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PubMed2005

Camouflage of self-inflicted razor blade incision scars with carbon dioxide laser resurfacing and thin skin grafting.

BACKGROUND: Self-cutting using a razor blade is a type of self-mutilating behavior that leaves permanent and socially unacceptable scars with unique patterns, particularly on the upper extremities and anterior chest wall. These scars are easily recognized in the community and become a source of lifelong guilt, shame, and regret for the self-mutilators. In the presented clinical study, we aimed to investigate the effectiveness of carbon dioxide laser resurfacing and thin skin grafting in camouflaging self-inflicted razor blade incision scars. METHODS: A total of 26 anatomical sites (11 upper arm, 11 forearm, and four anterior chest) of 16 white male patients, whose ages ranged from 20 to 41 years (mean, 23.8 years), were treated between February of 2001 and August of 2003. Detailed psychiatric evaluation preoperatively; informing the patient that the procedure is a "camouflage" operation; trimming hypertrophic scars down to intact skin level; intralesional corticosteroid injection to hypertrophic scars; carbon dioxide laser resurfacing as a single unit; thin (0.2 to 0.3 mm) skin grafting; compressive dressing for 15 days; use of tubular bandage; and protection from sunlight for at least 6 months constituted the key points of the procedure. RESULTS: The scars were successfully camouflaged and converted to a socially acceptable appearance similar to a burn scar. Partial graft loss in one case and hyperpigmentation in another case were the complications. No new hypertrophic scar developed. CONCLUSIONS: The carbon dioxide laser resurfacing and thin skin grafting method is effective in camouflaging self-inflicted razor blade incision scars.

Adult↗
PubMed2004

Smoking and suicidality among adolescent psychiatric patients.

PURPOSE: To investigate the relationship between smoking and suicidality among adolescent psychiatric patients in Finland. METHODS: Data from 157 patients (aged 12-17 years) admitted to inpatient psychiatric hospitalization between April 2001 and July 2002 were collected. Logistic regression analyses were used to examine the association between regular daily smoking and suicidality. The data were adjusted for several sociodemographic and clinical characteristics. RESULTS: The results showed over four-fold risk for definite and/or life-threatening suicide attempts among smoking adolescents in inpatient psychiatric facility compared with nonsmoking ones (OR 4.33, 95% CI 1.23-15.20). Also, the smoking adolescents had three times greater risk for occasional (OR 3.32, 95% CI 1.09-10.10) or frequent (OR 3.00, 95% CI 1.08-10.10) self-mutilation. Suicidality was more common among girls than boys and among those adolescents who suffered from depression. CONCLUSIONS: Among teens hospitalized for psychiatric illnesses, daily smoking was significantly related to suicide attempts and self-mutilation, even after controlling for several confounding factors, including psychiatric diagnosis.

Adolescent↗
PubMed2005

A case of non-psychotic autocastration: the importance of cultural factors.

Male genital self-mutilation has been known to occur in psychotic patients. We report a case of premeditated autocastration in the absence of clinical disorder, both at the time of the mutilation and upon follow-up. Coming from a strict Slavic family, this patient repressed gender identity issues for decades. After migrating to Western Europe, his sexual ambiguity became actuated. His motives can be understood in the light of his personal and cultural background. This case shows that cultural factors may contribute to explaining male genital self-mutilation behaviors.

Attitude to Health↗
PubMed1974

Lesch-Nyhan syndrome: evidence for abnormal adrenergic function.

Subjects with the Lesch-Nyhan syndrome (hypoxanthine-guanine phosphoribosyltransferase deficiency with self-mutilation) exhibit an apparently unique pattern of adrenergic dysfunction characterized by elevated plasma dopamine beta-hydroxylase activity and an absence of pressor response to acute sympathetic stimulation. Patients with a partial deficiency of hypoxanthine-guanine phosphoribosyltransferase without self-mutilation do not exhibit these abnormalities of adrenergic function.

Adolescent↗
PubMed2006

[Psychological factors of genital automutilation and medico-ethical interest in emergency vulvoplasty].

The genital self-mutilation is not rare in women. Risk factors found in these cases are: mood disorders, food behavior anomalies and antecedents of sexual aggression. However, surgical repair is not done in emergency: we find no similar report to our clinical case describing an added up bilateral reduction nymphoplasty carried out in emergency after hemorrhagic genital self-mutilation. We discuss psychological risk factors, psychiatric diagnosis and optimal treatment, studied from medico-ethical point of view, for this surgical emergency.

Circumcision, Female↗
PubMed1979

Deafferentation hypersensitivity in the rat after dorsal rhizotomy: a possible animal model of chronic pain.

