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PubMed1999

Clozapine reduces severe self-mutilation and aggression in psychotic patients with borderline personality disorder.

BACKGROUND: Clozapine has been reported to be effective in diminishing violence toward others in psychotic patients. This article describes the impact of clozapine on severe self-mutilation among patients with the dual diagnoses of borderline personality disorder and persistent psychoses. METHOD: Seven subjects known to the authors were selected for careful chart audits. These subjects had been admitted to 2 state psychiatric hospitals owing to severe self-mutilation and/or violence and subsequently treated with clozapine. A mirror-image design anchored to the start date of clozapine treatment and extending in either direction to a maximum of 1 year was used to extract data. Data extracted included incidents of self-mutilation (restraint), seclusion, the as and when needed (p.r.n.) use of medications, injuries to staff and peers, hospital privileges, and Global Assessment of Functioning (GAF) scores. RESULTS: The subjects were all white women with a mean age of 37 years. All subjects carried DSM-III-R or DSM-IV borderline personality disorder diagnoses and an Axis I disorder diagnosis. They had received trials of several psychotropic agents, often in combination and mostly without benefit. After clozapine treatment, there were statistically significant reductions in incidents of self-mutilation (restraint), seclusion, the use of p.r.n. antianxiety medications, and injuries to staff and peers. These subjects received higher levels of hospital privileges, and their GAF scores nearly doubled following clozapine treatment. Four subjects were subsequently discharged from hospital. CONCLUSION: These preliminary but nonetheless favorable results suggest that clozapine deserves careful consideration for a controlled study in patients with borderline personality disorder and psychoses, especially if the clinical issues include severe self-mutilation, aggression, and violence. Until such studies are done, the risk-to-benefit ratio of clozapine treatment needs to be carefully evaluated on an individualized basis in such subjects.

Adult↗
PubMed2003

Suicide attempt and self-mutilation among Turkish high school students in relation with abuse, neglect and dissociation.

A questionnaire consisting of items about abuse, neglect, self-mutilation and suicide attempt and the Turkish Version of the Dissociative Experiences Scale were given to 862 high school students. The rates of suicide attempt and self-mutilative behaviors were 10.1% and 21.4%, respectively. Abused or neglected groups (34.3%) had 7.6-fold higher suicide attempts and 2.7-fold higher self-mutilation behaviours. The logistic regression model showed that each type of trauma and dissociation contributed to suicide attempts and self-mutilation, but dissociation was the most powerful. Suicidal and self-destructive adolescents should precisely be evaluated for abuse, neglect and dissociation in clinical practice.

Adolescent↗
PubMed1998

Severe morbid onychophagia: the classification as self-mutilation and a proposed model of maintenance.

OBJECTIVES: The aim of this review is to make a distinction between a mild and a severe form of onychophagia (nailbiting) that has not been adequately recognised in clinical research. Furthermore, the aim is to emphasise the need for greater understanding of the motivation for such self-injury as occurs in the severe form. The purpose of making the distinction is to evaluate whether a label of self-mutilation can be applied to the severe form. If this is the case, the tension-reduction model of self-mutilation can be proposed as the mechanism which may maintain the behaviour in the face of serious social and physical consequences. METHOD: Examination was made of the literature relating to onychophagia and to self-mutilation. Treatment studies of onychophagia were examined to evaluate the mechanisms by which the behaviour may be maintained. RESULTS: Considering the self-mutilative nature of the severe form and the common theme of tension reduction in the literature on onychophagia, application of the tension-reduction model of self-mutilation is warranted. CONCLUSION: There is a need for empirical research as to the tension-reducing nature of severe onychophagia.

Anxiety↗
PubMed1978

Self-mutilation.

A controlled study of self-mutilators found them to be significantly more introverted, neurotic and hostile. They report excessive physical punishment in childhood, sado-masochistic fantasies and more suicidal attempts.

Adolescent↗
PubMed1991

Psychiatric aspects of male genital self-mutilation.

From the beginning of the century to this day 57 cases of male genital self-mutilation have been reported in the English literature. In German publications we found 5 case descriptions. Although no precise data are available on the prevalence of male genital self-mutilation, such acts are presumably much more frequent than the small number of published cases would suggest. In the literature several features are regarded as risk factors for self-mutilation, such as e.g. homosexual or transsexual tendencies, repudiation of the male genitals, absence of a competent male for identification during childhood, feeling of guilt for sexual offences, and self-injury in the anamnesis. The most frequent diagnoses are schizophrenia and affective psychosis; alcohol intoxication was diagnosed in about one-fourth of the cases published. In the present paper we summarize data from the literature on epidemiology, psychopathology, psychodynamic and sociocultural factors in male genital automutilation and we describe 2 new cases of self-castration in which several of the risk factors described above were observed. We conclude that although it is difficult to estimate the risk of self-castration in view of the heterogeneity of the respective patient groups, the danger of such deeds should be kept in mind if the above factors are present.

