Les automutilations recouvrent plusieurs types de conduites, de la simple excoriation cutanée à l’autocastration. Il est actuellement difficile d’obtenir une définition consensuelle de ce type de troubles. Pour certains auteurs, les blessures auto-infligées sont un symptôme pathognomonique de la personnalité « borderline » ; pour d’autres, il s’agit au contraire d’une entité diagnostique à part entière, amenant ainsi à définir de nouveaux syndromes. Ces comportements d’automutilation sont particulièrement fréquents chez les adolescents, avec une prépondérance féminine et chez les patients présentant une pathologie psychiatrique. La plupart des sujets utilisent plusieurs méthodes pour s’automutiler et privilégient différentes localisations pour les automutilations, celles-ci sont souvent associées à des comorbidités psychiatriques. Cette étude décrit une cohorte de 30patients hospitalisés s’automutilant et compare les données recueillies (sociodémographiques, antécédents, comorbidités et type d’automutilation) à celles de la littérature. Le groupe se compose majoritairement de filles et l’âge moyen est de 18ans. Trente pour cent des patients disent avoir subi des maltraitances durant l’enfance, 60 % sont suivis sur le plan psychiatrique et 73 % ont un antécédent de tentative d’autolyse. Tous les patients se sont infligés des blessures à au moins deux reprises et plusieurs moyens sont associés dans la plupart des cas (incision des avant-bras le plus souvent). Les conduites addictives telles que l’abus de substance (tabac 46,7 % ; alcool 23,3 % ; toxique 16,7 %) et les troubles des conduites alimentaires (33,3 %) sont fréquemment associés aux automutilations. Enfin, trois diagnostics sont principalement retrouvés dans notre cohorte (syndrome dépressif 36,7 % ; trouble de personnalité 20 % ; trouble psychotique 10 % ; association d’un syndrome dépressif et d’un trouble de personnalité 33,3 %).

Deliberate self-injury is defined as the intentional, direct injuring of body tissue without suicidal intent. There are different types of deliberate self-mutilating behaviour: self cutting, phlebotomy, bites, burns, or ulcerations. Sometimes, especially among psychotic inpatients, eye, tongue, ear or genital self-mutilations have been reported. In fact, self-mutilation behaviour raises nosological and psychopathological questions. A consensus on a precise definition is still pending. Many authors consider self-mutilating behaviour as a distinct clinical syndrome, whereas others hold it to be a specific symptom of borderline personality disorder. Self-mutilating behaviour has been observed in 10 to 15% of healthy children, especially between the age of 9 and 18months. These self mutilations are considered as pathological after the age of 3. Such behaviour is common among adolescents, with a higher proportion of females, and among psychiatric inpatients. Patients use different locations and methods for self-mutilation. Deliberate self harm syndrome is often associated with addictive behaviour, suicide attempt, and personality disorder.

We report on an observational study including 30inpatients and we compared the data with the existing literature. As a matter of fact, until now, most of the papers deal with case reports or with very specific patterns of self-mutilation (eye, tongue or genital self-mutilations). Otherwise, papers report the relationships between self-mutilation and somatic or personality disorders (Lesh Nyhan syndrome, borderline personality disorder, dermatitis artefacta, self-mutilation in children following brachial plexus related to birth injury, mental retardation...). Our study included all self harmed patients who had been admitted to our psychiatric hospital (whatever the location and type of self-mutilation). Patients suffering from brain injury or mental retardation were excluded.

In our sample, there was a higher percentage of women (29women and 1man) and the mean age was 18 (12 to 37). More than half of the patients were aged under 18. Single parent families were reported in 30% of cases. Thirty percent of patients had been physically or sexually abused during childhood. Sixty percent had a comorbid psychiatric disorder, 63% had been hospitalised previously (half of them twice or more). Seventy-three percent of patients had previously attempted suicide (notably deliberate self-poisoning and cutting) that was not considered as self-mutilating behaviour by the patients themselves. Each patient had self harmed themselves at least twice and most often different methods and locations were used (deliberate self harm of forearms 90%, thighs 26.7%, legs 16.7%, chest 10%, belly 10%, hands 6.9%, face 6.9%, arms 6.7%, and feet 3.3%). Addictive disorders, such as substance abuse (tobacco 46.7%; alcohol 23.3%; illicit drugs 16.7% mostly cannabis or cocaine) and eating disorders (33.3% and among them 50% of cases were restrictive anorexia nervosa) were often associated with a deliberate self harm syndrome. Three psychiatric diagnoses were often observed in our cohort: depressive disorder 36.7%; personality disorder 20%; psychosis 10% and depressive disorder associated with personality disorder 33.3%. In our sample, psychotic patients differed on several clinical aspects: the atypical location (abdomen, nails) and method (needles) of self-mutilating behaviour. None of them had been abused during childhood and none was suffering from addictive disorders.