Unilateral dorsal rhizotomies were done at the cervicothoracic and lumbosacral spinal cord levels in rats. In preliminary experiments dermatome maps were determined for the roots to be sectioned. The behavior of 37 rats was observed for many months after the rhizotomies. The rats with the dorsal roots sectioned in the cervicothoracic spinal cord exhibited the following behavior: at the border of the skin adjacent to the zone of deafferentation, the rat scratched vigorously and progressively denuded the skin; self-mutilation of varying degrees occurred in the deafferented limb. In some animals scratching occurred in the contralateral skin dermatome opposite to the partially deafferented zone. The rats with the dorsal roots sectioned at the lumbosacral level exhibited hypersensitivity to cutaneous stimulation but there was no scratching or self-mutilation. These results are discussed in the light of previous similar research.

Afferent Pathways↗
PubMedDate not supplied

[Factitious skin lesions as an expression of a family crisis].

The factitious disorder is a deliberately induced, hidden self-mutilation based on a psychic conflict. We present a previously healthy nine-year old girl with initially obscure symmetric skin lesions. Family history, psychological exploration, special tests like pictural expression and scenial exhibition revealed the child's fear of a divorce of her parents and her own identity problem. These examinations aroused the suspicion that the girl could only express her conflict of ambivalence by self-injury behavior in the meaning of artificial disease. Guided by this impression, an intensive conversation with both parents was undertaken, focussing the familiar crisis. Afterwards, the skin lesions disappeared the girl admitted the self-mutilation. A family therapy was initiated.

Child↗
PubMed2000

Multi-impulsivity of Japanese patients with eating disorders: primary and secondary impulsivity.

Several studies have noted that multi-impulsive bulimia nervosa tends to be refractory to treatment. However, it is not known whether these impulsivities are an expression of more fundamental psychopathology or simply the consequence of chaotic eating behaviors. Studies of the temporal relationship between the onset of eating disorder and the occurrence of impulsive behaviors will facilitate a better understanding of these issues. Subjects consisted of 60 patients with anorexia nervosa restricting type (AN-R), 62 patients with anorexia nervosa binge-eating/purging type (AN-BP), 114 patients with bulimia nervosa purging type (BN) and 66 control subjects. Impulsive behaviors and childhood traumatic experiences were assessed by self-report questionnaire. Multi-impulsivity (defined by at least three of the following: heavy regular alcohol drinking; suicide attempt; self-mutilation; repeated shoplifting of items other than food; sexual relationships with persons not well known to the subject) was found in 2% of AN-R, 11% of AN-BP, 18% of BN and 2% of control subjects. Eighty percent of BN patients with multi-impulsivity had a history of suicide attempts or self-mutilation history prior to the onset of bulimia nervosa. In BN patients, there tended to be a relationship between childhood parental loss or borderline personality disorder and multi-impulsivity. In conclusion, primary impulsivity (chronological prior occurrence of impulsive behaviors) does exist even in a very different culture, although the number of patients of this type is very limited.

Adult↗
PubMed1993

Six case studies depicting the deliberate self-harm syndrome.

This article comprises information on self-mutilation (and specifically on the Deliberate Self-harm Syndrome) which obtained from a study of mainly American and British literature. Included is data obtained from interviews conducted with a sample of South Africans suffering from the syndrome. Etiology was explained from both a psychological and biological perspective. The former highlighted deficiencies in coping and communication skills while the latter highlighted the compulsive and pain-killer role that endorphines play. From case studies and literature it was possible to clearly distinguish the Deliberate Self-harm Syndrome as a distinct disorder-a syndrome consisting of deliberate, repetitive and private acts of self-harm in the form of cutting, burning and banging oneself. This culminates in extreme tension release.

Adult↗
PubMed1993

Congenital insensitivity to pain with anhidrosis.

Congenital insensitivity to pain with anhidrosis is a rare disorder. Its primary clinical features include congenital analgesia, which leads to self-mutilation; inability to sweat, which leads to defective thermoregulation; and mental retardation. A five-year-old boy with consanguineous parents and no family history of the disorder presented with ulcerating lesions on both knees and elbows. His family had discovered the lack of sensation to pain and anhidrosis. Physical examination revealed ulcers on both knees and elbow, self-mutilation of the tongue, fingers, and toes. Sensation to touch was intact and lacrimation was normal. Moderate mental retardation and analgesia were noted in an otherwise normal neurologic examination. The results of electromyographic examination were normal and the application of pilocarpine showed anhidrosis. A skin biopsy specimen was also examined.

Child, Preschool↗
PubMed1997

[A Japanese family with Lesch-Nyhan syndrome resulting from a new point mutation in hypoxanthine-guanine phosphoribosyltransferase gene].

