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PubMed2004

Is there a specific relationship between childhood sexual and physical abuse and repeated suicidal behavior?

OBJECTIVE: Studies show that childhood sexual and physical abuse predict repeated suicide attempts and self-mutilation. Little is known about the importance of sexual and physical abuse when compared to other severe childhood adversities with respect to chronic suicidal behavior. METHOD: Seventy-four subjects, 65% of whom were women, consecutively admitted to a general hospital after having made a suicide attempt, were interviewed as part of the intake interview about prior suicide attempts and self-mutilation and received DSM-IV diagnoses. Sexual abuse, physical abuse, neglect, antipathy from parents, loss of parents, and severe discord in the family before the age of 18, were covered by the Childhood Experience of Care and Abuse (CECA) interview schedule. RESULTS: The prevalence of severe sexual abuse was 35%, severe physical abuse 18%, neglect 27%, antipathy 34%, loss of caregiver 37% and exposure to family violence 31%. Physical and sexual abuse were independently associated with repeated suicide attempts when controlling for the effects of the other childhood adverse factors. No other childhood adversity was related to chronic suicidal behavior. The odds ratio of exposure to sexual or physical abuse was highest among those who both repeated suicide attempts and self-mutilated. CONCLUSION: Physical and sexual abuse are significantly and independently associated with repeated suicidal behavior.

Adolescent↗

PubMed2006

Suicide and deliberate self-harm in personality disorders.

PURPOSE OF REVIEW: This article reviews literature published over the period January 2004-May 2005 on suicidal behaviour and self-harm in personality disorders. RECENT FINDINGS: Studies have confirmed that personality disorders and their co-morbidity with other psychiatric conditions are risk factors for both fatal and nonfatal suicidal behaviours, and self-mutilation. Negative life events, childhood sexual abuse, difficulties in social functioning, deficits in future-directed thinking and time perception, as well as familial and neurocognitive factors may be related to increased suicide risk in individuals with borderline and other personality disorders. Findings seem to confirm that suicidality and self-injurious behaviour are efficient DSM-IV diagnostic criteria for borderline personality disorder. Out of several psychosocial and pharmacological interventions for treating suicidality in personality disorders, only one randomized, controlled study has recently been published. Medico-legal concerns related to the clinical management of chronically suicidal patients, including hospitalization and alternative treatment approaches, are also discussed. SUMMARY: Although recent studies have contributed to the theoretical knowledge and clinical practice, there are unsettled questions that should be addressed in the future. More randomized, controlled trials evaluating the efficacy of interventions in suicidal individuals with personality disorders should be conducted. As the majority of studies conducted to date have concentrated on borderline personality disorder and antisocial personality disorder, the prevalence and risk factors for suicidal behaviours and self-mutilation in other personality disorders require further clarification. The introduction of unified nomenclature related to suicidal behaviours and self-mutilation would facilitate comparability of results across studies.

Comorbidity↗

PubMed1990

Infected wounds and repeated septicemia in a case of factitious illness.

During 19 years an assistant nurse, now 35 years old, has been repeatedly treated for several malingered and self-induced disorders escalating to self-mutilation. An ulcer of her right leg never epithelialised in spite of various local treatments and surgical intervention. During repeated attacks of self-induced septicemia altogether 11 different bacterial species were isolated; on 8 occasions Rhodococcus equi. The septicemias were successfully treated with antibiotics. The underlying psychiatric problem, a borderline personality disorder, has not been possible to treat in a conventional manner. Probably due to collaboration between the plastic surgeon and the psychiatrist she has had fewer attendances and shorter hospital stays lately. Her prognosis is still dubious as regards further self-mutilation and other expressions of self-destructive behaviour.

Actinomycetales Infections↗

PubMed1986

Long-term follow-up of ten patients with Lesch-Nyhan syndrome.

