dis 188;8:537-42

Favaro, A. and Santonastaso, P.

7894450 JA

Article describes 19 female patients with a similar biphasic pattern, consisting of anorexia/amenorrhea followed by return of menses over time with subsequent bulimia, obsessive-compulsive disorder and self-mutilation. 70% reported childhood sexual abuse.

1995 Int J Eat Disord 17;1:33-8

Yaryura-Tobias, J. A., Neziroglu, F. A., and Kaplan, S.

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Hair Pulling and Skin Picking

7615485 JA

Trichotillomania, an irresistible urge to pull one's hair, typically begins about age 11, and usually involves the scalp. Most do not seek treatment.

1995 J Clin Psychiatry 56;7:319-26

Cohen, L. J., Stein, D. J., Simeon, D., Spadaccini, E., Rosen, J., Aronowitz, B., and Hollander, E.

11891999 JA

Hair-pulling and skin picking share similar patient characteristics, and similar treatment may benefit both.

2002 Depress Anxiety 15;2:83-6

Lochner, C., Simeon, D., Niehaus, D. J., and Stein, D. J.

9048705 JA

54% of female hair pullers engaged in other self-injury behaviors, and that group had a more significant history of depression and suicidality.

1997 J Nerv Ment Dis 185;2:117-9

Simeon, D., Cohen, L. J., Stein, D. J., Schmeidler, J., Spadaccini, E., and Hollander, E.

7713862 R,T

Review of hair-pulling in the context of an obsessive-compulsive disorder, versus an impulsive disorder.

1995 J Clin Psychiatry 56 Suppl 4;28-34; discussion 35

Stein, D. J., Simeon, D., Cohen, L. J., and Hollander, E.

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7673571 CT

Physiologic data on self-cutters showed significant increases in heart rate, respiratory rate and skin resistance prior to an imagined act of self-harm, with all of these parameters dropping significantly during the act itself and subsequently. This was in contrast to the same group of self-cutters experiencing neutral or aggressive imagery, and to a group of non-self cutters experiencing self-harm imagery.

1995 J Abnorm Psychol 104;3:471-89

Haines, J., Williams, C. L., Brain, K. L., and Wilson, G. V.

12116193 JA

In patients with impulsive behavioral tendencies, those with more episodes were more likely to have a specific genetic form of tryptophan hydroxylase, an enzyme necessary for the synthesis of serotonin.

2002 Am J Med Genet 114;5:553-7

Staner, L., Uyanik, G., Correa, H., Tremeau, F., Monreal, J., Crocq, M. A., Stefos, G., Morris-Rosendahl, D. J., and Macher, J. P.

"Depersonalization is a subjective sense of unreality regarding various aspects of the self, experienced as disconnectedness from one's own body, mentations, feelings, or actions." This paper reviews depersonalization as a possible serotonin disorder, and its possible connection to self-injurious behaviors.

1995 J Clin Psychiatry 56 Suppl 4;36-9; discussion 40

Simeon, D., Stein, D. J., and Hollander, E.

1734743 MCC

The degree of self-mutilatory behavior in 26 patients was significantly correlated with impulsivity, chronic anger, somatic anxiety, and a biochemical serotonin dysfunction.

1992 Am J Psychiatry 149;2:221-6

Simeon, D., Stanley, B., Frances, A., Mann, J. J., Winchel, R., and Stanley, M.

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11513383 MA

Review of several trials showed that brief problem-solving therapy significantly improved depression, hopelessness and treatment outcomes for deliberate self-harm patients.

2001 Psychol Med 31;6:979-88

Townsend, E., Hawton, K., Altman, D. G., Arensman, E., Gunnell, D., Hazell, P., House, A., and Van Heeringen, K.

12080906 JA

Authors describe a successful cognitive-behavioral therapy program of "habit reversal" for patients with repetitive, ritualistic, or impulsive skin picking that leads to tissue damage.

2002 Behav Modif 26;3:361-77

Deckersbach, T., Wilhelm, S., Keuthen, N. J., Baer, L., and Jenike, M. A.

3434646 JA

Describes the successful use of hypnosis via relaxation training and positive imagery with self-cutters, helping them reduce anxiety and boost self-esteem and self-control.

1987 Am J Psychother 41;4:531-41

Malon, D. W. and Berardi, D.

9625002 JA

Article describes a holistic program for self-cutters that includes music and art therapy, aromatherapy, physical exercise and relaxation techniques, as well as a more tolerant view of why the injury takes place.

1998 Nurs Stand 12;29:25-6

Batty, D.

9582763 R,T

This paper discusses negative nursing attitudes towards people who self-mutilate, and suggests how to change perspective to a more collaborative approach.

1998 J Clin Nurs 7;2:129-37

Clarke, L. and Whittaker, M.

10796818 MA

Review of studies on treatment of various self-harm problems shows some help with psychotherapy as well as medication, but due to the small number of inconsistently defined trials, specific recommendations are difficult.

2000 Cochrane Database Syst Rev2:CD001764

Hawton, K., Townsend, E., Arensman, E., Gunnell, D., Hazell, P., House, A., and van Heeringen, K.

9536765 JA

A British nursing group who put together a holistic information pack on self-injury were inundated with requests from mental health workers, prisons, residential care, services for the homeless, schools and housing associations. They noted the extreme lack of readily available information, and started a global network with education conferences.

1998 Nurs Times 94;5:53

Hogg, C. and Burke, M.

9355464 R,T

Review of subtypes of self-mutilating behavior, how to identify at-risk adolescents, and appropriate nursing interventions.

1997 J Child Adolesc Psychiatr Nurs 10;3:35-40

Kehrberg, C.