Lesch-Nyhan syndrome is associated with complete deficiency of hypoxanthine-guanine phosphoribosyltransferase (HPRT), characterized by hyperuricemia and severe neurological signs. The HPRT gene has been mapped to the q26 region on the long arm of the X-chromosome. We are taking care of a family of Lesch-Nyhan syndrome. A 14-year-old male was noted the growth disturbance at the age of 7 months and self-mutilation behavior characterized by compulsive biting of his lip and fingers at the age of 18 months. In 1987, at the age of 4, he was diagnosed as Lesch-Nyhan syndrome from neurologic signs and hyperuricemia (9.8 mg/dl). Neurological examination revealed mild mental and growth retardation, spasticity and hyperreflexia of lower extremities, choreoathetoid movements of extremities, and compulsive self-mutilation. The HPRT activity in erythrocytes of this patient was 0.02 nmol/min/mg hemoglobin (control value 1.76 +/- 0.06), and adenine phosphoribosyltransferase (APRT) activity was 1.08 nmol/min/mg hemoglobin (control value 0.43 +/- 0.06). Using polymerase chain reaction (PCR) method coupled with direct sequencing, we analyzed the nucleotide sequences of each exon from the genomic DNA as well as the entire HPRT coding region of the cDNA by RT-PCR method. In the HPRT gene from the patient, a guanine to adenine substitution at base position 209 in exon 3 was identified, which resulted in a single amino acid substitution of glycine with glutamic acid at codon 70. The family studies indicated that his mother, sister and grandmother were heterozygotes. PCR-restriction fragment length polymorphism (RFLP) utilizing Mnl I site which created by the mutation, was useful for detection of the mutant gene. We have identified a new missense mutation of the HPRT gene in a Japanese patient. This mutation was reported at the same codon as foreign mutants and mighty be indicative of a location of mutation activity in the HPRT gene.

Adolescent↗
PubMed1992

Impact of borderline personality disorder in late life on systems of care.

Some symptoms that are benchmarks of borderline personality disorder in the younger patient--identity disturbance, impulsivity, self-mutilation, risk taking, and substance abuse--do not appear to define the disorder in late life. However, changes in the environment or social context of elderly persons may cause core symptoms to manifest differently. Identity disturbance in old age may be evidenced by an inability to formulate future plans or pursue goal-directed activities. Anorexia may be a substitute for more obvious forms of self-mutilation. Elderly patients with severe personality disorders may disrupt nursing homes and other service delivery systems. The authors suggest that staff who work with these patients receive special training and that more research is needed to identify which symptoms of personality disorders are maintained into old age.

Aged↗
PubMed2004

Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: a controlled trial.

Dialectical Behavioral Therapy (DBT) was initially developed and evaluated as an outpatient treatment program for chronically suicidal individuals meeting criteria for borderline personality disorder (BPD). Within the last few years, several adaptations to specific settings have been developed. This study aims to evaluate a three-month DBT inpatient treatment program. Clinical outcomes, including changes on measures of psychopathology and frequency of self-mutilating acts, were assessed for 50 female patients meeting criteria for BPD. Thirty-one patients had participated in a DBT inpatient program, and 19 patients had been placed on a waiting list and received treatment as usual in the community. Post-testing was conducted four months after the initial assessment (i.e. four weeks after discharge for the DBT group). Pre-post-comparison showed significant changes for the DBT group on 10 of 11 psychopathological variables and significant reductions in self-injurious behavior. The waiting list group did not show any significant changes at the four-months point. The DBT group improved significantly more than participants on the waiting list on seven of the nine variables analyzed, including depression, anxiety, interpersonal functioning, social adjustment, global psychopathology and self-mutilation. Analyses based on Jacobson's criteria for clinically relevant change indicated that 42% of those receiving DBT had clinically recovered on a general measure of psychopathology. The data suggest that three months of inpatient DBT treatment is significantly superior to non-specific outpatient treatment. Within a relatively short time frame, improvement was found across a broad range of psychopathological features. Stability of the recovery after one month following discharge, however, was not evaluated and requires further study.

Adolescent↗
PubMed2001

[Cranioplasty for isolated trigonocephaly with developmental disorder].

We reported 50 cases of mild to moderate trigonocephaly (most isolated type) treated by cranioplasty. All of them had clinical symptoms such as severe hyperactivity, speech delay, inability to communicate with others, self-mutilation (head banging), irritability, temper tantrum and mental retardation. Pre-operative CT scan and MRI showed no abnormal findings in the brain except for constricted frontal lobes. The 3 D-CT scan showed the most important diagnostic findings: a ridge of the metopic suture and narrow anterior fossa. TcECD SPECT was performed on 43 patients, and demonstrated in 31 cases some degree of decreased cerebral blood flow (CBF), mainly in the bilateral frontal lobes. Post-operatively, most patients improved to some degrees. The results were compared to those of trigonocephaly patients without cranioplasty. The operated group showed better improvement in the above clinical symptoms, especially, hyperactivity, indifference to others, understanding of verbal communication, self-mutilation, irritability and temper tantrum. The post-operative SPECT represented the increased CBF in 30 out of the 31 cases. MRI and CT scan revealed expanded frontal lobes. Thus, cranioplasty may alleviate the symptoms of patients with mild to moderate trigonocephaly and developmental disorders.

