Self-cutting is today's equivalent of anorexia and bulimia, Dr. Alan J. Ravitz said at the annual conference of the American Society for Adolescent Psychiatry.

This behavior is a form of affect regulation; patients resort to it when they feel that they are about to undergo psychic disorganization.

There is no specific diagnosis associated with self-mutilation. The behavior occurs among patients with borderline personality disorder, major depression, obsessive-compulsive disorder, posttraumatic stress disorder, and various types of psychosis.

For these patients, self-cutting induces an almost immediate sense of relief from an intolerable psychological experience, said Dr. Ravitz of the University of Chicago.

No one knows precisely how self-mutilation leads to the relief of unbearable anxiety, anger, or sadness, but biologic mechanisms may be involved. Intense pain leads to an outpouring of various neurochemicals into the central nervous system that can effect synaptic modifications and induce a different pattern of electrical activity, he said.

The behavior is not only maladaptive but also self-reinforcing. Like any addictive behavior, the intensity and frequency of the behavior must increase continually for release to be achieved.

First, appropriate drug therapy should be undertaken to address the underlying disorder. Another approach is to focus on helping the patient gradually tolerate increasing intensity of affect within the safe context of a trusted treatment relationship. The therapist also can help patients change the meaning of their experiences.

COPYRIGHT 2002 International Medical News Group
COPYRIGHT 2002 Gale Group