On the increase in Western societies, self-inflicted behaviors are difficult to define, due to their blurred limits with suicidal gestures and “body art”.

We mainly retain the definition put forward by researcher Stephan Herpertz:

Self-harm is a ” behavior that consists of deliberately, repeatedly harming oneself in a directly physical manner, without conscious intention to commit suicide, and which does not lead to life-threatening injuries. »

Fact, self-harm does not apply to acts with a sexual connotation and suicide attempts.

The definition given by the researcher Lorthiois seems more complete:

« Self-injury includes all practices that result in tissue or organ damage ; it can be defined as an attack on the integrity of the body; it may consist either of the injury or the total or partial removal of an organ or a limb, of the skin covering or of its appendages; or finally in maneuvers (combustion, necking, introduction of foreign bodies) that could compromise its vitality and its proper functioning without however being carried out with the aim of killing oneself.¹ »

According to the scientific literature, 17% of the population would experience self-harm at least once in her life. Among them, 75% have experienced several episodes, 36% say that no one has ever been aware of their actions and only 3% have consulted a doctor about it.

These figures should nevertheless be taken with caution as the identification of solitary and concealed acts is difficult.

La female population would be over-represented, but the figures vary widely and contradict each other.

Self-harm would start in 60% of cases around the age of 12-13 years. 

There is no consensus on what causes self-harm. The classification of Favazza³However, there are 3 types of self-injury:

• The major self-harm, which are serious acts of amputation, enucleation or emasculation. They are generally attributed to people with schizophrenia or suffering from various delusions.
• The stereotypical self-harm, which are often observed in syndromes linked toautism, mental retardation and several neurological syndromes. Typically, the victim bumps his head, bites or squeezes his eyes.
• The superficial to moderate self-harm, which are the most frequent and which are sub-divided into 2 categories:

· The automutilations compulsives concern the repetition of lesions such as abrasions, tearing of the skin, bites, trichotillomania, maintenance of the non-healing of wounds …

· The impulsive self-harm mainly concern the cuts episodic or repetitive by razor, pieces of glass, scissor blades, as well as Burns.

Le Repeated Self-Injury Syndrome is defined as the repetition of impulsive self-harm, marked by the person’s inability to resist the urge to self-harm. The person has no intention to kill herself when she self-injures. 

There would be some triggering factors among which :

• Strong inner tension;
• A feeling of emptiness;
• A feeling of failure, frustration and rejection;
• The need to express a feeling of hatred, to punish oneself.
• The need for care or attention from others;
• The need to change physical appearance;
• The need to belong to a group and to stop feeling alone;
• The need to reconnect with reality, to keep from thinking about suicide.

It happens that these mutilations are motivated by tendencies or the sign of a risk-taking behavior, just like the consumption of illicit substances. 

All parts of the body are concerned but certain regions are privileged, in particular the arms and wrists. Researcher Rosenthal has also described the wrist cutting syndrome, as these areas are popular⁴. The thighs, scalp, lips, hands, fingers and even genitals are also affected.

Generally, self-harm is not concealed, and rather even on the contrary exhibited, which differentiates them from the marks found in the context of the symptom of Lasthenie de Ferjol. 

Some authors report correlations between this type of practice and disorders recorded in the DSM-V, among which :

• Bipolar disorder;
• Post-traumatic stress disorder;
• Substance abuse;
• Explosive disorder;
• Suicide: 1 quarter to 1 third of suicides are preceded within a year by a form of self-harm⁵. Almost 9% of self-inflicted victims die within 20 years of the incident, and even 1,8% within the following year⁶.

Somatic care is obviously a priority in the event of proven mutilation.

A psychiatric assessment is essential afterwards, even if the person was not having suicidal thoughts.

We will attempt to diagnose an associated pathology, identify other risk-taking behaviors and carry out a social and family assessment. 

« When I see my blood flow, it’s like a purification » Anonymous

« The burns and the cuts allowed me to release the gigantic hatred that was in me. Now I don’t know what it is for me, this hatred is gone, all I have left is despair, no desire to live and an excessive attraction to death » Anonymous

« When I cut myself I feel better »  Anonymous

« They are not suicide attempts but attempts to live » Breton