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PubMed1976

Self-enucleation and psychosis. Report of two cases and discussion.

We report two cases of self-enucleation and the case histories of the two schizophrenic men who carried out this drastic form of self-mutilation. In a review of the literature and consideration of the case material, it is concluded that castration fears, failure to resolve oedipal conflicts, repressed homosexual impulses, severe guilt, and self-punishment are ubiquitous phenomena in such cases. However, we conclude that psychosis, most probably schizophrenia, with a severe disturbance in body image, are necessary variables in the act of self-enucleation.

Adult↗
PubMedDate not supplied

[Morphology findings in intentional hand amputation].

Presented is the case of a 33 years old farmer, who alleged to have lost his left hand accidentally when grasping into a chuff-cutter. Immediate investigation of the amputate proved, that the hand must have been severed initially by a single cut and was only secondarily bruised by multiple blunt contusions. The farmer confessed to have mutilated himself with some kind of a guillotine which he had constructed for that particular purpose. The amputate was then thrown into the chuff-cutter to make his allegation appear credible and to prevent replantation. The motivation of this self-mutilation was the expectation of considerable insurance payments.

Adult↗
PubMed1990

Genital self-amputation and the Klingsor syndrome.

Two psychotic individuals, who performed acts of genital self-amputation, are presented. One of the patients had self-mutilated with the intention of suicide and had also in the past amputated his hand. Psychotic patients with delusions (often religious), sexual conflict associated with guilt, past suicide attempts or other self-destructive behaviour and depression, severe childhood deprivation, and major premorbid personality disorder, are the group at risk for genital self-amputation. It has been proposed that the eponym, the "Klingsor" syndrome, be applied only to acts of genital self-mutation, involving religious delusions. The author suggests that this syndrome should be expanded to include all cases of genital self-mutation resulting from a psychotic illness.

Abdominal Injuries↗
PubMed1994

Pain insensitivity in schizophrenia: a neglected phenomenon and some implications.

The literature on insensitivity to pain in schizophrenia is reviewed. Numerous reports indicate that, relative to normals, individuals with schizophrenia are insensitive to physical pain associated with illness and injury. In addition, insensitivity to pain of various sorts administered in experimental studies has been reported frequently in this population. This extensive and diverse literature of clinical and experimental reports suggests that many individuals with schizophrenia are less sensitive to pain than normal individuals. However, because the experimental studies--almost all of which were conducted before 1980--suffer from a variety of methodological limitations, this research provides neither a satisfactory characterization nor an adequate explanation of pain insensitivity in schizophrenia. It is argued that this widely reported but currently neglected phenomenon has important implications for physical health, self-mutilation, homelessness, premorbid development, and affective flattening in individuals with schizophrenia.

Affective Symptoms↗
PubMed1995

'Naevophobia'.

In recent years there has been intensive media interest in pigmented lesions and several skin cancer prevention/early detection campaigns. Pigmented lesions may cause great anxiety, although patients are usually reassured once their moles have been examined by a dermatologist. We describe a case in which a young man with multiple pigmented naevi attempted to remove all the lesions himself. This self-mutilation occurred despite his having attended a dermatology clinic.

Adult↗
PubMed2005

Acral mutilation and analgesia in 13 French spaniels.

Acral mutilation and analgesia (AMA) is reported in 13 French spaniels in Canada. This newly recognized disorder shares striking similarities in clinical features and biopsy findings to the other acral mutilation syndromes or hereditary sensory neuropathies reported in German short-haired pointer dogs, English pointer dogs and English springer spaniels. Clinical signs are first noted between 3.5 and 12 months of age. Affected dogs lick, bite and severely self-mutilate their distal extremities resulting in ulcers with secondary bacterial infection. Auto-amputation of claws, digits and footpads occurs in severe cases. Single or multiple feet can be affected. Affected dogs walked on their severely mutilated feet without evidence of pain, lameness, or ataxia. The majority of the dogs were euthanized within days to months of diagnosis.