Ten cases of Lesch-Nyhan syndrome have been followed for 3-19 years (mean, 11 years and four months). Criteria of Lesch-Nyhan syndrome were restricted to the following: complete absence of hypoxanthine-guanine phosphoribosyltransferase (HPRT) in hemolysate and fibroblast, spasticity, choreoathetosis, mental retardation, self-mutilation, and occurrence in males. Two patients have died of pneumonia and two died suddenly. However, autopsies produced no positive findings. Hyperuricemia has been controlled by benzbromarone in nine patients. One patient did not take any medical treatment and died suddenly when he was 19 years old, but showed no gouty signs. Patients with Lesch-Nyhan syndrome indicated no change or aggravation of choreoathetosis or spasticity. Self-mutilation was difficult to control by any treatment with continuing effect. After the age of ten, self-mutilation declined in seven cases, and in one patient disappeared completely. Mental delay was remarkable and suspected developmental age (DA) was 7 months - four years and 10 months (chronological age, 7 years and five months - 19 years and 6 months). Mean DQ score was 15.6. Physical development was severely delayed, and weight age was 28.9-46.4%, mean 37.4% of chronological age. Future investigations will evolve clarification of CNS signs and its treatment, and etiological research of sudden death.

Adolescent↗

PubMed1985

Autotomy following limb denervation: effects of previous exposure to neurectomy.

Neurectomy, dorsal rhizotomy or spinal cord lesions can evoke self-attack and autotomy of portions of insensate limbs. This behavior has been attributed to dysesthesia and/or pain. However, the majority of animals subjected to these lesions do not exhibit self-mutilation. This study was designed to test for individual predisposition to self-mutilative behaviors by effecting two sequential limb denervations. In susceptible animals, denervation of the first limb induced circulatory, trophic and inflammatory reactions and/or autotomy. Inflammation developed slowly in one or two digits of some animals and then spontaneously resolved. Other animals attacked the tips of inflamed digits effecting local autotomy. Still other animals aggressively attacked multiple digits, rapidly developed diffuse inflammation and produced extensive autotomy. Denervation of a second limb, following complete healing of all tissue injury, induced by the first denervation, produced several dramatic responses. Nearly 90% of those responding with autotomy to the first denervation responded with autotomy to the second denervation. In contrast, only 11% of the non-attackers showed autotomy following the second denervation. The inflammatory and autotomy responses to the second denervation were markedly reduced in latency and increased in intensity. The pattern of autotomy was stereotyped, initiated at the digit tips, progressed proximally, lead by advancing inflammation. It is suggested that a strong host-response component is involved in the autotomy response.

Afferent Pathways↗

PubMed2004

[Alterations of symptoms with borderline personality disorder after fronto-temporal traumatic brain injury. A case study].

We report a case of borderline personality disorder in which severe self-mutilation, sense of futility and tendency to manipulate others disappeared after fronto (orbital cortex and dorso-lateral surface) temporal traumatic brain injury. The patient, a right-handed 34 year-old woman began having severe depressive moods, irritability, and performed recurrent self-mutilation by wrist cutting after her marriage at age 20. She was diagnosed as having borderline personality disorder. At the age of 30, she attempted to kill herself by leaping from a building, and sustained a frontotemporal traumatic brain injury. After 5 years of follow-up, she recovered from Wernicke's-like aphasia, but could not understand anything complex. She also showed disturbances of writing, calculating, attention, working memory, recent and remote memories, motivation, and sense of self. The results of tests of higher brain function were as follows: Wisconsin card sorting test (Keio version), C = 1, D = 2, P = 23; FAB (Frontal Assessment Battery) = 7/18; Trail making test B = impossible. Brain MRI demonstrated left frontal lobe (orbital cortex and dorso-lateral surface) contusions, severe atrophy in the left temporal cortex including the hippocampus and amygdala, and diffuse axonal injury in the left frontal white matter. Although her recurrent self-mutilation had disappeared after brain injury, a certain type of anxiety, which occasionally induced irritability, unstable moods and devaluation of others, occurred without any trigger once or twice a month. This anxiety continued two or three days and faded away within a week. Because of its frequency and duration, this anxiety can be considered to originate not from the traumatic brain injury, but from her intrinsic nature, and seems to be parallel to annihilation anxiety (Reich A, Klein M) and abandonment anxiety (DSM-IV). Because she showed this anxiety after a severe higher brain dysfunction including disturbances of language, attention, working memory, recent and remote memories, motivation, and sense of self, we considered this anxiety to be an unarticulated form of annihilation anxiety and abandonment anxiety.

