Concept analysis of self-mutilation.

AIM This paper is a report of a concept analysis to define and describe self-mutilation. BACKGROUND Although there has been an increased interest in self-mutilation, as evidenced by recent publication of opinion literature, anecdotal reports and a few clinical studies, the concept has not been well developed to guide nursing research and interventions. METHOD Definitions and uses of self-mutilation were obtained in a comprehensive review of the health, psychology and education literature up to April 2007 to identify the defining attributes, antecedents and consequences. Walker and Avant's concept analysis strategy was the organizing framework. FINDINGS Self-mutilation is the intentional act of tissue destruction with the purpose of shifting overwhelming emotional pain to a more acceptable physical pain. Antecedents of self-mutilation are impaired coping skills and an unhealthy response to situations that cause unbearable emotional stress. Limited research suggests that risk factors for self-mutilation may be White race, adolescent age, female sex and history of sexual abuse as a child. Although self-mutilation allows the individual to gain control over emotions and provides a diversion from emotional pain, a release of endorphins after the physical damage that contributes to the feeling of relief supports an addictive maladaptive coping cycle of pain, relief, shame and self-hate. CONCLUSION The theoretical definition of the concept of self-mutilation offers the basis for nurses to develop interventions to provide competent care when discovering injuries that are self-inflicted.