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PubMed2005

Clinical correlates and repetition of self-harming behaviors among female adolescent victims of sexual abuse.

This study investigated self-harming behaviors in 149 female adolescent victims of sexual abuse, first, by determining the rates of nine types of self-mutilating behavior at intake and nine months later and, second, by investigating comorbidity of clinical correlates associated with these behaviors. The adolescents were divided into three groups according to level of self-mutilating behavior and then compared on symptom self-reports; 62.1% of the adolescents engaged in at least one self-mutilating behavior. A graded relation was observed between level of self-mutilating behavior and rate, and total number of clinical disorders. At nine month follow-up, one in four teenagers still reported a moderate or high level of self-harm. The need for systematic assessment and intervention of self-mutilating behaviors is discussed.

Adolescent↗
PubMed1997

[Open self-injury behavior with special reference to child and adolescent psychiatry. A review of the literature and first study findings].

The present investigation combines a review of the literature on self-mutilation and our own findings. The literature on this topic is extensive, but there are very few reports on self-mutilation in children and adolescents with a psychiatric diagnosis. In our study we explored the symptoms and psychopathological features of 64 children and adolescents with self-mutilative behavior who had been seen at an inpatient psychiatric facility. The topic is presented from a phenomenological and nosological point of view. We identified a subgroup of adolescents with both self-mutilative and suicidal behavior. The implications for the use of longitudinal studies are discussed.

Adolescent↗
PubMed1999

Perceived abuse and neglect as risk factors for suicidal behavior in adolescent inpatients.

The aim of this study was to assess relative risk of histories of different types of abuse (sexual, physical, and emotional) and neglect (physical and emotional) for suicidal behavior (attempts, ideation, and self-mutilation) in psychiatrically hospitalized adolescents. Seventy-one adolescent inpatients (34 boys, 37 girls) completed self-report measures of abuse and neglect, current suicidal ideation, and lifetime suicide and self-mutilation attempts. The prevalence of sexual and physical abuse was 37.5% and 43.7%, respectively, with 31.3% and 61% of youngsters reporting emotional and physical neglect. Fifty-one percent of youngsters had made suicide attempts, and 39% had self-mutilated. Suicide attempters were significantly more likely to be female, Latino, to report sexual, physical, and emotional abuse, and to endorse emotional neglect. In multivariate analyses, female gender, sexual abuse, and emotional neglect remained significant predictors of self-mutilation and suicidal ideation. Female gender and sexual abuse remained significant predictors of suicide attempts. These findings suggest that emotional neglect is an important and deleterious component of maltreatment experiences and may be a more powerful predictor of suicidal behavior in hospitalized adolescents than physical abuse, emotional abuse, and physical neglect.

Adolescent↗
PubMed2005

Suicide and attempted suicide in bipolar disorder: a systematic review of risk factors.

OBJECTIVE: To determine the main risk factors for suicide and nonfatal suicidal behavior in patients with bipolar disorder through a systematic review of the international literature. DATA SOURCES: Studies were identified through electronic searches of MEDLINE (1966-December 2003), EMBASE (1980-December 2003), PsycINFO (1872-November 2003), and Biological Abstracts (1985-December 2003) using index and free-text search terms for bipolar disorder, bipolar depression, manic depression, mania, and affective disorders; combined with terms for self-harm, self-injury, suicide, attempted suicide, automutilation, self-mutilation, self-poisoning, and self-cutting; and combined with terms for risk, case control, cohort, comparative, longitudinal, and follow-up studies. No language restrictions were applied to the search. STUDY SELECTION: Included studies were cohort, case-control, and cross-sectional investigations of patients with bipolar disorder in which suicide (13 studies) or attempted suicide (23 studies) was reported as an outcome. The selected studies also used diagnostic tools including the DSM, International Classification of Diseases, and Research Diagnostic Criteria. DATA SYNTHESIS: Meta-analysis of factors reported in more than 1 study identified the main risk factors for suicide as a previous suicide attempt and hopelessness. The main risk factors for nonfatal suicidal behavior included family history of suicide, early onset of bipolar disorder, extent of depressive symptoms, increasing severity of affective episodes, the presence of mixed affective states, rapid cycling, comorbid Axis I disorders, and abuse of alcohol or drugs. CONCLUSIONS: Prevention of suicidal behavior in patients with bipolar disorder should include attention to these risk factors in assessment and treatment, including when deciding whether to initiate treatment aimed specifically at reducing suicide risk.

Bipolar Disorder↗
PubMed1995

A method for reporting self-harm according to level of injury and location on the body.

