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Tbini M, Abid E, Kamel HE, Ben Salah M. Self-mutilation of the eyes as a form of protest. J Fr Ophtalmol 2023; 46:1265-1266. [PMID: 37666738 DOI: 10.1016/j.jfo.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 05/18/2023] [Indexed: 09/06/2023]
Affiliation(s)
- M Tbini
- ENT Department, Charles Nicolle Hospital, boulevard du 9-Avril 1938, 1006 Tunis, Tunisia; Faculty of medicine of Tunis, University Tunis el Manar, Tunis, Tunisia.
| | - E Abid
- ENT Department, Charles Nicolle Hospital, boulevard du 9-Avril 1938, 1006 Tunis, Tunisia; Faculty of medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
| | - H E Kamel
- ENT Department, Charles Nicolle Hospital, boulevard du 9-Avril 1938, 1006 Tunis, Tunisia; Faculty of medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
| | - M Ben Salah
- ENT Department, Charles Nicolle Hospital, boulevard du 9-Avril 1938, 1006 Tunis, Tunisia; Faculty of medicine of Tunis, University Tunis el Manar, Tunis, Tunisia
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Abstract
BACKGROUND Three distinct subtypes of Skin Picking (SP) have been identified in previous research: Focused, Automatic and Mixed. Early Maladaptive Schemas (EMS) were not investigated across the subtypes. Understanding which EMS are associated with the subtypes might suggest the evaluation of Schema Therapy for SP and guide clinicians using it according to subtypes. The current study explored the relationship between EMS and SP subtypes in community adults. METHODS Five hundred ninety-six adults [mean age = 35.23 years, 66% females] self-reporting SP behaviours completed the Milwaukee Inventory for Dimensions of Adult Skin Picking and the Young Schema Questionnaire-Long form third version (YSQ-L3). RESULTS Higher Dependence/Incompetence EMS was a common predictor of both Focused and Automatic subtypes, while lower Emotional Deprivation EMS and younger age predicted all three subtypes. Higher Approval/Recognition Seeking, Mistrust/Abuse and Failure to Achieve were specific predictors of Automatic, Focused and Mixed subtypes, respectively. Lower Social Isolation/Alienation and Enmeshment/Undeveloped Self were specific predictors of Focused subtype. Male gender was a specific predictor of Mixed subtype. CONCLUSIONS The assessment and psychological treatment of individuals with SP behaviour may focus on specific EMS. Future longitudinal studies using clinical samples may clarify this association.
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Affiliation(s)
- Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale Bracci 16, 53100, Siena, Italy.
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste, via de Pastrovic 4, 34128, Trieste, Italy
| | - Davide Dèttore
- Department of Health Sciences, University of Florence, via di San Salvi 12 - Building 26, 50135, Florence, Italy
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Abstract
Self-mutilation is not a new trend or phenomenon in adolescents. Self-mutilation can be divided into three categories: major, stereotypic, and moderate/superficial. Moderate/superficial self-mutilation is the most common type in adolescents and includes cutting, burning, and carving. School nurses are positioned to identify, to assist, and to educate adolescents who are self-mutilating, as well as those who may be at risk. A crucial intervention by school nurses is referral of students who are self-mutilating, because it is a gateway to treatment. Treatment, which includes therapy and medication, may be a difficult and lengthy process. The adolescent who self-mutilates may find the school environment difficult during treatment. School nurses must become educated about adolescent self-mutilation in order to care for those who engage in this behavior. Prevention of self-mutilation should focus on increasing coping mechanisms, facilitating decision-making strategies, encouraging positive relationships, and cultivating self-esteem.
