The Arts in Psychotherapy 40 (2013) 120–129 Contents lists available at SciVerse ScienceDirect The Arts in Psychotherapy Self-mutilation as expressed in self-figure drawings in adolescent sexual abuse survivors Angi Jacobs-Kayam, MA * , Rachel Lev-Wiesel, PhD, Gali Zohar, PhD The Graduate School of Creative Arts Therapies and The Emili Sagol Creative Arts Therapies Research Center, Haifa University, Israel article info Keywords: Self mutilation Self harm Sexual abuse Adolescent Draw A Person Test Self-figure drawing abstract Given the detrimental long-term physical and emotional effects of self-mutilation (SM) coupled with the tendency not to disclose suffering and the shortcomings of current diagnostic tech- niques, early detection of the phenomena utilizing an external tool such as a projective drawing test (not a medical examination) might provide an opportunity to identify and consequently assist self-mutilators. This study aimed to determine if and to what extent indicators of self-mutilating behaviors are expressed in self-figure drawings of female adolescents who were sexually abused. Researchers used a version of (draw yourself) Machover’s Draw A Person (DAP) Test, because it is an easy to administer and non-intrusive screening tool, hypothesizing that it will improve the detection of SM. This will facil- itate practitioners’ future location of adolescent females at risk for SM as well as assist in prioritizing accessibility to treatment. A convenience sample of 92 adolescent girls was recruited for this study. Participants completed the DAP test in addition to a previously validated self-report questionnaire, the Traumatic Events Question- naire (TEQ). Findings include positive correlations between psychometric assessments and two indicators of self-mutilation in the DAP test (body line and sexual signs). The study also provides validation of four indicators of sexual abuse previously documented in research: face line, eyes, hands/arms, and genitals. © 2012 Elsevier Inc. All rights reserved. Self-mutilation Self-mutilation (SM) is defined as an intentional, direct dam- age of one’s own body, which results in superficial to moderate physical harm, without suicidal intent (Favazza, 1998). Dozens of interchangeable terms have been used by researchers in order to describe the aforementioned behavior (e.g. Bakken & Whitney, 2012; Klonsky, 2007; Kress, 2003; Zila & Kiselica, 2001) – self- harm, deliberate self-harm, parasuicide, non-suicidal self-injury, self-mutilation, self-injury and self-inflicted harm, among others. This lack of consensus has encumbered research efforts, made it difficult to estimate prevalence of the phenomena and hampered the conduct of comparative studies. * Corresponding author at: The Graduate School of Creative Arts Therapies, Haifa University, Mount Carmel 31905, Israel. Tel.: +972 50 5977394; fax: +972 8 9717020. E-mail addresses: angi jk@yahoo.com (A. Jacobs-Kayam), rlev@haifa.univ.ac.il (R. Lev-Wiesel). Characteristics of self-mutilation Underlying the act of SM is a desire to divert intense emotional pain to a more intelligible physical pain (Van Sell et al., 2005). A variety of socially acceptable body alterations, such as tattoo- ing, ear piercing, plastic surgery, as well as religious rites, such as circumcision, do not fall under the definition of SM. SM is deter- mined, among other factors, such as social and religious norms, the subject’s intention, and the effect the injury has on the self (Kress, 2003). While emotionally and physically detrimental, SM is hardly ever life-threatening and the majority of self-inflicted injuries do not demand hospitalization, a fact which prevents much needed intervention (Hicks & Hinck, 2007; Hurry, 2000). The need for intervention is magnified by the repetitive nature of SM, as many self-mutilators repeat the self-destructive behav- iors time and again (Sampson, Mukherjee, Ukoumunne, Mullan, & Bullock, 2004; Zila & Kiselica, 2001). Nonetheless, while not perceived as rooted in suicidal tendencies, SM does carry a risk of death (Clarke & Whittaker, 1998; Gratz, 2006; Nock, Joiner, Gordon, Lloyd-Richardson, & Prinstein, 2006; Nock, Prinstein, & Sterba, 2009; Zila & Kiselica, 2001). SM is typically a solitary behavior, 0197-4556/$ – see front matter © 2012 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.aip.2012.11.003