Animals↗
PubMed1997

[Behavior dissorders in psittacines. 1. Symptoms and causes].

Psittacines embody in an ideal fashion the child-like characteristics that humans adore. Animal lovers are unable to resist their expressive eyes, brightly coloured plumage, tameness and mimicry of human speech. The desire of pet-owners to have a tame, speaking bird with a very strong bond to its owner is achieved through hand-rearing, but this results in psychoreactive behavioural abnormalities in these highly social birds due to abnormal fixation. The signs and causes of these behavioural abnormalities, also called cage neuroses, are explained. The complex of feather-plucking, feather-ingestion and self-mutilation is considered in depth, and there are numerous illustrations.

Aggression↗
PubMed1980

Oral manifestations of the congenital insensitivity-to-pain syndrome.

The congenital insensitivity-to-pain syndrome is a sensory syndrome in which pain is impaired. It has been variably classified under a variety of terms, on occasion leading to some confusion. The condition is present at birth. The patient is usually, but not always, normal with respect to intelligence, development, and psychological adjustments. Other sensory perceptions are normal. Traumatic lesions as a result of self-mutilative acts are not uncommon, especially at an early age. The condition may not be apparent clinically until the time of initial tooth eruption. As the primary teeth erupt, the patient acquires the necessary apparatus for self-infliction of wounds to oral structures, skin, and fingernails. A case of congenital indifference to pain is presented, with clinical documentation of tooth-related problems occurring over a 2-year period and of the steps taken to correct or minimize the traumatic effects of chewing.

Humans↗
PubMed2004

Self-inflicted orodental injury in a child with Leigh disease.

Leigh disease is an inherited progressive mitochondrial neurodegenerative disease that affects the neurological, respiratory and cardiovascular systems and is associated with retardation of the intellectual and physical development. This report describes the case of a 4-year-old boy with Leigh disease who presented with self-inflicted traumatic injury to the teeth, alveolar bone, lips and tongue during repeated episodes of intense orofacial spasms. Conservative management of the injury included repositioning the fractured alveolar bone, splinting the traumatized teeth and planning for a mouthguard. However, after a second incident of severe self-induced injury to the teeth and alveolar bone, extraction of the anterior teeth became inevitable to protect the child from further self-mutilation and to allow healing of the injured tissues.

Alveolar Process↗
PubMed1991

Adolescent dress, Part I: Dress and body markings of psychiatric outpatients and inpatients.

This paper investigated the dress and body markings of 100 adolescent psychiatric patients (both hospitalized and never-hospitalized). Data were obtained from in-depth interviews conducted by a child psychiatrist. In contrast to nonhospitalized patients, hospitalized patients had a higher incidence of self-scarring, i.e., marks applied to self, either as a self-mutilation/suicide gesture or serving another purpose (for example, carving a boyfriend's initials into one's arm). Other individual expressions of appearance did not differentiate hospitalized from nonhospitalized patients. Detailed dress and appearance observations, questionnaires, photo reviews, self-portraits, and family discussions contributed to the beneficial effect of psychotherapy by focusing on feelings evoked and symbolized in dress and body markings.

Adolescent↗
PubMed2004

Self-inflicted eye injuries: a review.

PURPOSE: To review the pathogenesis, clinical characteristics, and management of self-inflicted eye injuries. METHODS: Review of the medical literature. RESULTS: Psychiatric theories of pathogenesis for self-inflicted behaviour include religious and sexual ideation, symbolism, guilt, and displacement. Biological theories include disorders of serotonergic, dopaminergic, and opiate neurotransmitters. Clinical characteristics of self-mutilators include acute or chronic psychoses, drug-induced psychoses, other psychiatric conditions, and certain organic states. The majority are young-to-early middle-aged male subjects, though it can also rarely occur in children. Management of self-inflicted eye injury requires close cooperation between ophthalmologists and psychiatrists as well as other medical specialists, to ensure quick resuscitation of the patient, prompt diagnosis and treatment of any injuries, and treatment of the underlying behaviour that led to the injuries. CONCLUSIONS: Self-inflicted eye injuries are a rare but important group of ophthalmic conditions that require close cooperation between different medical specialties to ensure optimum care of the often severely disturbed patient.