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Abstract
INTRODUCTION Self-mutilating behaviour is expanding, especially among adolescents and patients with a psychiatric disorder. CLINICAL MATERIAL We have tried to describe the self-mutilating behaviour in Moroccan inpatients of the psychiatric department of Mohammed V Military Hospital of Rabat, through a prospective and descriptive longitudinal study over a period of four months, based on a questionnaire prepared according to the literature data to allow discussing its results. RESULTS The rate of participation was 90.4%, or 19 patients. All patients were male. The age of onset of self-injury was between 14 and 62 years with an average of 26.3 years. Only two patients had an age of onset in adolescence, before age 20, the majority (57.8%) in a young adult age. Eight patients (42.1%) report having experienced physical abuse while only four patients were sexually abused, especially by relatives. The number of episodes varied from one episode in twelve cases (63.15%), to seven cases (37%) with repetitive self-mutilation. The most common type of self-injury was cuts (16 cases), twelve patients inflicted burns, and two patients inflicted fist blows. The forearm was the most common location. All patients were unable to resist the pressing need to self-harm after various reasons, often in a relational or professional frustration state. The use of concomitant substances to self-mutilation was reported in nine episodes, alcohol in seven episodes (24.1%) and cannabis in three episodes (10.3%). Only five patients reported receiving medical care for physical consequences of self-harm. Only two patients underwent a psychiatric care following their self-mutilation and admitted to our service. Personality disorders was the psychiatric disorder most diagnosed in our sample, followed by mood disorders. Borderline personality disorder was the pathological personality disorder most commonly diagnosed in our study with nearly two thirds of cases, followed by antisocial personality. DISCUSSION The size of our population and the prevalence of self-harm are comparable to most studies on self-mutilation in clinical populations. The low prevalence of patients beginning this behaviour early was low in our population, explained by the pre-commitment visits, which limit their integration into the military body. The role of physical and sexual abuse in childhood in the development of self-harm behaviour in adolescence is still a subject of discussion, but shame and fear of the breakdown of the family union have significantly limited the mention of such a history by our patients. The use of self-harm to relieve an intolerable anger thus the absence of suicidal intent, confirms the difference between self-harm and suicide. The intolerant nature of the military environment to self-behaviour limits its repetition and allows their early management. The high frequency of personality disorders in our sample is consistent with studies indicating high levels in patients who self-harm, including borderline personality, and supports that the DSM-IV considers self-harm to be a diagnostic criterion of this personality disorder. CONCLUSION Self-injury is a common pathological behaviour and serious in its relational impact. Our present data collected mainly similarities with that of the literature. For cultural reasons, the self-mutilation in our sample is more linked to an impulse control problem than to childhood abuse. So the establishment of a system of care adapted to preserve the privacy of patients, understanding of self-harm, informing the general public and the early treatment of victims of abusive families seems essential to reduce expansion of this behaviour.
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Affiliation(s)
- R Karrouri
- Hôpital militaire Moulay Ismail, BP 16185, 50070 Meknès-kortoba, Meknès, Maroc.
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Uctepe E, Aktas D, Alikasifoglu M, Gunduz E, Sonmez FM. TWO CASES WITH DIFFERENT EPILEPSY TYPE AND DYSMORPHIC FEATURES ASSOCIATED WITH 17q21.31 MICRODELETION SYNDROME. Genet Couns 2016; 27:357-365. [PMID: 30204964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The 17q21.31 microdeletion syndrome is characterized by intellectual disability, epilepsy, facial dysmorphism and friendly behavior. Recently, KANSLJ gene has been considered as a major causal gene for this phenotype. Here we report on two Turkish patients with different seizure types and additional dysmorphic features associated with 17q21.31 microdeletion syndrome. A 4 year-old female patient with generalized tonic-clonic seizures, mild mental retardation, dysmorphic features and friendly behavior and a 14 years-old female with intractable epilepsy, different dysmorphic features, severe mental and motor retardation and self-mutilation were evaluated by array-based comparative genomic hybridization (microarray CGH). Array CGH identified 17q21.31 microdeletion that contains MAP7 CRHR1, KANSLI, PLEKHMI genes in case I and CRHR1, PLEKHM but not KANSLJgenes in case 2. To the best of our knowledge this is the first report of a patient with the 17q21.31 microdeletion which does not encompass KANSLI gene. These data imply another gene or genes causing similar phenotype in this patient.
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Abstract
Factitious disorders are conditions which are unknown to many physicians but have a prevalence of 1-5 % in outpatient departments and hospitals. In order to avoid prolonged and complicated (false) treatment in surgery this article gives a review of the definition, epidemiology and pathogenesis of factitious disorders as well as clinical symptoms and therapy options. A focus is placed on the identification of patients, treatment strategies and the prevention of malpractice. Additionally, clinical features of the disorder are illustrated with the description of some characteristic cases.
