The challenge of self-mutilation: a review.

The challenge of self-mutilation among humans arises from the imprecision of much of the existing literature, as well as the countertransference such disturbing behavior mobilizes. Self-mutilation is defined as an individual's intentionally damaging a part of his or her own body apparently without a conscious intent to die. The importance of understanding this behavior is reflected in the frequency with which it is encountered among psychiatric patients, particularly those diagnosed with borderline personality disorder or schizophrenia. The distinguishing characteristics of dermal, ocular, and genital self-mutilation illustrate the diverse clinical settings in which mutilation arises. Numerous explanations with differing degrees of complexity and merit have been offered; yet, no clear consensus has emerged. Psychotherapy, behavior therapy, and chemotherapy, while controversial, remain the most compelling treatment options. Salient areas for further study include epidemiology both for specific groups and the general population, possible biologic bases for the behavior, and additional management options.