Adult↗
PubMed1989

Venesection as a rare form of self-mutilation.

This case history records a rare form of self-mutilation, venesection. Underlying psychopathological mechanisms are presented, and contrasted with findings in the only other similar case reported in the English literature. The complex etiology of self-mutilating is reviewed with reference to this case report.

Adult↗
PubMed1994

Oro-dental self-mutilation in familial dysautonomia.

Orodental self-mutilation (ODSM) has not gained sufficient recognition in familial dysautonomia (FD). Among 38 patients with FD, ODSM was found in 14 (36.8%). ODSM may be due to peripheral neuropathy with insensibility to pain, which is characteristic of FD. Elimination of the sharp edges of teeth was found to be helpful.

Adolescent↗
PubMed1995

Self-injury and self-mutilation. Nursing approaches.

Self-injury/self-mutilation behaviors often are associated with organic conditions, such as mental retardation, encephalitis, Lesch-Nyhan disease, de Lange syndrome, Tourette's syndrome, acute intoxication, Addison's disease, and various behavioral and personality disorders. Among the many reasons why individuals resort to self-injury/self-mutilation are to reduce tension, the communication of intense or depressive emotions, dissociative experiences, or to gain control of earlier traumatic experiences through reenactment. The treatment of clients who engage in self-injury/self-mutilation must focus on improving communication skills, raising self-esteem, identifying support persons and groups, and eliminating positive and negative reinforcement.

Attitude of Health Personnel↗
PubMed1997

Effects of REM sleep deprivation on the d-amphetamine-induced self-mutilating behavior.

It is well known that self-mutilating behavior (SMB) is developed in rats and humans during the daily treatment with d-amphetamine. Accordingly, in this work it was found that the daily treatment with 7.5 mg/kg d-amphetamine induced in rats a progressive appearance of SMB. Lower doses (5.0 mg/kg) were uneffective and higher doses (10 mg/kg) produced a pattern of SMB in which the mutilation induced at the beginning of the d-amphetamine administration disappears completely as the treatment progresses. Interestingly, it was also found that REM sleep deprivation (48 h) potentiated significantly the SMB induced by the daily administration of 7.5 mg/kg d-amphetamine, and to lesser extent, the SMB induced by the daily treatment with 10 mg/kg d-amphetamine. R(+)-SCH-23390 a D1 dopamine (DA) receptor antagonist blocked completely or abolished the SMB induced by 7.5 mg/kg d-amphetamine in REM sleep deprived rats while (+/-)-sulpiride a D2 DA receptor antagonist had only a partial blocking effect. Haloperidol a D1/D2 DA receptor antagonist behaved as a D1 antagonist. Our results indicate that REM sleep deprivation enhances the SMB induced by the daily administration of d-amphetamine and suggest the involvement of D1 DA receptors in the mechanism underlying the SMB. A role of REM sleep deprivation is also suggested in the appearance of self-mutilating episodes in d-amphetamine addicts.

Animals↗
PubMed1998

Self-mutilation in the Lesch-Nyhan syndrome: a corporal consciousness problem?--a new hypothesis.

The Lesch-Nyhan syndrome (LNS) has been extensively studied from the genetic and biochemical point of view. The main characteristic of the syndrome is the self-mutilation feature, which has been poorly studied and understood. We propose a new hypothesis about the self-mutilation physiopathology, which is related to the supersensitivity of the dopaminergic D1 receptors in the neuromatrix found in the cingulum cortex region. The LNS shows an increase of uric acid levels as a result of the deficiency of hypoxanthine phosphoribosyltransferase enzyme. This increase could induce damage to dopaminergic neurons. As a consequence, a decrease in dopamine synthesis during gestation and the early postnatal period could occur, producing a functional dopaminergic denervation of the D1 receptors, located on the prefrontal cortex, specifically in the cingulum bundle projections. This phenomenon could induce a codification disturbance in the 'genetic body' of the neuromatrix, that could be expressed functionally as anosognosia, giving rise to self-mutilation. We suggest that this self-mutilation is a pain consciousness problem.

Brain↗
PubMed1977

[Genital self-mutilation in women].

