History
The term "self-mutilation" occurred in a study by L. E. Emerson in 1913 where he considered self-cutting a symbolic substitution for masturbation. The term reappeared in an article in 1935 and a book in 1938 when Karl Menninger refined his conceptual definitions of self-mutilation. His study on self-destructiveness differentiated between suicidal behaviours and self-mutilation. For Menninger, self-mutilation was a non-fatal expression of an attenuated death wish and thus coined the term partial suicide. He began a classification system of six types:
- neurotic – nail-biters, pickers, extreme hair removal and unnecessary cosmetic surgery.
- religious – self-flagellants and others.
- puberty rites – hymen removal, circumcision or clitoral alteration.
- psychotic – eye or ear removal, genital self-mutilation and extreme amputation
- organic brain diseases – which allow repetitive head-banging, hand-biting, finger-fracturing or eye removal.
- conventional – nail-clipping, trimming of hair and shaving beards.
Pao (1969) differentiated between delicate (low lethality) and coarse (high lethality) self-mutilators who cut. The "delicate" cutters were young, multiple episodic of superficial cuts and generally had borderline personality disorder diagnosis. The "coarse" cutters were older and generally psychotic. Ross and McKay (1979) categorized self-mutilators into 9 groups: cutting, biting, abrading, severing, inserting, burning, ingesting or inhaling and hitting and constricting.
After the 1970s the focus of self-harm shifted from Freudian psycho-sexual drives of the patients.
Walsh and Rosen (1988) created four categories numbered by Roman numerals I–IV, defining Self-mutilation as rows II, III and IV
| Classification | Examples of Behavior | Degree of Physical Damage | Psychological State | Social Acceptability |
|---|---|---|---|---|
| I | Ear-piercing, nail-biting, small tattoos, cosmetic surgery (not considered self-harm by the majority of the population) | Superficial to mild | Benign | Mostly accepted |
| II | Piercings, saber scars, ritualistic clan scarring, sailor and gang tattoos | Mild to moderate | Benign to agitated | Subculture acceptance |
| III | Wrist- or body-cutting, self-inflicted cigarette burns and tattoos, wound-excoriation | Mild to moderate | Psychic crisis | Accepted by some subgroups but not by the general population |
| IV | Auto-castration, self-enucleation, amputation | Severe | Psychotic decompensation | Unacceptable |
Favazza and Rosenthal (1993) reviewed hundreds of studies and divided self-mutilation into two categories: culturally sanctioned self-mutilation and deviant self-mutilation. Favazza also created two subcategories of sanctioned self-mutilations; rituals and practices. The rituals are mutilations repeated generationally and "reflect the traditions, symbolism, and beliefs of a society" (p. 226). Practices are historically transient and cosmetic such as piercing of earlobes, nose, eyebrows as well as male circumcision (for non-Jews) while Deviant self-mutilation is equivalent to self-harm.
Read more about this topic: Self-harm
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