Cerebrovascular Circulation↗
PubMedDate not supplied

[Congenital insensitivity to pain with anhidrosis associated with congenital myasthenic syndrome].

INTRODUCTION: Congenital insensitivity to pain with anhidrosis (CIPA) or hereditary sensory and autonomic neuropathy type IV (HSAN IV) is a rare autosomal recessive disorder featuring recurrent fever episodes, inability to sweat, absent response to noxious stimuli, self mutilating behavior and mental retardation. It has been associated with mutations in the NTRK1 gene, located in 1q21-22 and encoding a high-affinity NGF receptor. CASE REPORT: An 8-year-old boy, the first son of consanguineous parents, presented with hypotonia, episodic hyperpyrexia and global developmental delay since the neonatal period. In addition to these signs, typical of CIPA, he displayed some other not previously described in this disease, such as facial dysmorphism, a severe swallowing disorder and a myogenic EMG pattern, that led to the initial suspicion of a muscle disorder. Molecular genetics studies uncovered a mutation c.C2011T in exon 15 of the NTRK1 gene. Genetic counselling was possible in the following pregnancy of the couple, where the female fetus was found to harbour the mutation in heterozygosity. The subsequent diagnosis of a congenital myasthenic syndrome in this sister led to neurophysiological re-evaluation of the probandus, in whom a myasthenic pattern of muscle activation was also found. CONCLUSIONS: A patient with CIPA and congenital myasthenic syndrome is described. CIPA must be the first diagnostic hypothesis when assessing a patient with insensitivity to pain, anhidrosis and self-mutilation. Given the rather homogeneous presentation of CIPA, the occurrence of atypical myopathic manifestations should raise the suspicion of a concurrent disorder. The present consanguineous kindred illustrates a rare instance of transmission of two mutated alleles giving rise to two unrelated, infrequent neurological syndromes.

Alleles↗
PubMed1998

Ileal exclusion for Byler's disease: an alternative surgical approach with promising early results for pruritus.

BACKGROUND/PURPOSE: Progressive familial intrahepatic cholestasis (Byler's disease) is often characterized by pruritus-induced self-mutilation with minimal response to medical therapy. The causative cholestasis is likely to progress to cirrhosis necessitating transplantation. Partial external biliary diversion has been used with promising results for the jaundice and debilitating pruritus but all the potential complications and aesthetic concerns of long-term stomas attend this approach. METHODS: The authors describe a terminal ileal exclusion that was first developed for patients who had previously undergone cholecystectomy. Over a 3-year period, we identified for study seven children with liver histology characteristic of Byler's disease accompanying a clinical picture of chronic cholestasis without a defined metabolic or anatomic abnormality. The first two patients underwent a cholecystojejunal cutaneous stoma, until now, the recommended treatment for this condition. The third had previously undergone cholecystectomy so an ileocolonic anastomosis was performed excluding the distal 15% of the small bowel. This child had complete relief of pruritus without evidence of diarrhea. Two more terminal ileal exclusions were performed with similar results before standardizing this approach. The authors approximated small intestinal length using Siebert's graph relating crown-heel length to small intestinal length. The midpoint between the mean and one standard deviation below the mean was determined. Fifteen percent of the estimated small bowel length was measured back from the ileocecal valve and then divided using a linear stapling device. A stapled anastomosis was created between the proximal ileum and the cecum, bypassing the terminal ileum. RESULTS: Four of five children have had relief from their pruritus and self-mutilation with no evidence of diarrhea. Terminal ileal bypass offers a stoma-free, completely reversible "biliary diversion." CONCLUSION: Early results on a few patients are promising, but long-term evaluation of growth, development, and liver function and histology is needed before advocating this as the primary therapy for Byler's disease.

Adolescent↗
PubMed1983

A behavioral treatment of compulsive lip-biting.

This case report describes the successful behavioral treatment of compulsive lip-biting and face scarring in a 12 yr-old boy. The condition had been long standing, self-mutilating and intractable. A regime of tracking (self-recording), aversive response substitution, and relaxation effected immediate and long lasting tissue repair and cure.

Aversive Therapy↗
PubMed1987

Dermatitis artefacta of the paraoral region.

Factitial injuries constitute a group of lesions that relate only in the manner in which they are produced and have no particular physical appearance. The possibility of correctly diagnosing a factitial injury is difficult unless this unusual condition is considered in a differential diagnosis. In this article, a case report of factitial injury of the paraoral soft tissue in a 33-year-old white man is presented. A review of self-mutilation and of the psychological aspects of self-destructive behavior is also included.

Adult↗