Concerning the very rare phenomenon of female self-mutilation, some long-term observations of 2 young women are reported. In consequence of their frequent self-mutilation an exstirpation of their uterus had become necessary. Their pathodynamics under reference to the few analogic cases in the literature are outlined.

Adolescent↗
PubMed2005

Contextual features and behavioral functions of self-mutilation among adolescents.

Adolescent self-mutilative behavior (SMB) is a pervasive and dangerous problem, yet factors influencing the performance of SMB are not well understood. The authors examined the contextual features and behavioral functions of SMB in a sample of 89 adolescent psychiatric inpatients. SMB typically was performed impulsively, in the absence of physical pain, and without the use of alcohol or drugs. Moreover, analyses supported the construct validity of a functional model in which adolescents reported engaging in SMB for both automatic and social reinforcement. Considering the functions of SMB clarified the relations between SMB and other clinical constructs reported in previous studies such as suicide attempts, posttraumatic stress, and social concerns and has direct implications for the assessment and treatment of SMB.

Adolescent↗
PubMed2003

Modes and patterns of self-mutilation in persons with Lesch-Nyhan disease.

Lesch-Nyhan disease (LND) is a rare X-linked recessive genetic disorder associated with cognitive impairment, choreoathetosis, hyperuricemia, and the hallmark symptom of severe and involuntary self-mutilation. This study examines data gathered from a survey of 64 families in the USA and abroad regarding the self-injury of their family members who have LND. The individuals with LND ranged in age from 1 to 40 years (mean 16 years 7 months, SD 11 years 2 months) and, with the exception of one, were males. The most common initial mode of self-mutilation, and the most frequently cited past or current behavior, was biting of lips and/or fingers. Other behaviors, in order of frequency, included head banging, extension of arms when being wheeled through doorways, tipping of wheelchairs, eye-poking, fingers in wheelchair spokes, and rubbing behaviors. Hierarchical cluster analysis identified patterns of association among the types of self-mutilation. Modes of self-mutilation in which external surfaces (such as a wheelchair component) served as instruments of self-injury tended to co-occur, as did biting of lips and fingers.

Adolescent↗
PubMed1986

[Secret self mutilation, a psychosomatic disease].

The present article contains initial results form systematic psychoanalytic work with patients practicing secret self-mutilation (our term for these is "mimicry patients"). The group we examined was treated on an in-patient basis in a hospital for psychosomatic disorders. The article may be considered as a preliminary report. Up until now the international range of experience is rather limited. We have therefore, made use of this occasion also for developing an applicable clinical definition of the different forms of self-mutilation. This definition is based upon psychological criteria rather than, as has hitherto been the custom, upon the techniques and the morphology of the self-inflicted injuries. Clandestine self-mutilation, in our understanding, is a psychosomatic illness. The self-manipulation has the character of a psychosomatic symptom which, although self-inflicted, is beyond the control of the afflicted individual and is accompanied by extremely reduced consciousness. So far, the experience gained in therapy points to a variety of subconscious conflicts at the back of this symptom, most frequently a severe guilt problem which is not only manifest intrapsychically but also within the family milieu of the patient. On the whole therapeutic results correspond to those observed with other grave psychosomatic disorders accompanied by organic lesions, that is to say improvement sets in slowly after a therapy extending over periods of several months to several years. Initially, a long time before any treatment of the subconscious conflict may be attempted, such therapy must employ supportive ego-consolidating methods and establish a therapeutic alliance. Even so we see no reason for resignation with regard to therapeutic success.

Adult↗
PubMed2001

A topical mixture for preventing, abolishing, and treating autophagia and self-mutilation in laboratory rats.

The dysesthesia and paresthesia that occurs in laboratory rats after spinal cord injury and peripheral nerve injury results in autophagia and self-mutilation. This self-destructive behavior interferes with functional assessments in designed studies and jeopardizes the health of the injured rat. We developed a topical mixture that prevents, abolishes, and treats autophagia and self-mutilation. When the mixture is applied to the limb, its bitterness effectively prevents the rat from licking and biting the limb. In addition, the mixture has antiseptic properties.

Administration, Topical↗
PubMed1984

Self-inflicted ocular injuries. A rare form of self-mutilation.

Two unusual patients with chronic, undifferentiated schizophrenia committed acts of ocular self-mutilation. The types of patients who perform acts of self-inflicted ocular injuries are described, with particular emphasis on individuals suffering from post-traumatic stress disorder (PTSD). A discussion of these cases, as well as a review of the literature on the more common forms of self-mutilation, is presented.

Adult↗