A rare case of self-mutilation: self-enucleation of both eyes.
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Adult↗
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[Differential approach of self mutilation and self offending behaviors from the point of view of object relation and defense mechanisms].
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Aggression↗
The psychophysiology of self-mutilation.
Self-mutilators' psychophysiological and subjective responses during an imaged self-mutilative act were examined. Differences in arousal to 3 imaged control events (neutral, accidental injury, and aggression) were examined between 3 self-mutilation groups (prisoner, prisoner control, and nonprison control). Imagery scripts were presented in 4 stages; scene setting, approach, incident, and consequence. Results indicated a decrease in psychophysiological and subjective response during self-mutilation imagery. No such decrease was evident for nonmutilators who were administered standard self-mutilation imagery. A lag between psychophysiological and psychological response to the self-mutilative act was evident. Responses elicited during self-mutilation imagery were different from those of control imagery. Results indicated that self-mutilative behavior is maintained by its reinforcing tension-reducing qualities.
Adult↗
Insertion of foreign bodies into the abdominal cavity. An unusual form of self-mutilation.
Self-mutilation is self-infliction of bodily injury without a conscious suicidal intent. Repeated self-inflicted abdominal stab wounds with insertion of foreign bodies into the abdominal cavity is an uncommon form of self-mutilation. We describe such a case in a 35-year-old male inmate who committed suicide by hanging. At autopsy metallic foreign bodies were found in the liver and paraduodenal soft tissue. Because of its high prevalence in the incarcerated population, self-mutilation among prisoners should be given attention. Self-mutilation should also be considered in cases of atypical behavior, psychiatric disorders, intoxication, mental retardation, and sudden death from unexplained causes.
Abdominal Injuries↗
Interpersonal loss and self-mutilation.
Self-mutilation was hypothesized to increase in frequency during periods of interpersonal loss in a treatment program for seriously disturbed adolescents. The study examined changes in the frequency of acts of self-mutilation, aggression, and running away for 32 teenagers who experienced interpersonal loss when staff members left employment. Data were collected for a 4-year period. Statistical findings indicated that the frequency of self-mutilation increased significantly during the time period of anticipated loss, 2 weeks prior to staff terminations. There was no significant increase in the frequency of self-mutilation immediately following the staff terminations. Also, there was no significant change in the rates of aggression or running away either before or after the loss events. It was concluded that the time of anticipated loss was the period of highest risk for these adolescents in terms of self-mutilative behavior.
Adolescent↗
Addictive characteristics of the behavior of self-mutilation.
Self-mutilation has numerous characteristics that also have been identified in the self-destructive behavior of addiction; these characteristics include similarities in origin, in emotions experienced, in family structure and in the repetitive nature of tension-release responses. Clinicians must deal with the various obstacles when trying to provide care to patients with self-mutilation behaviors, including the lack of information and a preferred treatment and the fact that self-mutilation is an act that occurs in isolation and privacy. The advanced clinician can utilize knowledge of the processes of self-mutilation and addiction to assist unit staff in understanding potential needs of these particular clients and provide resource information to the staff, which may assist in resolving some of the fear and frustration in interacting with self-destructive clients.
Adolescent↗
Understanding those who self-mutilate.
Self-mutilating behavior is a symptom seen in both men and women with various psychiatric disorders, but the majority of those who self-mutilate are women with borderline personality disorder. This complex, maladaptive behavior is used by clients as a means of self-preservation and emotion regulation, and is often associated with childhood trauma. Clients who self-mutilate perceive they receive poor care in hospital emergency departments and are retraumatized by these experiences. Clinicians who understand the complexity and purposes of self-mutilating behavior are better able to provide clients with supportive, empathetic care.
Adult↗
The plight of chronic self-mutilators.
Self-mutilation is a more common behavior than generally realized; its prevalence may be 750 per 100,000. From the responses of 250 subjects to a Self-Harm Behavior Survey we have learned that self-mutilation typically begins in early adolescence and may assume a chronic course characterized by severe psychosocial morbidity. Some chronic self-mutilators already are heavy and generally dissatisfied users of mental health services. The number of them seeking help may increase as a result of heightened public awareness. Community mental health facilities may be hard-pressed to meet the needs and demands of these clinically vexing patients.