Adult↗
PubMed1991

Acknowledging abuse backgrounds of intensive case management clients.

Routine inquiry about abuse experiences as children and adults yielded high levels of positive responses among 89 intensive case management clients. Through structured interviews administered by their case managers, clients disclosed backgrounds in families with one or more alcoholic adults, incest, other childhood sexual abuse, and extensive physical abuse. Gender played a major role. Being an ACOA also predicted extensive additional abuse. Clients were not treated for abuse, nor diagnosed for its impact, nor responded to when they initiated discussion with mental health providers. Later outcomes include frequent hospitalizations, substance abuse and self-mutilation.

Adult↗
PubMedDate not supplied

Oedipism in a patient with frontal lobe encephalomalacia.

There is a growing recognition of the role of the frontal lobes in the aetiology of severe behavioural aberrations. The authors describe a case of Oedipism in a patient who had MRI evidence of frontal lobe encephalomalacia. After discussing the function of the frontal lobes in modulating behaviour the authors suggest that the structural lesion seen on the MRI was in part responsible for the patient's self-destructive act. Treatment issues and the importance of recognizing underlying structural lesions in instances of extreme self-mutilation are discussed.

Adult↗
PubMedDate not supplied

[Axe blow injuries caused by reflex action?].

In cases of questionable insurance fraud through self mutilation axe blows now as before play an important role. Occasionally it is alleged that the billet began to totter during the stroke and that the left hand responded to this stimulus by an unwilled movement to the billet. By this the thumb or forefinger was placed unfortunately on the upper surface of the timber and hit by the chopper. According to the literature and on the basis of own experiments we estimate the reaction time, i.e. initiation time plus movement time, at 700 msec., at least, whereas the stroke needs only 220-290 msec. (chopper), and 280-380 msec. (axe), respectively, as could be shown in further experiments. That means, that the left hand can only touch the billet when the blow already has reached the goal. Hence unwilling finger mutilations can scarcely be the result of a "reflex action" of this kind.

Amputation, Traumatic↗
PubMed2000

A unique case of secondary microvascular glansplasty: the last genitoreconstructive frontier?

Isolated amputation of the noncarcinogenic penile glans is an extremely rare event. Immediate replantation as a composite graft or by microvascular techniques is the treatment of choice. Secondary reconstruction of the penile glans may be indicated after necrosis as a sequela of infection, surgical resection for malignancy, traumatic loss, and self-mutilation. To date, reported surgical techniques of glanular reconstruction have only been described as part of total phalloplasty. Secondary reconstruction of the penile glans using a sensate radial forearm free flap was performed in a 28-year-old man who presented 3 years after self-amputation in a psychotic state.

Adult↗
PubMed1983

Microsurgical replantation of a completely amputated penis.

Replantation of a penis with microsurgical repair of vessels and nerves can restore normal genitourinary function. A case is presented of an amputated penis that was ischemic for sixteen hours before being microsurgically revascularized. The patient has at all times appreciated having an intact penis despite the fact that the injury was self-inflicted. Self-mutilation is not considered to be an absolute contraindication to replantation.

Adult↗
PubMed1994

Congenital sensory neuropathy with anhidrosis.

A 6-year-old girl had congenital sensory neuropathy with anhidrosis (CSNA), one of the five variants of a group of very rare genetic disorders of the peripheral nervous system--hereditary sensory neuropathies (HSN). Clinical, laboratory, and physiopathologic aspects are discussed. Dermatologic findings of anhidrosis and self-mutilation suggest the diagnosis.

Child↗