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PubMed1989

Why patients mutilate themselves.

Self-mutilation, the deliberate destruction or alteration of body tissue without conscious suicidal intent, occurs in a variety of psychiatric disorders. Major self-mutilation includes eye enucleation and amputation of limbs or genitals. Minor self-mutilation includes self-cutting and self-hitting. The author examines patients' explanations for self-mutilation which frequently focus on religions or sexual themes, and discusses scientific explanations that draw on biological, psychological, social, and cultural theories. Although no one approach adequately solves the riddle of such behaviors, habitual self-mutilation may best be thought of as a purposeful, if morbid, act of self-help.

Adolescent↗
PubMed2003

Dialectical behaviour therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands.

BACKGROUND: Dialectical behaviour therapy (DBT) is widely considered to be a promising treatment for borderline personality disorder (BPD). However, the evidence for its efficacy published thus far should be regarded as preliminary. AIMS: To compare the effectiveness of DBT with treatment as usual for patients with BPD and to examine the impact of baseline severity on effectiveness. METHOD: Fifty-eight women with BPD were randomly assigned to either 12 months of DBT or usual treatment in a randomised controlled study. Participants were recruited through clinical referrals from both addiction treatment and psychiatric services. Outcome measures included treatment retention and the course of suicidal, self-mutilating and self-damaging impulsive behaviours. RESULTS: Dialectical behaviour therapy resulted in better retention rates and greater reductions of self-mutilating and self-damaging impulsive behaviours compared with usual treatment, especially among those with a history of frequent self-mutilation. CONCLUSIONS: Dialectical behaviour therapy is superior to usual treatment in reducing high-risk behaviours in patients with BPD.

Adult↗
PubMed2002

Mutilation of self and object: the destructive world of the paranoid-schizoid patient and the struggle for containment and integration.

Using case material, I have described the three overlapping phases of treatment that occur with some borderline, narcissistic, or psychotic patients. These patients are dealing with paranoid-schizoid experiences of the self and the object. In this part-self, part-object world, many shifting, opposing, and contrary states of feeling and thought occur. Acting out is the first phase of analytic treatment. This is an externalization of persecutory anxiety, primitive guilt, and phantasies of annihilation. Projective identification, splitting, and denial are common and tend to make for difficult transference and countertransference problems. During the middle phase of treatment, pathological superego states and manifestations of death instinct color the analysis. The death instinct reacts defensively to the sadistic superego. Technically, the destructive internal conflicts created by these two elements must be clarified and interpreted in the transference. Flexible analytic management and containment are crucial supplements to ongoing interpretation. If these chaotic patients are able to stay in treatment for a period time, the acting out and the superego/death instinct phase gradually give way to phantasies of loss. This is still a paranoid-schinoid perspective of loss, making it persecutory experience. Although depressive anxieties do enter the picture, these still involve pathological anddestructive states of guilt and all-or-nothing threats of abandonment and attack. A case was presented in which the patient managed to continue into the third stage of analytic treatment, long enough to benefit frominternal, structure change. In this final stage, the patient "O" was able to acknowledge, work through, and integrate her prior feelings and phantasies of loss, persecution, and abandonment anxiety into more manageable and reality-based depressive functioning.

Adult↗
PubMed1981

Self-inflicted ocular mutilation.

Self-inflicted mutilation of the eyes is an uncommon but fairly distinct entity. Patients are typically young men; they often have criminal records and histories of drug abuse. Underlying schizophrenia is a common feature. The patients frequently suffer from castration fears, oedipal conflicts, repressed homosexual impulses, severe guilt, and a need for punishment. We treated two patients with this disorder. The first, a 26-year-old prison inmate convicted of murdering his grandfather, cut his eyes with a razor blade. He had previously attempted to commit suicide, suffered from delusions, and experienced auditory hallucinations. Surgical repair of his injuries improved his visual acuity to R.E.: 6/15 (20/50) and L.E.: 6/30 (20/100). The second patient, a 24-year-old inmate of a mental institution, had previously undergone a lensectomy for a hypermature cataract induced by a self-inflicted lye burn in his left eye. One year later, he was treated for lacerations of his right eye and partial amputation of his tongue. In the year between admissions, he had enucleated his left eye. Visual acuity in his remaining eye was no light perception, so no surgery was performed.