Adaptation, Psychological↗
Self-mutilation and self-blame in incest victims.
A case is made for self-blame as the psychic link between children's experiences of incestuous sexual abuse and their self-mutilating behavior later in life. Representative case histories and the results of a small pilot study are presented to illustrate the author's theoretical formulation.
Adolescent↗
The coming of age of self-mutilation.
Self-mutilation (SM), the deliberate, nonsuicidal destruction of one's own body tissue, occurs in such culturally sanctioned practices as tattooing; body piercing; and healing, spiritual, and order-preserving rituals. As a symptom, it has typically been regarded as a manifestation of borderline behavior and misidentified as a suicide attempt. It has begun to attract mainstream media attention, and many more who suffer from it are expected to seek treatment. This review suggests that SM can best be understood as a morbid self-help effort providing rapid but temporary relief from feelings of depersonalization, guilt, rejection, and boredom as well as hallucinations, sexual preoccupations, and chaotic thoughts. Major SM includes infrequent acts such as eye enucleation and castration, commonly associated with psychosis and intoxication. Stereotypic SM includes such acts as head banging and self-biting most often accompanying Tourette's syndrome and severe mental retardation. Superficial/moderate SM includes compulsive acts such as trichotillomania and skin picking and such episodic acts as skin-cutting and burning, which evolve into an axis I syndrome of repetitive impulse dyscontrol with protean symptoms.
Adolescent↗
Self-mutilation.
Self-mutilation presents great diagnostic and therapeutic difficulties and the financial expenditure involved in its treatment is considerable. The ten patients comprising the present investigation were on average hospitalized for 314 days and were operated on 15 times. Only two can be considered to have recovered. Greater knowledge of these patients and closer cooperation between the surgeon, psychiatrist, general practitioner and social authorities should make their treatment more effective.
Adult↗
The significance of aggression and impulsivity for self-mutilative behavior.
Self-mutilative behavior (SMB) is presented as a specific form of inwardly directed aggressiveness which is thought to be associated with problems of impulse control. Conceptual problems concerning impulsivity and impulsive aggression are discussed. Among different forms of dyscontrolled behavior, SMB is of special heuristic interest because of distinction can be made between patients committing impulsive and those committing premeditated self-harming actions. Psychometric and biological measures of impulsivity and aggressiveness were assessed in self-mutilators in comparison to depressives and normal probands. Self-mutilators were differentiated into two subgroups, those with an impulsive (ISMB) and those with a premeditated (PSMB) form of SMB, and depressives were also differentiated into two subgroups, those with a history of suicide attempts and those without. Only patients with ISMB (and depressives with a history of suicide attempts) showed an enduring tendency towards dyscontrolled patterns of behavior and cognition; therefore, SMB cannot be generally regarded as an indicator of high impulsivity or an impulse control disorder. Measures of impulsivity and aggressiveness did not behave analogically to each other and aggressive or autoaggressive modes of behavior should not be generally used as an index of impulsivity. A reduction of serotonergic activity, proved by a blunted prolactin response to D-fenfluramine, was found in all patient-groups in comparison to normal probands. Prolactin response after D-fenfluramine challenge turned out to be most blunted among self-mutilators with ISMB and among depressives with a history of suicide attempts.
Adult↗
Pain perception during self-reported distress and calmness in patients with borderline personality disorder and self-mutilating behavior.
Self-mutilation occurs in 70-80% of patients who meet DSM-IV criteria for borderline personality disorder. Approximately 60% of these patients report that they do not feel pain during acts of self-mutilation such as cutting or burning. Findings of recent studies measuring pain perception in patients with BPD are difficult to interpret since variables such as distress, dissociation or relevant psychotropic medication have not been controlled. The Cold Pressor Test (CPT) and the Tourniquet Pain Test (TPT) were administered to 12 female patients with BPD who reported analgesia during self-mutilation and 19 age-matched healthy female control subjects. All subjects were free of psychotropic medication. The patients were studied on two occasions: during self-reported calmness and during intensive distress (strong urge to cut or burn themselves). Even during self-reported calmness, patients with BPD showed a significantly reduced perception of pain compared to healthy control subjects in both tests. During distress, pain perception in BPD patients was further significantly reduced as compared with self-reported calmness. The present findings show that self-mutilating patients with BPD who experience analgesia during self-injury show an increased threshold for pain perception even in the absence of distress. This may reflect a state-independent increased pain threshold which is further elevated during stress. Interpretation of these findings is limited by their reliance upon self-reports.
