Schizophrenia and Self Injury

While most people can’t fathom purposely hurting themselves, self-injury is not uncommon with certain types of psychiatric disorders. Although it is most frequently seen in individuals with borderline personality disorder, it is also seen at times in a variety of other disorders, including obsessive-compulsive disorder, eating disorders, stereotypic movement disorder, and schizophrenia.

What is self-injury?

Self-injury is a term often used to mean the same things as self-harm or self-mutilation. Essentially, it involves the act of injuring or causing pain to your own body. Types of self-injury can range from something relatively minor (in terms of degree of harm) such as picking one’s skin, superficial cutting, or pulling out hair, to something more serious or dangerous like deep cutting or amputating part of one’s own body. Using dangerous substances or essentially starving oneself, as in anorexia, are also considered types of self-injury.

Regardless of the act, self-injury is different than a suicide attempt in that death is not the conscious goal. Rather, the goal is often to numb painful feelings or punish oneself in some way. However, in individuals with psychosis, it is typically due to a delusional belief (e.g., the person believes his hand is evil so he cuts it off) or in response to command auditory hallucinations – voices telling the person to harm him/herself in some specific way.

Risk factors

While individuals with borderline personality disorder, for example, typically engage in mild to moderate forms of self-injury or self-mutilation, schizophrenics are more likely to engage in major self-mutilation (MSM). A 2008 study suggests that one of the primary causes for MSM is the individual’s first psychotic break 1.

Five common variables

Another study which reviewed the various risk factors for self-injury in schizophrenics revealed five common variables 2. These were:

  1. Thoughts of suicide (either recent or previous)
  2. Past incidents of self-injury
  3. Abuse of or dependence on drugs
  4. History of depression
  5. Higher number of psychiatric hospitalizations

Dangers of self-injury among schizophrenics

When a person with schizophrenia engages in self-injury, it often involves something rather bizarre and potentially very serious. For example, individuals with schizophrenia may cut off a finger or remove one of their eyes. Genital self-mutilation may occur, as in the case of a schizophrenic man who initially cut off his index finger, and then later cut off his penis. He reported that voices told him that by doing so he would save the world 3.

The primary danger is that while the person isn’t trying to commit suicide, the self-injurious act itself may be fatal or at least life-threatening if not quickly treated. Particularly in the case of self-amputation, there is risk of bleeding to death, not to mention serious infection if the wound is not treated quickly and properly.

Prevention

While self-injury in schizophrenia can’t be prevented 100%, it almost always occurs during acute psychosis. The best prevention is adhering to one’s treatment regimen as well as getting treatment sooner than later, preferably before symptoms become full-blown. Antipsychotic medications help alleviate various symptoms, particularly the hallucinations and delusions which play a primary role in schizophrenic self-injury. As long as s/he takes his/her medication as prescribed, s/he is much less likely to engage in self-injurious behavior.

written by Dr. Cheryl Lane, PsyD

References

  1. Major Self-mutilation in the First Episode of Psychosis
  2. Schizophrenia and Deliberate Self-Harm: A Systematic Review of Risk Factors
  3. A Patient with Chronic Schizophrenia Presenting with Multiple Deliberate Self-Harm and Genital Self-mutilation (pdf file)

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