A Contribution to the Understanding of Self-Mutilating Behaviour in Adolescence

Often, adolescents who cut their wrists or other body parts are admitted to hospital, and the treatment focuses on the “suicide gesture” and the conceptual model used is a suicide one. What I have found is that the act of mutilation of the body such as wrist-cutting, becomes de-emphasized or ignored. As with suicidal patients, the method and meaning are often not specifically directed towards ending life. The primary focus of this paper will be on the mutilating behaviour of an adolescent girl, and its meaning in a developmental context. I will not discuss her entire treatment; instead I will confine myself to the period of treatment and aspects of material that most clearly illustrate this girl's pathology as reflected in her wrist-cutting behaviour.

With mutilating patients, their self-injurious behaviour has a sexual component, primarily masturbatory, which is expressed by means of the act. Maltzberger and Buie (1980) state, “The craving for punishment is associated with sexual activity, is frequently associated with the guilt for oedipal wishes. Psychoanalytic study of a high proportion of patients reveals minor masochistic trends in adolescent masturbatory fantasies, wherein intercourse is permitted only if some punishment is inflicted” (p. 62). It is my contention that cutting on the skin represents a self-stimulating masturbatory activity, involving both expression of masturbatory sexual gratification as well as punishment for the impulse to stimulate the self. These patients have severely disturbed body egos and distort pain into pleasure, which is an attempt to restore body integrity in the face of the self-injurious act. Biven (1977) points out how the skin is “an organ of contact” (p. 351) and plays an important role in fantasies. As we know with infants, polymorphous perversity is where gratification is gained through diverse organic processes, and in this case of mutilation, the behaviour finds expression in masochistic, autoerotic trends. Menninger (193