Adult↗

PubMed1978

Auto-mutilation in animals and its relevance to self-injury in man.

Self-mutilation in non-human mammals is a well-established, although not a widely known phenomenon, which has been reported under zoo and laboratory conditions. In macaque monkeys, laboratory rearing and isolation are important predisposing factors, and the more serious self-injury is initiated by some immediate stimulating event. It is commonly accompanied by behaviour normally shown by the animal in a fighting context. Lower mammals are also known to mutilate themselves under laboratory conditions after administration of drugs wich probably cause increased sympathetic activity. The implications of this behaviour for an understanding of states of self-injury in man are discussed.

Aggression↗

PubMed1992

[Auto- and hetero-aggression in Gilles de la Tourette syndrome].

A 29-year old patient with Gilles de la Tourette's syndrome exhibited severe compulsive self-mutilation and hostility leading to long-term hospitalisation. A history of refractory self-mutilation increases the risk for suicidal acts, which represent a rare complication in the course of the Tourette disorder.

Adult↗

PubMed1994

Lesch-Nyhan syndrome. A case report.

Lesch-Nyhan syndrome is a rare anomaly consisting of a deficiency in the production of hypoxanthine phosphoribosyltransferase that leads to the overproduction of purine and the accumulation of uric acid. Major manifestations include mental retardation and self-destructive behavior resulting in self-mutilation through biting and scratching. Because no medical treatment exists to alleviate the symptoms of self-mutilation, direct dental intervention is the only way these behaviors can be affected. A unique case of this type involving two male identical twins is reported.

Child↗

PubMedDate not supplied

[An unusual case of self-harm with petroleum distillate].

After surgical treatment of an inguinal hernia, a 26-year-old male was discharged from hospital with a well healing surgical wound. Four weeks later he was admitted again with a major localized painful swelling of the soft tissues, whereas the clinical examination revealed no further local or systemic signs of inflammation. The immediate operation disclosed no abscess formation, but a large colliquation necrosis of the subcutaneous tissue with an outstanding petroleum-like odour. On toxicological examination of the necrotic tissue, a respective petroleum distillate was found. The patient was confronted with the suspicion of having injected the petroleum preparation himself to prolong the wound healing and finally admitted the self-mutilating behaviour. The pathophysiology, clinical history and morphological findings are discussed in comparison with case reports of chemically induced self-mutilation.

Adult↗

PubMed1981

Command Hallucinations and self-amputation of the penis and hand during a first psychotic break.

An unusual case is presented of a psychotic young man who experienced command auditory hallucinations which directed him to amputate his right hand and distal penis to atone for a "terrible sexual transgression." The existing literature on genital self-mutilation is reviewed as well as some recent work on factors that might be used to predict an episode of self-mutilation. In patients who are felt to be at extremely high risk, careful monitoring and rapid medication schedules might be effective in preventing such an incident.

Adult↗

PubMed2005

Congenital insensitivity to pain--review and report of a case with dental implications.

Pain is a protective mechanism for the body. Absence of pain is a symptom in several disorders, both congenital and acquired. The congenital types are present at birth and affect the number and distribution of types of nerve fibers. At present, 5 types of hereditary sensory and autonomic neuropathies have been identified. The various disorders within this group are classified according to the different patterns of sensory and autonomic dysfunction and peripheral neuropathy and the presence of additional clinical features such as learning disability. However, the field is currently moving away from classification based on clinical presentation toward classification based on underlying genetic abnormality. In the absence of pain, patients are at risk of late presentation with illnesses or injuries, and have an increased incidence of traumatic injury. Self-mutilation is an almost invariable feature of these disorders. We report the case of a patient with congenital insensitivity to pain that presented with self-mutilation injuries to his hands and oral tissues caused by biting. The severe nature of these injuries necessitated serial extraction of his primary teeth soon after eruption, which led to a cessation of the problem. The mutilation has not returned following the eruption of the first of his permanent teeth, suggesting that he has learned not to bite himself, even though to do so causes him no discomfort.