Adult↗
PubMed2004

Effects of anesthesia and nociceptive stimulation in an experimental model of brachial plexus avulsion.

Unilateral dorsal rhizotomy of brachial plexus nerves (C5-Th1) performed under general anesthesia is known to induce self-mutilation in rats. The aim of this study was to determine the effect of different anesthetic agents, and of pre-rhizotomy nociceptive stimulation on the appearance of self-mutilation. Self-mutilation appeared in 78% of animals after rhizotomy had been performed under pentobarbital anesthesia. When ketamine was used as the general anesthetic, self-mutilation was almost suppressed (13%) and consisted of superficial erosions. Mechanical nociceptive stimulation, when applied just before the induction of ketamine anesthesia and subsequent rhizotomy, provoked self-mutilation in 91% of rats. Furthermore, a serious type of self-mutilation consisting of total amputation of the distal part of the forepaw was present in 28% of all self-mutilating animals after previous nociceptive stimulation. In terms of self-mutilation, these results suggest 1) the crucial role of anesthesia, especially that which involved NMDA receptors (ketamine), and 2) the need of an additional factor to chronic deafferentation, formed either by activity of nociceptive pathways just before rhizotomy (nociceptive stimulation preceding ketamine anesthesia) or by injury discharges (pentobarbital anesthesia).

Anesthesia↗
PubMed2004

Paradoxical firing of thalamic neurons under neuropathic pain state in rats.

OBJECTIVES: A novel evaluative approach was used to determine single unit activities of non-bursting intralaminar thalamic nuclei under neuropathic pain state following dorsal rhizotomy. SETTINGS AND DESIGN: Extensive dorsal rhizotomy at cervicothoracic level in rats was used as a model of central pain. After rhizotomy, rats were divided into two groups: rats without any signs of self-mutilation, and those presenting self-mutilation. Spontaneous single unit activities of neurons of intralaminar thalamic nuclei were recorded and interspike intervals (ISIs) of non-bursting cells were counted for both groups and compared with that of non-rhizotomized control rats. Chaodynamic methods were applied for the evaluation of the ISIs. RESULTS: In control rats Lyapunov exponents, Shannon entropy and mutual information average values were significantly higher than those of rhizotomized rats without any signs of self-mutilation. Paradoxically, in animals presenting self-mutilation following rhizotomy the evaluated parameters were similar to those of controls. Further, Lyapunov exponents were positive values in all animals indicating chaotic pattern of the neuronal firing. MAIN FINDINGS: 1. Neurons behave in chaotic way in all animals, 2. The most regular firing was found in non-mutilating rhizotomized animals, 3. Patterns of the firing in selfmutilating rats were similar to those in controls. CONCLUSIONS: It is concluded that pain feeling is not executed neither by changes of chaotic dynamics of non-bursting intralaminar thalamic neurons. On the other hand, the paradoxical firing of the neurons under pathological brain matrix might participate in modification pain feeling.

Action Potentials↗
PubMedDate not supplied

Orofacial manifestations of congenital insensitivity to pain with anhidrosis: a report of 24 cases.

PURPOSE: To report the incidence and severity of the oral and dental manifestations associated with congenital insensitivity to pain with anhidrosis (CIPA). METHODS: Young children with CIPA underwent orofacial examination. The tongue, lips, and buccal mucosa were examined for soft tissue disorder. Missing and luxated teeth were recorded. RESULTS: Twenty four patients (14 males and 10 females, mean age 60 months, range 9-144 months) with CIPA showed moderate to severe self-mutilation. Oral self-mutilation, such as biting injuries and scarring of soft tissues (tongue, lip, and buccal mucosa) were found in all patients. Fingertip biting was also found in most patients. Among infant patients, the mutilation was typically characterized by decubital ulcers of the tongue. Many edentulous areas due to previously extracted teeth were also found. CONCLUSIONS: Early diagnosis and specific dental care for patients with CIPA can be helpful in prevention of the fingertip biting and orofacial manifestations seen in this disorder.