Self-mutilation occurs on a continuum from superficial to severe, yet previous studies have not differentiated these acts. This study, conducted over 4 years with emotionally disturbed adolescents, presents a method for reporting four levels of severity of self-mutilation. A group of 32 subjects inflicted 128 self-mutilations. Each wound was rated for level of injury and was mapped according to the location of the wound on the body. This method for reporting self-mutilation was seen as an efficient and reliable procedure for describing the full continuum of self-inflicted injuries. The term self-harm was seen as a more accurate and useful description of these behaviors.

Adolescent↗
PubMed1998

Evaluation of risperidone in the neonatal 6-hydroxydopamine model of Lesch-Nyhan syndrome.

Rats were treated as neonates with 6-hydroxydopamine (6-OHDA) 100 mg free base in 10 microl intracisternally. Upon maturation, animals were injected with L-dopa and placed in photocell cages for monitoring of locomotion, stereotypies, and self-mutilation. Pretreatment with either risperidone or SCH-23390 significantly reduced locomotion and stereotypies. SCH-23390 eliminated L-dopa induced self-mutilation in all subjects, while risperidone eliminated self-mutilation in all but one subject.

Animals↗
PubMed1991

Effects of different sensory and behavioral manipulations on autotomy caused by a sciatic lesion in rats.

We studied the effects of different sensory and behavioral manipulations on autotomy (self-mutilation). Lidocaine and bupivacaine pretreatments of the transected nerves delayed the onset of autotomy. Short prelesional stimulation (crush) of the transected nerve did not enhance autotomy significantly. Daily handling decreased autotomy behavior strongly and a visual cue placed on the denervated skin increased autotomy slightly. The delayed onset of the autotomy behavior after locally administered anesthetics suggests that the lesion-induced afferent barrage modified self-mutilation. The decreased self-mutilation after daily handling could be a consequence of handling stress. The increase of autotomy after the visual cue might have resulted from the attention-induced increase of the activity in ascending nociceptive tracts.

Afferent Pathways↗
PubMed2006

Results of psychodynamically oriented trauma-focused inpatient treatment for women with complex posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD).

In a naturalistic outcome study, the authors evaluated the results of a specific psychodynamically oriented trauma-focused inpatient treatment for women with complex posttraumatic stress disorder and concomitant borderline personality disorder, self-mutilating behavior, and depression. At admission, the frequency of self-mutilating behavior and the amount of inpatient treatment (an average of 68 days annually) of the sample was high, characterizing this patient group as "previously therapy resistant." Treatment outcome was assessed both at the end of treatment and in a 1-year follow-up. In comparison with a treatment-as-usual control group, the treatment program brought about significant and stable improvements both in trauma-specific symptoms (e.g. dissociation, intrusion, avoidance) and in general psychiatric symptoms (e.g., general symptom distress, frequency of self-mutilating behavior, number of hospitalizations). The frequency of inpatient treatments (hospitalizations) decreased dramatically (< 10 days annually; effect size: d = 2.88).

Adult↗
PubMed2002

Analgesia in phasic and tonic pain tests in a pharmacological model of autotomy.

Self-mutilation or self-injurious behaviour is a well known behavioural disorder in humans. The proposition that this behaviour in animals is a response to chronic pain of peripheral nerve injury has been met with controversy. In the present study a pharmacological model, which produces no sensory or motor loss was used to study how autotomy is related to pain. In a group of rats autotomy was induced by amphetamine in phenoxybenzamine and reserpine treated animals. The pain tests, both phasic and tonic were then performed. The results of this study showed that a total analgesia was produced in both phasic and tonic pain tests, in animals that exhibited autotomy. Injection of naloxone in these animals prevented autotomy. A correlation between autotomy and no pain is suggested in this pharmacological model of autotomy.

Adrenergic Uptake Inhibitors↗
PubMed1993

[Depersonalization and self-injury].

Patients with deliberate self harm syndrome and with factitious disorders often describe depersonalisation phenomena, during which they have a diminished pain sensitivity or analgesia. The self-mutilating act can stop the depersonalisation temporarily. Concerning the psychodynamic processes there are common traits between depersonalisation and self-mutilation. The connections between depersonalisation and self-mutilating behaviour are described. Depersonalisation is understood as a defense mechanism, ranging between mature and immature defense mechanisms. An illustrative case is demonstrated.

Adult↗
PubMed2000

Borderline personality and obsessive-compulsive symptoms.

Diagnostic criteria for borderline personality disorder (BPD) are diverse, covering a broad range of symptoms. One criterion, self-mutilation, is a behavioral excess that may be considered a predictor of other psychopathological states. The present study sought to determine the extent to which two groups of BPD patients, those who mutilate and those who do not, differed on measures of general psychopathology, depression, anxiety, and obsessive-compulsive symptoms. Results indicate that the only source of significant variation was the level of obsessive-compulsive symptoms, with mutilators exhibiting greater symptomatology. The findings from this study support the idea that self-mutilation is a more severe form of psychopathology relative to the rest of the BPD population. These results are interpreted based on the affect regulation model of self-mutilation, and contrasted with contemporary models of impulse control in relation to obsessive-compulsive disorder.

