The following article deals with sensitive topics which may be distressing to some readers.
A case report published on the academic website Cureus shows that self-injury still lacks understanding in some countries. The article, titled Self-Mutilation: A Way to Protect Yourself From a Committed Crime or to Gain Personal Benefits1 describes four cases of self-injuries, purportedly inflicted to obtain personal gain. The cases differ greatly: the first one being that of a man who suffers from substance use disorder who injured himself in detention, the second a man who pretended to have been abused by his wife, the third of a young girl, and the last of a man who appears to have attempted thieving.
All the authors belong to the Department of Forensic Medicine and Deontology, at the Medical University of Sofia in Bulgaria. It suggests that this case study is written within the medico-legal scope and that the outcomes of examination of injuries could be legal or punitive. As explained in the article, forensic medicine aims at analyzing an injury in order to determine its cause and time, and whether it was self-inflicted or caused by someone else. Failing to spot self-inflicted injuries can lead to insurance fraud or wrongfully accusing an innocent of a crime. The authors argue that self-inflicted injuries are usually motivated by personal gain or severe underlying psychiatric illness. Yet, such a limited definition of self-harm is outdated and we now know that many individuals who self-injure do not suffer from serious psychiatric disorders.
Case 3 tells about a young girl who was brought by her parents to forensic physicians to undergo a virginity test. She declined ever having sex which was confirmed by the test. During the examination, physicians also found self-inflicted cuts and abrasions on her arm that wrote the name of her boyfriend. She admitted self-harming to punish her parents because they did not allow her to see her boyfriend.
The inclusion of this young girl’s case in an article about malingering is alarming as it not only fails to support this vulnerable person, but it also perpetuates stigma surrounding self-harm and the practice of virginity tests. It is particularly shocking to see the publication of such an article in a journal that belongs to Springer Nature Group without any condemnation of virginity tests.
Virginity tests are a gynecological examination that has no scientific value and cannot prove virginity or loss of it. They are illegal in many countries due to their cruel and discriminatory nature, and are harmful to women who undergo such procedures. They are often performed without definitive consent, and can cause psychological distress such as anxiety, depression, PTSD, and self-harming behaviors. They are a violation of fundamental human rights and a form of sexual assault2, 3. Such examination is putting the young girl in the case study of further self-harm risk. But instead of taking this factor into consideration, or the fact that the familial context such as discord between parents and children is another risk factor for self-harm4, the article stigmatizes the behavior.
Stigma attached to self-harm, such as the misconception that it is an “attention-seeking” or “manipulative” behavior, still persists even among health professionals, which can lead to further self-harm or the avoidance of health services5, and minimizes people’s distress. Instead of helping this young girl get access to treatment and resources for better mental health, the forensic physicians failed to take into consideration the motives behind her self-harm and dismissed it as “parental punishment and protest against their prohibition”. It is particularly deplorable as contact with experienced physicians can be an opportunity to detect mental health issues. The photograph of the girl’s injuries shows at least two episodes of self-harm at various stages of healing. Repetitive self-harm increases the risk for suicide6, once again stressing the fact that her distress should not be minimized.
Physicians across the world must be aware of the harmful stigmas surrounding sexuality and mental health, and ban virginity tests so that they can help people at risk instead of worsening their condition.
References
[1] Mileva, B., Goshev, M., Georgieva, M., Tsranchev, I. I., & Alexandrov, A. (2023). Self-Mutilation: A Way to Protect Yourself From a Committed Crime or to Gain Personal Benefits. Cureus, 15(10). https://doi.org/10.7759/cureus.48085
[2] Independent Forensic Expert Group. (2015). Statement on Virginity Testing. Journal on Rehabilitaiton of Torture Victims and Prevention of Torture, 25(1), 62-68. https://irct.org/wp-content/uploads/2022/08/IFEG-Statement-Virginity-Testing.pdf
[3] Olson, R. M., & García-Moreno, C. (2017). Virginity testing: a systematic review. Reproductive Health, 14(61). https://doi.org/10.1186/s12978-017-0319-0
[4] Ferrey, A. E., Hughes, N. D., Simkin, S., Locock, L., Stewart, A., Kapur, N., Gunnell, D., & Hawton, K. (2016). The impact of self-harm by young people on parents and families: a qualitative study. BMJ Open, 6(1). http://dx.doi.org/10.1136/bmjopen-2015-009631
[5] Sandy, P. (2013). Motives for self-harm: views of nurses in a secure unit. International Nursing Review, 60(3). https://doi.org/10.1111/inr.12038
[6] Lewis, S. P., & Hasking, P. A. (2023). Self-Injury and Suicidal Thoughts and Behaviors. In Understanding Self-Injury: A Person-Centered Approach. Oxford University Press, Incorporated.
Exploring self-harm 