Byard et al correlated certain types of skin lesions and self-mutilation. The authors are from The University of Adelaide in Australia and the Institute of Legal Medicine and Forensic Sciences in Berlin.
Features of self-mutilation - all of the following:
(1) deliberate harm to the body
(2) not intended to commit suicide
(3) no more plausible explanation
(4) absence of self-defense wounds, cuts in clothing, or other sign of external agent
Self-mutilation most often takes the form of cutting or burning in accessible skin areas. Lesions tend to reflect the person's handedness (on left side if right-handed; on right side if left-handed).
Risk factors:
(1) severe psychiatric illness
(2) intoxications
(3) financial or social benefit
Patterns highly suspicious of self-mutilation:
(1) chessboard (checkerboard)
(2) symmetrical and "mirror-image"
Diagnostic problems:
(1) atypical lesions
(2) fabricated stories
Differential diagnosis of suspicious skin lesions:
(1) abuse
(2) torture
(3) malingering
(4) sadomasochistic relationship