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Affiliation(s)
- F Werdin
- Abteilung für Plastische Chirurgie und Handchirurgie, Chirurgische Klinik, Diakonieklinikum Stuttgart, 70176, Stuttgart, Deutschland.
| | - A Amr
- Abteilung für Handchirurgie, Mikrochirurgie und rekonstruktive Brustchirurgie, Marienhospital Stuttgart, Stuttgart, Deutschland
| | - A Eckhardt-Henn
- Klinik für Psychosomatische Medizin und Psychotherapie, Klinikum Stuttgart, Stuttgart, Deutschland
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Affiliation(s)
- Katrina Feichtner
- Klinik und Poliklinik für Dermatologie und Allergologie, Thalkirchner Str. 48, D-80337, München, Deutschland,
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Askari M, Grewal H, Alexander SA. Self-mutilation during orthodontic treatment. J Mass Dent Soc 2015; 63:24-26. [PMID: 25872284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Abstract
Data indicate persistence facilitates suicidal behavior. Non-suicidal self-injury (NSSI) is characterized by difficulty persisting while upset. The relationship between NSSI and suicidal behavior thus may hinge upon persistence. Participants were 604 undergraduates (79.5% women; 42.4% African American; 6.1% with 1 + prior suicide attempt). Data were collected online via self-report and analyzed using hierarchical multiple regression. As expected, higher levels of grit and perseverance predicted more frequent suicide attempts. Furthermore, grit and perseverance moderated the relationship between NSSI and suicide attempts, which increased in magnitude as individuals reported greater persistence. Findings depict suicidal behavior as a deliberate pursuit of death.
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Affiliation(s)
- Michael D Anestis
- a Department of Psychology , University of Southern Mississippi , Hattiesburg , Mississippi , USA
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Klatte J, Lockemann U, Püschel K. [Delusional disorder, autoaggression und suicide]. Arch Kriminol 2013; 232:43-50. [PMID: 24010385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The authors report on the suicide of a 27-year-old woman with extreme self-inflicted injuries. The victim suffered from schizophrenic psychosis with several stays in mental institutions and one previous suicide attempt. Autopsy revealed multiple cut and stab injuries in various body regions (51 stabs to the chest, cutting off parts of ears and nose, stab to the eye and transection of the scalp). Death was caused by exsanguination.
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Affiliation(s)
- Julia Klatte
- Institut für Rechtsmedizin der Universität Hamburg
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Yang L, Ji SF, Yue RJ, Cheng JL, Niu JJ. Old fractures in two patients with congenital insensitivity to pain with anhidrosis: radiological findings. Clin Imaging 2013; 37:788-90. [PMID: 23478071 DOI: 10.1016/j.clinimag.2013.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 09/26/2012] [Accepted: 01/27/2013] [Indexed: 11/17/2022]
Abstract
Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive disease that is characterized by anhidrosis, insensitivity to noxious stimuli, and mental retardation. Patients who suffer from CIPA easily sustain injuries due to pain insensitivity. Radiological findings in two CIPA patients revealed several old fractures of which the patients were unaware of previous injury. An early diagnosis of CIPA is important for the prevention and treatment of various complications. Our data indicate that radiological findings may provide important information for the diagnosis of CIPA.
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Affiliation(s)
- Li Yang
- Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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Oluwole LO, Dada MU, Obadeji A. Self-inflicted bilateral orchidectomy precipitated by erotic bizarre delusions: a case report. Afr J Psychiatry (Johannesbg) 2013; 16:89-91. [PMID: 23875224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Negredo L, Melis F, Herrero O. [Psychopathy and suicidal behaviour in a sample of mentally disordered offenders]. Rev Esp Sanid Penit 2013; 15:3-7. [PMID: 23529362 DOI: 10.4321/s1575-06202013000100002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 09/18/2012] [Indexed: 06/02/2023]
Abstract
Empirical literature has yielded a positive association between psychopathy levels and suicide attempts. This association is centred around impulsivity and disinhibitory facets of psychopathy, whereas suicide and emotional poverty remain independent. Evidence about the relation between suicide and psychopathy in mentally disordered offenders is not conclusive. The present work explores the relation between several measures of antisocial personality, suicide attempt and deliberate self mutilation in a sample of inmates from a forensic psychiatric hospital. Results support the association between disinhibitory aspects of personality and suicide in this population.
