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The term self-mutilation includes a variety of forms of intentional self-harm without the intent to die. It is the result of feelings of shame or the need to relieve tension. The damage is done to oneself, without the involvement of another person, and the damage may be severe enough to cause tissue damage (such as scarring). But this category excludes acts that are committed with conscious suicidal intent, body decoration, spiritual enlightenment through rituals, or are associated with sexual arousal.

A mood can be positive or negative, or even neither. Some people harm themselves to end a dissociative episode, to punish them, and to return to reality. Self-mutilation is one way to stop this dissociative episode. Dissociation is a process in which the mind separates itself from certain memories and thoughts that are too painful to keep in awareness. Some people report feeling numb during the dissociation phase, and getting hurt allows them to feel “alive.”

Compulsive skin picking (CSP) is not to be taken lightly. It is a form of self-mutilation and over time it can be very serious. Other variations of this disorder are cutting, burning, skin picking, hair pulling, bone breaking, hitting, and interfering with wound healing. These behaviors are repetitive and intentional behaviors that cause substantial physical harm and result in clinically significant distress or functional impairment.

CSP is often classified as an impulse control disorder within the spectrum of obsessive-compulsive disorder (OCD), as skin picking is often recurrent, ritualistic, and stress-reducing. This disorder tends to run in families. As a result of the constant pinching, this can cause infection, bruising, bleeding, or permanent disfigurement of the person’s skin.

Symptoms of self-mutilation often include wearing long-sleeved or loose-fitting clothing, even in hot weather, and an unusual need for privacy. People with this disorder often hesitate to change their clothes or undress in the presence of other people. Other behaviors include not wearing a bathing suit because areas of the body have been shaved or using heavy makeup to cover scabs and shaved areas of the face. In most cases, the individual also shows signs of depression.

The behavior is often unconscious, and people with this disorder may not stop because they are often unaware of their actions. There is no specific disorder name for this problem in the Diagnostic and Statistical Manual (DSM-IV) published by the American Psychiatric Association (APA), but some researchers believe that the disorder deserves recognition as a separate diagnostic entity.

Therefore, skin picking is a self-injurious behavior in which many people feel they need to create surfaces that allow them to satisfy their compulsions and also relieve their tensions. Individuals engage in these behaviors to produce scabs that can then be collected. CSP may be related to another condition called dermophagia, which involves swallowing skin or scabs that patients have torn off.

Prevention of self-mutilation should focus on increasing coping mechanisms, facilitating decision-making strategies, fostering positive relationships, and cultivating self-esteem.

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