One form of self-mutilation can be thought of as culturally accepted, even in the United States. Tattoos, body piercings and earlobe earring holes are all fairly accepted in some if not all social milieux in the U.S. While these behaviors may be viewed by some as pointless self-mutilation, they have a long and multi-varied history in this and many other cultures. The focus of this article is on generally-accepted mutilation, which causes harm to the body and does not meet cultural norms. In its worst form, self-mutilation can include cutting off a limb or self-castration; it is thus a serious problem with a subset of those in the SIB cohort. As with many forms of OCD, self-mutilation generally begins in late childhood and the early teen years.
The authors argue that moderate- to severe SIB requires a combination of therapies. Since much of the etiology is based in family problems with children and young teens, it is necessary to, when possible, initiate family therapy in order to discover the problems which may have led to SIB. The authors recommend combining this with individual therapy, as the child may have specific self-reinforcing behaviors which need to be adapted. It would have been helpful if the authors had indicated what forms of individual therapy were employed in their practice and in the literature. There was also no mention of the use of drugs as an adjunct to treatment, either by the authors themselves or in their study of the relevant literature.
In family therapy, the theme of repression and poor communication seems to be common. According to the authors, families must express their feelings, including “scare, angry, manipulated, useless, nervous, irritated…,” as lack of such expression may lead to SIB behaviors. It would have been helpful if the authors had indicated how boys react in such families; one is left to surmise that they are more likely to act out aggressively to the outside world, rather than take action against their bodies.
Measurement of Nonclinical Personality Characteristics of Women with Anorexia Nervosa or Bulimia Nervosa (Pryor, 1996)
The authors analyze a significant population of women with anorexia nervosa (n=35) and bulimia nervosa (n=45), looking for personality traits which may be inherited. As two of the more severe OCDs which afflict children and young teens, these diseases prove particularly difficult to treat successfully. The authors administered the MPQ (Multidimensional Personality Questionnaire) to the subjects, and found very low scores on well-being, social closeness and positive affectivity.
As one might expect, these same teens had high scores on stress reaction, alienation and negative affectivity. The authors posit that these non-clinical observations may be helpful in treating these patients.
OCD encompasses a broad number of disorders which first appear in children and early teens. The advent of SSRIs has assisted the profession in dealing with acute symptoms, but talk therapy of various forms is needed in order to bring an understanding of the fundamental causes of the OCD, and to assist the patients in ameliorating the diseases over a longer period of time.
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March, J. (2004). Cognitive-Behavior Therapy, Sertraline, and Their Combination for Children and Adolescents With Obsessive-Compulsive Disorder. JAMA, n.p.
Nelson, T.R. (2007). A Narrative Approach to Body Dysmorphic Disorder. Journal of Mental Health Counseling, 67-80.
Pryor, T. a. (1996). Measurement of Nonclinical Personality Characteristics of Women with Anorexia Nervosa or Bulimia Nervosa. Journal of Personality Assessment, 414-422.
Stone, J. a. (2003). Self-Injurious Behavior: A Bi-Modal Treatment Approach to Working with Adolescent Females..