[Psychosomatic dermatology; a case of autolesions].
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Self-inflicted injurious behavior Auto-aggressive behavior such as the simulation of crimes, attempted insurance fraud or suicidal intent are observed in psychiatric diseases and, in particular, in borderline personality disorder. The self-inflicted injuries often show typical characteristics, the knowledge of which is helpful for making a diagnosis and can critically influence further therapy. Borderliner injuries are often noticeably uniform, arranged in parallel, superficial and on body locations that are easily reached. For affected persons who are at high risk for suicide, it is of great importance that they receive psychiatric therapy as soon as possible.
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Depersonalization is a subjective sense of unreality regarding various aspects of the self, experienced as disconnectedness from one's own body, mentations, feelings, or actions. When episodes of depersonalization are recurrent or persistent and lead to distress or dysfunction, the diagnosis of depersonalization disorder is made. Certain similarities in phenomenology, comorbidity, neurochemistry, and treatment response suggest a relationship to the obsessive-compulsive spectrum. However, depersonalization is a very poorly studied condition, and any conclusions must be viewed tentatively. Self-injurious behaviors are defined as intentionally self-inflicted bodily injuries without lethal intent. Basic categories are briefly described. Subsequently, the phenomenology and biology of both impulsive and compulsive self-injurious behaviors, and their relationship to the obsessive-compulsive spectrum, are discussed.
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A suicide will naturally be a shock to the surroundings, unexpected and brutal as it is. Suicide survivors will often emphasize the unexpected. Nevertheless a suicide must be regarded as the end result of a long process. In this paper the extremely well-documented case of Vincent van Gogh is used to study suicidal processes and suicidal motives. In van Gogh's case, an early childhood trauma initiated a life-long suicidal process. His difficulties as regards attachment to and separation from his parents continued throughout his life and his emotional instability, intensity and lowered tolerance to frustration seem to portray a borderline personality. Vincent van Gogh's chronic suicidal ideation and behaviour led to a series of crises throughout his life, escalating during the last 18 months before his suicide in 1890. It is possible to identify at least three prominent suicidal motives in van Gogh's case. The first is unbearable emotional pain related to personal experience of loss which reactivated the childhood trauma. The second is introverted murderous rage arising from conflicts with other persons. The third motive described is the need for a cathartic release of energy and emotion.
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We have observed mutilative self-biting leading to multiple finger amputations in two patients following C4 complete spinal cord injury (SCI). Both men were of normal intelligence without psychosis and each had a neurotic personality and history of fingernail biting. They related the self-biting to anxiety and depression. We believe these to be the first English language reports of multiple finger amputations due to self-biting following SCI.
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