Adult↗
Self-mutilation and severe self-injurious behavior associated with amphetamine psychosis.
Amphetamine abuse is widespread and is frequently encountered in general hospital settings. We have recently seen amphetamine-induced transient psychosis associated with severe self-injurious behavior and self-mutilation. In the setting of bizarre and/or severe self-injurious behavior, screening for amphetamines is indicated.
Adult↗
Nursing care of the self-mutilating patient.
Self-mutilative behavior is common among patients with multiple personality and other dissociative disorders. Nursing staff members face particular challenges in managing these patients because one act of self-mutilation can disrupt the entire inpatient milieu. The authors present an approach to nursing care that focuses on working with patients to understand and develop a specific plan to curtail the self-mutilative behavior.
Affect↗
Coping and problem solving of self-mutilators.
People who self-mutilate have been hypothesized to have deficient skills in coping and problem-solving that leave them vulnerable to the adoption of self-mutilation as a coping strategy. This hypothesis was tested using male incarcerated self-mutilators with comparisons being made with non-multilating, prisoner, and non-prisoner control groups. Examination of the inherent resources which enable an individual to effectively cope with stress demonstrated a depressed score for self-mutilators on the scale measuring self-worth and optimism about life. Assessment of the strategies used to cope with real problems demonstrated that self-mutilators engage in more problem avoidance behaviors. Self-mutilators also recorded less perceived control over problem-solving options. The results are discussed in terms of the effectiveness of self-mutilation as a coping strategy and the need to adopt a multidimensional approach to the investigation of coping.
Adaptation, Psychological↗
Multiple autoextractions: oral self-mutilation reviewed.
Oral self-mutilation occurs in a variety of clinical settings. The etiology of oral self-mutilation can be divided into organic and functional categories. Organic etiologic factors include metabolic and genetic disorders. Functional self-mutilation is performed knowingly, as a response to certain stimuli, and may or may not serve a cognitive purpose. The occurrence of oral self-mutilation with a functional cause represents a diagnostic challenge to practitioners. In this article, a case of autoextraction of multiple posterior teeth in a psychotic 27-year-old white man is presented. Though a wide range of self-mutilation in a person in a psychotic state is well documented, oral self-mutilation, particularly autoextraction, is rare. Although the case reported is extreme in nature, incidence of oral self-mutilation is not uncommon and should be considered in the differential diagnosis of lesions of unknown cause.
Adult↗
Self-burning versus self-cutting: patterns and implications of self-mutilation; a preliminary study of differences between self-cutting and self-burning in a Japanese juvenile detention center.
The purpose of the present paper was to examine the differences in clinical features between self-cutters and self-burners, to clarify clinical implications of self-mutilating behaviors other than self-cutting. Subjects were 201 delinquent adolescents consecutively entering a Japanese juvenile detention center from February 2003 to March 2003. The subjects were assessed using a self-reporting questionnaire to evaluate self-mutilation, traumatic events, and problematic behaviors. Beck Depression Inventory-2 (BDI-2) and Adolescent Dissociative Experience Scale (A-DES) were also tested. Subjects were classified into four groups according to self-mutilating behaviors: non-self-cutting or -burning (NSCB), self-cutting (SC), self-burning (SB), and self-cutting and self-burning (SCB). The questionnaire answers and scores of the BDI-2 and A-DES were compared between the four groups. Of 201 subjects, 33 (16.4%) had cut their wrists or forearms at least once, and 72 of 201 (35.8%) had burned themselves at least once. The SC and SCB group had traumatic events, problematic behavior, and various types of self-mutilating behavior more frequently than the other two groups. The SCB group reported additional types of self-mutilating behavior more than the SC group. The SCB group also experienced multiple body customizations compared to the SC group, and exhibited higher scores on the BDI-2 and A-DES than the other three groups. The self-burning without self-cutting may have limited clinical implications. However, the self-burning with self-cutting may suggest depression and dissociation, as well as possible indication of self-mutilating behavior.
Adolescent↗