Psychotherapeutic approaches
Psychodynamic psychotherapy is the most common form of individual therapy used in treating self-mutilation. Effective therapy enables patients to understand why they self-mutilate and teaches them more healthy ways to deal with negative internal states.2,3
Individual therapy is the mainstay of self-mutilation treatment, although no known studies have confirmed that psychodynamic psychotherapy reduces acts of self-mutilation. Because self-mutilators tend to have poor boundaries, supervision and peer collaboration are highly recommended to maintain an effective therapeutic relationship.1
Yet to be answered is whether healthier coping strategies alter measures of impulsivity. Patients who have improved report they are better able to cope with negative affective states and to verbalize their feelings.
Dialectical behavior therapy (DBT) is another psychotherapeutic option. Used in treating personality disorders, DBT combines cognitive, behavioral, and supportive interventions. In one study, DBT reduced the frequency of self-mutilation to 1.5 acts per year, compared with 9 acts per year in a treatment-as-usual control group.21
Need for ‘emergency plans’
Relaxation training, exposure therapy, and response prevention have been suggested as treatments for pathologic self-mutilation, but there is no convincing evidence to support their efficacy.1 Contracts against self-mutilation do not appear to be effective. Instead, “emergency plans” may be needed to deal with urges to self-mutilate.
Crisis intervention strategies that may help the self-mutilator include:
- partial hospitalizations to focus on increasing coping skills and strengthening a patient’s sense of self-reliance and individual responsibility
- increased frequency of visits
- educating the patient to use medications such as atypical neuroleptics or benzodiazepines as needed (“in case of emergency, take this medication instead of cutting”).
Crisis interventions should focus on understanding and changing pathologic behaviors. Self-mutilation behavior may be reinforced if attention is given without enough emphasis on developing coping skills.
Group therapy may be another treatment option. Group support helps patients with pathologic gambling, addictive, or other impulse control disorders to prevent relapse and learn to deal with urges and impulses.
Related resources
- Self-injury Web site offering information about self-harming behavior plus coping skills, alternatives to self-injury, support groups. www.selfabuse.com
- Levenkron S. Cutting: understanding and overcoming self-mutilation. New York: WW Norton and Company Ltd, 1998.
- SAFE (Self-Abuse Finally Ends), www.selfinjury.com. Resources for patients, families, and therapists. Recording at 1-800-DON’T-CUT (800-366-8288) offers to mail information on self-injury and the SAFE Alternatives program.
Drug brand names
- Clonazepam • Klonopin
- Clozapine • Clozaril
- Fluoxetine • Prozac
- Lorazepam • Ativan
- Naltrexone • ReVia
- Nalmefene • Revex
- Olanzapine • Zyprexa
- Paroxetine • Paxil
- Sertraline • Zoloft
- Topiramate • Topamax
Disclosure
Dr. Fong reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.