Adult↗
PubMed1995

Self-amputation of the ear: three men amputate four ears within five months.

Four instances are presented of self-amputation of the pinna of the external ear carried out by three right-handed, white males between January 1993 and May 1993. The common characteristics of these subjects--two men with personality disorder and one with schizophrenia--are discussed and compared with other examples of self-mutilation involving the face and ears, including that of van Gogh. A survey of Australian and New Zealand prisons was conducted to determine the frequency of this form of self-mutilation within the last five years, and yielded only one other case. Connections exist between the amputees supporting the notion that self-mutilation is "contagious"; the relevance of this to issues of management is considered.

Adolescent↗
PubMedDate not supplied

Vomiting as a manifestation of borderline personality disorder in primary care.

BACKGROUND: Patients with borderline personality disorder often are found and treated in psychiatric settings following episodes of self-mutilation, such as wrist-slashing. Family physicians care for many patients with borderline personality disorder, but in primary care settings wrist-slashing or other physical mutilation is a less common presenting problem. Frequently these patients complain of such symptoms as nausea and vomiting that do not so obviously suggest psychopathology. METHODS: Three primary care patients with borderline personality disorder in whom episodic vomiting was the chief complaint are presented. Hypotheses from the literature about the neurobiology of vomiting and self-mutilation are discussed. RESULTS: Vomiting is a primary care analogue of self-mutilation in some patients with borderline personality disorder. CONCLUSIONS: Family physicians should include careful history taking to corroborate other features of borderline personality disorder in evaluating patients with persistent, episodic vomiting. Obtaining a history of early sexual abuse or chronic interpersonal problems as an adult should not only mitigate the compulsion for extensive, costly, and invasive gastrointestinal system evaluations in such patients, but also suggest more effective treatment strategies.

Adult↗
PubMed2003

Affective, behavioral, and cognitive functioning in adolescents with multiple suicide attempts.

The purpose of this study was to examine affective, behavioral, and cognitive functioning in adolescents with multiple suicide attempts. Forty-seven adolescents with a history of multiple suicide attempts (MA) were compared to 74 single suicide attempters (SA) on psychiatric diagnosis, depressive symptoms, affect regulation, self-mutilation, alcohol use, and hopelessness. Results revealed that the MA group was more likely to be diagnosed with a mood disorder, and reported more severe depressive symptoms and anger, in comparison to the SA group. Behaviorally, the MA group had higher rates of disruptive behavior disorders and higher levels of affect dysregulation and serious self-mutilation than the SA group. Further, greater levels of hopelessness were reported by the MA than the SA group. After controlling for a mood disorder diagnosis, only differences in anger, affect dysregulation, and serious self-mutilation remained significant. Overall, results suggest that treatment with adolescent suicide attempters might specifically target anger and affect dysregulation to reduce risk for future suicidal behavior.

Adolescent↗
PubMed1994

A self-controllable mask with helmet to prevent self finger-mutilation in the Lesch-Nyhan syndrome.

Self-mutilation is a characteristic symptom of Lesch-Nyhan syndrome. We report a newly developed orthosis for managing self-mutilation of the fingers through biting. The orthosis has a plastic mask attached to a helmet; the patient can manage the mask with one hand to stop biting fingers on the other hand. This is a report of a 6-year-old boy who was able to control finger biting by using the orthosis. Eighteen months later he has stopped biting his fingers and no longer wears the orthosis.

Child↗
PubMed1997

[Genital self-injury behavior--phenomenologic and differential diagnosis considerations from the psychiatric viewpoint].

There is only a small number of publications concerning psychiatric aspects of genital-self-mutilation, all of these are case reports. This presentation adds results of self-inflicted genital injuries in another seven males which are discussed in relation to relevant scientific literature focussing on psychopathology and dynamic considerations. It is argued that genital self-mutilations should primarily be considered as symptomatic behavioural patterns and that-beside quasi-normal psychological procedures as part of certain religious or cultural rituals-such acts can be interpreted as a common final pathway of a variety of psychopathological problems. The inclusion of sexually (co-)motivated genital-automutilations in a complete work up and analysis of this topic seems to be reasonable and is advocated by the authors. The assumption that genital self-injuries are more often seen in non-psychotic conditions than in productive psychotic states is substantiated. Finally, the relation between genital automutilations and self-harm in general is discussed and some recommendations on the management are listed.

Adult↗