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PubMed1978

Self-destructive behavior on an inpatient ward.

Suicidal and self-destructive behavior on a psychiatric inpatient service are said to be related to the degree of staff demoralization and dissension. Staff factors that may permit or encourage self-destructive acts include poor communications, staff disagreements, scapegoating of patients, poor staff judgment, staff self-preoccupation, and reversal of staff-patient roles. However, it is also possible that a major contributory factor is not individual patient or staff psychopathology, but rather the destruction of the underlying traditions and values of the ward which occurs at times of major change. The thesis is presented that the ritualization of ward values, when operative, provides a coherent world-view which renders the therapeutic activities, and life itself, meaningful, and that such ritualization can provide a framework of stability in times of critical staff turnover. Without such tradition and ritualization, however, therapeutic activities become hollow and meaningless, and fail to provide self-destructive patients a reason to view their life more positively.

Hospitals, Psychiatric↗
PubMed1979

A biological approach to two forms of human self-injury.

One hundred cases of self-injury, comprising 39 self-cutters and 61 self-poisoners, were interviewed when they became able to describe the act: 83 in a casualty department, 17 in a hospital. Standardized recordings were made of their feeling state before and after the act, together with an account of the social circumstances under which it occurred. The information was obtained in a way which allowed comparison with existing animal data on self-injury, although comparisons were made between what is known of animal behavior in this area and human feelings as reported by these subjects. The results indicate similarities between what is known of animal self-injury and self-cutting in man in the form of the injury, in the social situation preceding the act, and in the agitation preceding it. Similarities also exist, but are less close, for the self-poisoners. The most obvious effect of the act is a reduction in tension; this may constitute its physiological value.

Adolescent↗
PubMed1979

Self-inflicted eye injuries and self-inflicted blindness.

The case of a young man, suffering from schizophrenia, who injured his eyes with his hands and blinded himself, is described, along with his rehabilitation program. The classical and contemporary literature on self-inflicted blindness and self-inflicted eye injuries is reviewed and shows a wide range or psychiatric diagnoses and illustrates the inadequacy of attempting to apply oversimplified psychodynamic explanations. In contrast, the reaction to blindness appears to be relatively uniform, leading to the possibility of using established rehabilitation programs.

Adult↗
PubMed1982

A case of self-inflicted eye injuries.

The case is described of a young man who repeatedly injured his left eye. There was a history of previous deliberate self-injury and of childhood epilepsy. A diagnosis of borderline personality disorder was made. Similarities to other reported patients who injured their eyes, to "wrist-cutters," and to "delicate self-cutters" are discussed.

Adolescent↗
PubMed1986

Laxative abuse as a variant of bulimia.

Two groups of bulimic patients, one group characterized by a pattern of laxative abuse for purposes of weight control and the other group characterized by no history of laxative abuse, were compared on several behavioral variables associated with bulimia. Relative to the nonabusers, the laxative abusers were more likely to abuse diuretics; to use diet pills; to chew and spit out food; and to report a history of suicide attempts, self-injurious behavior, and prior inpatient treatment for depression.

Adult↗
PubMed1988

Profiles of aggression among psychiatric patients. I. Nature and prevalence.

Based on the Yudofsky scale, a Modified Overt Aggression Scale (MOAS) with upgraded psychometric properties was developed to assess the nature and prevalence of aggression in a psychiatric population. The present report describes the standardization of this scale and the pattern of findings on two cohorts of 114 and 150 inpatients. The results support the discriminative validity of the MOAS and its internal, interrater, and retest reliabilities. Within 1 week some form of aggression was noted in about one fourth of the patient samples, with verbal aggression the most prevalent and autoaggression the least. Chronic patients showed the lowest incidence of physical assault and general aggression, whereas gender differences and daily variations were not significant. Greater stability of aggression was demonstrated for patient groups and for forms of aggression with higher base rates and for the short term (within 1 week) rather than the long course (3 months). The high prevalence of aggression and the consistency of profiles across patient samples suggested that sensitive, multivariable scaling can improve the accuracy of measurement and the depiction of the construct.

Adult↗
PubMed2002

Severity of reported childhood sexual abuse and its relationship to severity of borderline psychopathology and psychosocial impairment among borderline inpatients.

This study has two purposes. The first purpose is to describe the severity of sexual abuse reported by a well-defined sample of borderline inpatients. The second purpose is to determine the relationship between the severity of reported childhood sexual abuse, other forms of childhood abuse, and childhood neglect and the severity of borderline symptoms and psychosocial impairment. Two semistructured interviews of demonstrated reliability were used to assess the severity of adverse childhood experiences reported by 290 borderline inpatients. It was found that more than 50% of sexually abused borderline patients reported being abused both in childhood and in adolescence, on at least a weekly basis, for a minimum of 1 year, by a parent or other person well known to the patient, and by two or more perpetrators. More than 50% also reported that their abuse involved at least one form of penetration and the use of force or violence. Using multiple regression modeling and controlling for age, gender, and race, it was found that the severity of reported childhood sexual abuse was significantly related to the severity of symptoms in all four core sectors of borderline psychopathology (affect, cognition, impulsivity, and disturbed interpersonal relationships), the overall severity of borderline personality disorder, and the overall severity of psychosocial impairment. It was also found that the severity of childhood neglect was significantly related to five of the 10 factors studied, including the overall severity of borderline personality disorder, and that the severity of other forms of childhood abuse was significantly related to two of these factors, including the severity of psychosocial impairment. Taken together, the results of this study suggest that the majority of sexually abused borderline inpatients may have been severely abused. They also suggest that the severity of childhood sexual abuse, other forms of childhood abuse, and childhood neglect may all play a role in the symptomatic severity and psychosocial impairment characteristic of borderline personality disorder.

Adolescent↗
PubMed1997

Household objects as a cause of self-inflicted orbital apex syndrome.

This report describes two cases of self-inflicted penetrating nonprojectile orbitointracranial injury. Suicide attempts caused by these types of injuries are very rare. An understanding of the orbital and intracranial anatomy and the avoidance head turn help to predict potential injury sites. Computed tomography and cerebral angiography were helpful in the treatment of these two cases.

Adult↗
PubMed1977

Microsurgical replantation of a completely amputated penis and scrotum: case report.

A successful replantation of an amputated penis-scrotum, by microneurovascular anastomoses, is presented. There were no significant postoperative complications. A satisfactory result was obtained with sensory reinnervation of the glans. Microsurgical replantation, with anastomoses, is the best procedure in these cases when the circumstances permit it.

Adult↗
PubMed1978

Factitious (self-inflicted) skin wounds.

We represent 4 of our recent cases of factitious skin wounds. The general aspects of these wounds--including etiology, diagnosis, detection, and treatment--are discussed.

Adult↗
PubMed1997

Replantation of the complete external genitals.

Most cases of genital amputation represent an isolated penile amputation; the combined amputation of both penile and testes is reported very seldom. We describe a case of complete amputation of the external genitals with successful replantation and good functional outcome. The problem is analyzed with respect to operative strategy, ischemic periods, postoperative management, and psychiatric background. For the replantation of the testes, time frames are comparable to those for macroreplantations.

Adult↗

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