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Affiliation(s)
- L Negredo
- John Jay College of Criminal Justice, New York City University, New York, USA
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Wes JT, Bouwens JA, van Fenema EM, van Merkesteyn JPR, Gortzak RAT. [Automutilation of the palate in a psychiatric patient]. Ned Tijdschr Tandheelkd 2012; 119:120-122. [PMID: 22497089 DOI: 10.5177/ntvt.2012.03.11239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 46-year-old man with a history of alcohol abuse was referred to an oral and maxillofacial surgeon with a large necrotic wound with raised edges on the palate. After history taking, radiography and clinical assessment, together with a psychiatrist, the lesion was diagnosed as an automutilation resulting from a period of alcohol abstinence. After a period of care in a medical centre, the lesion improved quickly. Following this treatment, the patient was admitted to a psychiatric treatment centre for supplemental treatment of his addiction problems.
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Affiliation(s)
- J T Wes
- Afdeling Mondziekten, Kaak- en Aangezichtschirurgie, Leids Universitair Medisch Centrum
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Bakay S, Scantamburlo G, Ansseau M, Pitchot W. [Image of the month: Voluntary ingestion of foreign bodies: Psychiatric aspects]. Rev Med Liege 2012; 67:105-106. [PMID: 22611824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- S Bakay
- Service de Psychiatrie, CHU de Liège
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Simopoulos EF, Trinidad AC. Two cases of male genital self-mutilation: an examination of liaison dynamics. Psychosomatics 2012; 53:178-80. [PMID: 22281435 DOI: 10.1016/j.psym.2011.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 09/09/2011] [Accepted: 09/12/2011] [Indexed: 11/16/2022]
Affiliation(s)
- Eugene F Simopoulos
- Dept. of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA.
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Benbouzid A, Jellab B, Bighouab H, Moutaouakil A. [Congenital corneal anesthesia. A case report]. Bull Soc Belge Ophtalmol 2012:17-22. [PMID: 22978180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Congenital corneal anesthesia (CCA) is an uncommon condition difficult to diagnose. We report the case of a 4-year-old girl who presented with bilateral congenital corneal anesthesia revealed by a corneal ulcer which had been unresponsive to adapted local treatment. Self-inflicted corneal injuries were present. It is important to search for corneal anesthesia in children with chronic ulceration of the cornea and selfinflicted injuries.
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Affiliation(s)
- A Benbouzid
- Service d'Ophtalmologie, CHU Mohammed VI, Marrakech, MAROC
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Broniarczyk-Dyła G, Pajor A. [Skin self-injuries in psychodermatological aspect]. Wiad Lek 2011; 64:142-146. [PMID: 22026281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Mental disorders are the most frequent cause of self induced injuries (self-injury). Self-mutilation is a form of auto-aggression, which is a manifestation of psychic discomfort. Skin changes, defined as self-induced skin diseases, constitute the secondary problem, and require patients to consult dermatologists. Self-induced skin diseases include Münchhausen syndrome, acne excoriée, trichotillomania, nail biting (onychophagia), dermatitis artefacta, neurotic self-mutilation, self-mutilation when associated with hallucinations and delusions. A knowledge of psycho-dermatological issues among dermatologists, general practitioners, psychiatrists and psychologists facilitates proper diagnosis and the appropriate choice and form of treatment and enables patients to be provided with more complex medical care.
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Jiménez García R, Puente C, Martos I, De Ceano-Vivas M, Adrián J. An unusual dermatosis in a child. J Pediatr 2010; 156:505. [PMID: 20056233 DOI: 10.1016/j.jpeds.2009.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 09/04/2009] [Indexed: 11/18/2022]
Affiliation(s)
- Raquel Jiménez García
- Urgencia Pediátrica, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
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Kocks JWH, Tanja TA. [A girl with haematomas]. Ned Tijdschr Geneeskd 2010; 154:A215. [PMID: 20178663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 17-year-old woman had recurrent haematomas of both arms due to automutilation; she had a history of sexual violence.
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Affiliation(s)
- Janwillem W H Kocks
- Universitair Medisch Centrum Groningen, afd. Huisartsgeneeskunde, Groningen, The Netherlands.
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Knudsen R, Damborg F. [Münchhausen's syndrome--a diagnosis to remember]. Ugeskr Laeger 2009; 171:3794-3796. [PMID: 20018157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We hereby report a case of self mutilation against the right upper extremity in a 26-year-old male. The condition started after a minor trauma. After a few days the diagnosis compartment syndrome was suspected and a fasciectomy of the forearm was performed. The patient subsequently claimed that he had experienced further symptoms. Despite countless investigations, it was not possible to identify the course of the patient's symptoms. It has become clear that the patient suffers from >>Münchhausen's syndrome<<.