Bites, Human↗

PubMed1992

Self-inflicted ocular mutilation in the pediatric age group.

Three mentally retarded children with severe self-inflicted ocular injuries are presented. All three suffered from severe ocular injuries including retinal detachment resulting in progressive visual loss and even blindness. Self-inflicted injuries to the eyes, including self enucleation, is an extremely uncommon form of behavior, rarely encountered by pediatricians. The risk of ocular morbidity is high if the diagnosis is overlooked. Technical advances in ophthalmology permit much improvement in some formerly hopeless cases of ocular self-mutilation, but there is still no accurate method to repair destroyed retinal or nervous tissue. Early identification of patients at risk of ocular self-mutilation is essential in order to prevent or minimize such severe ocular injuries.

Child↗

PubMed2001

An unusual cause of renal impairment: a latex glove.

Male genital self-mutilation is thought to be increasing in incidence and is underreported in the literature. We therefore have no clear and uniform treatment programmes. We present a case of genital self-mutilation involving a 16-year-old male. The case highlights an important complication and the multidisciplinary approach to its management.

Adolescent↗

PubMed1999

["Self-inflicted injuries"--psychiatric, forensic and insurance aspects (II)].

German law distinguishes between attempted suicide which is not punishable and self-mutilation which is prohibited. This article describes the historical development of self-injurious behaviour, reviews the social, juridical, and ethical assessments of the past, and examines the statistical and biological results of current research. It relates observations from forensic medicine and psychiatry to specific clinical symptoms, toxicological circumstances, and social influences (stress incurred by everyday life, war, or imprisonment). Drawing on pertinent cases, it clarifies criminal and civil jurisdiction and emphasizes the importance of self-mutilation for private insurers. Intended for insurers, forensic scientists, and psychiatrists, recommendations concern the procedures to be followed in the examination, jurisdiction, and therapy involving cases of self-inflicted injuries.

Forensic Medicine↗

PubMed1999

Dissociation, abuse and the eating disorders: evidence from an Australian population.

OBJECTIVE: A number of European and Northern American studies have investigated a possible association between dissociative phenomena, eating disorders, child sexual abuse and self-mutilation. However, there has been little confirmation from other countries and cultures, and the Australian experience of these interrelationships has not previously been studied. METHOD: Dissociative symptomatology and self-reported history of abusive experiences, physical and sexual, were retrospectively studied in a sample of Australian eating disordered patients using a self-report measure, the Dissociation Questionnaire (DIS-Q). RESULTS: As hypothesised, dissociative symptoms were particularly frequent in those who reported child and adult sexual abuse and in those who self-mutilated. A correlation between multiple forms of abuse and higher dissociation scores was only partially upheld. CONCLUSIONS: Interrelationships between victimisation and dissociation are discussed within the context of current knowledge in the field, and brief suggestions for therapeutic strategies are offered.

Adolescent↗

PubMed1992

Corneal transplantation in a patient with congenital sensory neuropathy.

We describe penetrating keratoplasty for corneal scarring in a patient with congenital sensory neuropathy and repeated self-mutilation. This patient underwent a successful penetrating keratoplasty but suffered a series of postoperative complications necessitating three repeat grafts. Some of these complications were attributable to decreased corneal sensation while others were caused by self-mutilation. Since his last penetrating keratoplasty 4 years ago, this patient has had functional visual acuity.

Child↗

PubMed1988

Congenital sensory neuropathy with anhidrosis.

Congenital sensory neuropathy with anhidrosis (CSNA) is a well-defined entity among a group of sensory deficiency syndromes. Children with this genetic disease are insensitive to pain and temperature, do not sweat, and suffer from mental retardation. Self-mutilation may be severe and may lead to insoluble orthopedic problems. We treated a girl with CSNA, who was born to nonconsanguineous Japanese parents. This disease is important in the dermatological field, since the degree of anhidrosis and self-mutilation influence the prognosis of patients with CSNA.

Female↗