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The term "self-mutilation" occurred in a study by L. E. Emerson in 1913[87] where he considered self-cutting a symbolic substitution for masturbation. The term reappeared in an article in 1935 and a book in 1938 when Karl Menninger refined his conceptual definitions of self-mutilation. His study on self-destructiveness differentiated between suicidal behaviours and self-mutilation. For Menninger, self-mutilation was a non-fatal expression of an attenuated death wish and thus coined the term partial suicide. He began a classification system of six types: neurotic – nail-biters, pickers, extreme hair removal and unnecessary cosmetic surgery. religious – self-flagellants and others. puberty rites – hymen removal, circumcision or clitoral alteration. psychotic – eye or ear removal, genital self-mutilation and extreme amputation organic brain diseases – which allow repetitive head-banging, hand-biting, finger-fracturing or eye removal. conventional – nail-clipping, trimming of hair and shaving beards.[88] Pao (1969) differentiated between delicate (low lethality) and coarse (high lethality) self-mutilators who cut. The "delicate" cutters were young, multiple episodic of superficial cuts and generally had borderline personality disorder diagnosis. The "coarse" cutters were older and generally psychotic.[89] Ross and McKay (1979) categorized self-mutilators into 9 groups: cutting, biting, abrading, severing, inserting, burning, ingesting or inhaling and hitting and constricting.[90] After the 1970s the focus of self-harm shifted from Freudian psycho-sexual drives of the patients.[91] Walsh and Rosen (1988) created four categories numbered by Roman numerals I–IV, defining Self-mutilation as rows II, III and IV[92] Classification Examples of Behavior Degree of Physical Damage Psychological State Social Acceptability I Ear-piercing, nail-biting, small tattoos, cosmetic surgery (not considered self-harm by the majority of the population) Superficial to mild Benign Mostly accepted II Piercings, saber scars, ritualistic clan scarring, sailor and gang tattoos, minor wound-excoriation, Trichotillomania Mild to moderate Benign to agitated Subculture acceptance III Wrist- or body-cutting, self-inflicted cigarette burns and tattoos, major wound-excoriation Mild to moderate Psychic crisis Accepted by some subgroups but not by the general population IV Auto-castration, self-enucleation, amputation Severe Psychotic decompensation Unacceptable Favazza and Rosenthal (1993) reviewed hundreds of studies and divided self-mutilation into two categories: culturally sanctioned self-mutilation and deviant self-mutilation.[93] Favazza also created two subcategories of sanctioned self-mutilations; rituals and practices. The rituals are mutilations repeated generationally and "reflect the traditions, symbolism, and beliefs of a society" (p. 226). Practices are historically transient and cosmetic such as piercing of earlobes, nose, eyebrows as well as male circumcision (for non-Jews) while Deviant self-mutilation is equivalent to self-harm.[91][94] |
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