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Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G, Weinberg I, Gunderson JG. The 10-year course of physically self-destructive acts reported by borderline patients and axis II comparison subjects. Acta Psychiatr Scand 2008; 117:177-84. [PMID: 18241308 PMCID: PMC3884820 DOI: 10.1111/j.1600-0447.2008.01155.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The purpose of this paper was to determine the frequency and methods of two forms of physically self-destructive acts (i.e. self-mutilation and suicide attempts) reported by borderline patients and axis II comparison subjects over 10 years of prospective follow-up. METHOD Two hundred and ninety borderline patients and 72 axis II comparison subjects were interviewed about their physically self-destructive acts during their index admission and at five contiguous 2-year follow-up periods. RESULTS It was found that a high percentage of borderline patients reported multiple acts and methods of each of these two forms of physically self-destructive behavior prior to their index admission. It was also found that the percentage of borderline patients reporting multiple acts and methods declined significantly over time. However, these acts remained significantly more common among borderline patients than axis II comparison subjects. CONCLUSION The course of self-mutilation and suicide attempts among borderline patients is initially more serious and ultimately more benign than previously recognized.
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Affiliation(s)
- M C Zanarini
- Laboratory for the Study of Adult Development, McLean Hospital, Belmont, MA 02478, USA.
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Messer JM, Fremouw WJ. A critical review of explanatory models for self-mutilating behaviors in adolescents. Clin Psychol Rev 2008; 28:162-178. [PMID: 17618024 DOI: 10.1016/j.cpr.2007.04.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Revised: 04/10/2007] [Accepted: 04/20/2007] [Indexed: 10/23/2022]
Abstract
The present paper presents critical reviews of studies that have explored models of adolescent self-mutilation. Current definitional problems were addressed, as well as a proposal for a classification system of self-mutilation. Seven historically significant explanatory models were included, the sexual/sadomachistic model, the depersonalization model, the interpersonal/systemic model, the suicide model, the physiological/biological model, the affect regulation model, and the behavioral/environmental model. Each model was briefly described, and studies were critiqued according to methodology, research design, and basis upon which authors provided support or rejection of a model. Suggestions for improvement in the literature were made throughout the paper. Studies often overlapped within the models, and the strongest empirical support was shown for the behavioral/environmental model, which included components of the affect regulation model, interpersonal/systemic model, and depersonalization model. Explaining adolescent self-mutilation is a complex task, and evidence provided in this paper suggests that aspects of several models, or an integration of models, likely contribute to the understanding of this phenomenon.
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Affiliation(s)
- Julia M Messer
- West Virginia University, 1124 Life Sciences Building, 53 Campus Drive, PO Box 6040, Morgantown, WV 26505-6040, United States.
| | - William J Fremouw
- West Virginia University, 1124 Life Sciences Building, 53 Campus Drive, PO Box 6040, Morgantown, WV 26505-6040, United States
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Arora M, Praharaj SK, Prakash R. [Electroconvulsive therapy for multiple major self-mutilations in bipolar psychotic depression]. Turk Psikiyatri Derg 2008; 19:209-212. [PMID: 18561053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Self-mutilation is form of self-injurious behavior which is either low intensity, high frequency form seen in personality disorder and mental retardation or low frequency, highly destructive form which occurs in the context of psychosis or acute intoxications. We report a 32 yr-old male with bipolar affective disorder presenting with multiple acts of major self-mutilation during an episode of psychotic depression. At presentation he had broken upper central incisors, circular burn scar on right palm, crush injury of left index finger with avulsed nail and cut injury over glans penis. In view of his extreme self-mutilating behavior, he was administered electroconvulsive therapy on second day following which self-mutilating behavior improved after fourth ECT. After 8 ECT sessions, he was started on lithium carbonate with a serum level of 0.82 meq/L and haloperidol 15 mg/day and there was no recurrence of self-mutilating behavior during follow up after four months.
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Affiliation(s)
- Manu Arora
- Lyell McEwin Hospital, Adelaide, Avusturalya.
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Hsee L, Civil I, Kang N. Medical images. Cardiac stab injury. N Z Med J 2007; 120:U2867. [PMID: 18157193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Li Hsee
- Trauma Services, Auckland City Hospital, Auckland, New Zealand.
