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Treatment of adolescents can be challenging and difficult at times. Their propensity for acting out conflicts is great and requires special understanding and technical skill on the part of the therapist. When the behaviour becomes destructive of the patient's own body, we often find ourselves reacting by misperceiving this act as suicidal and moving towards having the patient hospitalized (Daldin, 1988). No matter where the treatment takes place, work with mutilating adolescents is both fascinating and arduous. In this paper I will attempt to clarify the meanings of self-mutilating behaviour in adolescents, present the psychogenesis of the pathology and discuss treatment techniques.
Self-mutilating patients have in common some characteristics and some early experiences. Most are female adolescents or young adults (Raine, 1982). Rosenthal et al. (1972) have found that most of these patients perceive menarche as something to make them frightened and miserable; they often have irregular menses. Many suffer from psychosomatic disorders (Friedman et al., 1972), eating disorders, e.g. anorexia, bulimia (Pao, 1969; Raine, 1982), are sexually promiscuous (Pao, 1969; Raine, 1982) and are sexually inhibited (Raine, 1982). Occasionally there is some suicidal ideation and rumination (Daldin, 1988; Hurry, 1989; Pao, 1969). A study by Rosenthal et al. (1972) found that many of these patients have had early physical trauma or surgery, usually before the age of 6. Most mutilation is of the wrist or forearm (Raine, 1982). Biven (1977) described the earlier years of his self-destructive patient as a ‘tragic and chaotic life, dominated by object loss, and struggle against depressive affect’ (p. 327), making adolescent development difficult at best. This statement seems to characterize many of the patients I have encountered who inflict injury upon themselves.