Self-mutilation and pharmacotherapy.
OBJECTIVE
To critically review clinical reports on the pharmacotherapy of self-mutilation.


METHODS
PubMed search and review of articles dating back to 1950 contributing to the understanding of self-mutilation and its treatment, with a special focus on pharmacotherapy. Key word searches include self-mutilation, deliberate self-harm, and pharmacotherapy of borderline personality disorder.


RESULTS
Clinical reports specifically demonstrating reductions in self-mutilation mainly consist of open studies and case reports. These reports support the use of SSRIs, naltrexone, atypical antipsychotics, mood stabilizers, and clonidine in the treatment of self-mutilation. Better constructed studies demonstrate general reductions in impulsive aggression, often in the context of borderline personality disorder, through treatment with antidepressants, antipsychotics, and mood stabilizers.


CONCLUSIONS
There is evidence, albeit limited, for the pharmacologic management of self-mutilation. Further studies, especially double-blind, placebo-controlled trials, are needed to substantiate these preliminary findings.
Dr. Smith is from the Department of Psychiatry, Michigan State University, East Lansing, Michigan.
Brian Daniel
BD
Smith