Arabs↗
PubMed2005

Autodestructive syndromes.

BACKGROUND: The phenomenon 'autodestructive behaviour' is becoming an increasingly serious disease and cost factor in a wide range of medical fields. The present paper presents a survey of the literature on autodestructive behaviour, excluding psychotic, substance-induced or organic brain disorders. Starting out with a conceptual overview, the paper goes on to look into the epidemiology of autodestructive behaviour and the forms in which it manifests itself. METHOD: A literature search was conducted in Medline, Psycinfo and Psyndex using the search terms 'artifact', 'artificially induced', 'autodestructive', 'self-mutilation', 'factitious', 'self-harm', 'self-induced', 'self-inflicted', 'self-injuring' and 'self-mutilation' for the period from 1977 to 2003. RESULTS: Five of a total of 18 empirical studies describe the simultaneous occurrence of direct and indirect forms of autodestructive behaviour. Reported prevalence rates range from 0.032% to 9.36%. The ratio of females to males was found to be 2:1 (average age: 31.5 years; SD: 9.3 years); in contrast, the gender ratio was reversed for Munchausen's syndrome. The case history data presented are patchy and differ in terms of their priorities. We found a large number of codiagnoses, which seems to indicate that personality and dependence disorders, or substance misuse, are characteristic of both direct and indirect forms of autodestructive behaviour. CONCLUSIONS: The task at hand is to use a yet-to-be-developed nomenclature and adequately operational diagnostic criteria to work out standardised survey instruments that do justice to the heterogeneity of this disorder complex.

Comorbidity↗
PubMed1990

Skoptic syndrome: the treatment of an obsessional gender dysphoria with lithium carbonate and psychotherapy.

Cases of body image pathology are often misdiagnosed. Recognition of the obsessional annoyance with body image, especially with primary and secondary sex characteristics (skoptic syndrome), is important in making a differential diagnosis with other psychiatric and gender identity disorders. We have reported the successful use of lithium carbonate in treating two cases of skoptic syndrome. The initial low dosage (600 mg./day) resulted in dramatic reversal of obsessional thoughts of self-mutilization and self-castration. Increased dosages (900 mg./day) are still well below those usually used for manic-depressive illness. Our choice of lithium carbonate was prompted by our experience in successfully treating other forms of sexually related dysphorias at low doses, its ability to act rapidly, and the minimal side effects. These changes have been dramatic and lasting. In addition, there was marked lessening of dysthymia and intense anhedonia manifested by severe isolation, listlessness, and apathy. We believe that these cases are important to report in order that psychotherapists make better differential diagnoses of psychiatric disorders related to body image pathology and gender identity disorders. We also feel it is important to report a medication which was found effective in reducing the threat of self-mutilating behavior and making patients more receptive to psychotherapy. These cases increase our understanding of sexually obsessive and compulsive drives and some methods which have been found efficacious in reducing these symptoms.

Body Image↗
PubMed1997

Affect regulation and suicide attempts in adolescent inpatients.

OBJECTIVE: To examine the relationship between affect dysregulation and self-destructive behaviors in adolescent suicide attempters. METHOD: Measures of affect dysregulation, number of risk-taking behaviors in past year, presence of self-mutilative behaviors in past year, and number of different types of self-mutilative behaviors in past year were individually administered to adolescents admitted to an inpatient unit who were either suicide ideators (n = 25) or suicide attempters (n = 35). RESULTS: Suicide attempters reported significantly higher levels of affect dysregulation and a greater number of different types of self-mutilative behaviors in the past year than suicide ideators. In addition, the number of different types of self-mutilative behaviors in the past year had the strongest relationship to suicide attempts. CONCLUSION: Suicidal behavior among adolescent psychiatric patients is related to poor affect regulation. A risk factor for suicidal behavior in adolescents is a broad range of self-mutilative acts in the year preceding the suicide attempt.

Adolescent↗