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Ang M, Chee SP. An unusual case of self-inflicted penetrating needle injury to both eyes. Graefes Arch Clin Exp Ophthalmol 2007; 244:1696-7. [PMID: 16552529 DOI: 10.1007/s00417-006-0301-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2005] [Revised: 01/28/2006] [Accepted: 02/01/2006] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND To describe an unusual case of non-accidental, penetrating needle injury to both eyes. METHODS Case report. RESULTS The patient was a 12-year-old girl with no medical or psychiatric problems detected during regular school health screenings. She presented with sudden bilateral eye pain with severe visual loss, but denied any prior trauma. She was was found to have central, penetrating corneal wounds in both eyes, which extended to the fovea in the left eye. The penetrating needle track involved the mid-cornea to the fovea, suggesting that the patient had intentionally aimed the needle into the eye while directly focusing on the needle. She subsequently underwent bilateral cataract operations; and an associated tractional retinal detachment in the left eye remained stable. Postoperatively, her visual acuity improved from perception of light to 6/9 in the right; 6/30 in the left eye. Psychological evaluations and clinical assessments did not suggest any evidence of child abuse or sexual assault. It is thus highly possible that these needle injuries could be self-inflicted. CONCLUSIONS This is an unusual case of self-inflicted needle injury to the eyes in a pediatric patient.
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Affiliation(s)
- Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
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29
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Abstract
OBJECTIVE The purpose of this study was to characterize the course of 24 symptoms of borderline personality disorder in terms of time to remission. METHOD The borderline psychopathology of 362 patients with personality disorders, all recruited during inpatient stays, was assessed using two semistructured interviews of proven reliability. Of these, 290 patients met DSM-III-R criteria as well as Revised Diagnostic Interview for Borderlines criteria for borderline personality disorder, and 72 met DSM-III-R criteria for another axis II disorder. Over 85% of the patients were reinterviewed at five distinct 2-year follow-up waves by interviewers blind to all previously collected information. RESULTS Among borderline patients, 12 of the 24 symptoms studied showed patterns of sharp decline over time and were reported at 10-year follow-up by less than 15% of the patients who reported them at baseline. The other 12 symptoms showed patterns of substantial but less dramatic decline over the follow-up period. Symptoms reflecting core areas of impulsivity (e.g., self-mutilation and suicide efforts) and active attempts to manage interpersonal difficulties (e.g., problems with demandingness/entitlement and serious treatment regressions) seemed to resolve the most quickly. In contrast, affective symptoms reflecting areas of chronic dysphoria (e.g., anger and loneliness/emptiness) and interpersonal symptoms reflecting abandonment and dependency issues (e.g., intolerance of aloneness and counterdependency problems) seemed to be the most stable. CONCLUSIONS The results suggest that borderline personality disorder may consist of both symptoms that are manifestations of acute illness and symptoms that represent more enduring aspects of the disorder.
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Affiliation(s)
- Mary C Zanarini
- Laboratory for the Study of Adult Development and the Psychiatric Epidemiology Research Program, McLean Hospital, 115 Mill St., Belmont 02478, and the Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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30
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Torgersen T, Løvås E, Tofte T. [Planned hospitalization after deliberate self-harm]. Tidsskr Nor Laegeforen 2007; 127:1521-3. [PMID: 17551558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Deliberate self-harm appears to be a common problem, especially among young people. In mental health care deliberate self-harm is often associated with emotionally unstable patients or with personality disorders of a more serious nature. Our department offers planned hospitalisation during 1-2 years for patients who deliberately and frequently harm themselves and often use psychiatric services. MATERIAL AND METHODS Chart journals for 9 patients were examined retrospectively for determination of long-term outcome. Rates of deliberate self-harm were selected into two categories, suicide attempts and self-mutilation. The number and type of inpatient hospitalisations and inpatient days were used to estimate the use of psychiatric services. RESULTS AND INTERPRETATION The rates of deliberate self-harm, use of psychiatric health services and especially use of acute psychiatric services were reduced after introduction of planned hospitalization. Planned hospitalisation may be useful for this group of patients, but the results of this study should be interpreted with care as they are based on a small retrospective study.
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31
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Abstract
Autoerotic manipulations of external male genitals resulting in mutilation with different degrees of severity are rare. We report the clinical case of a 12-year-old boy who injured his glans, left corpus cavernosum and corpus spongiosum with opened urethra as a consequence of autoerotic genital self-mutilation. According to our knowledge of the current literature this is the first description of autoerotic genital self-mutilation with a Moulinette. A Moulinette is a kitchen tool with an electric engine and an extremely fast rotary double knife, which is used to reduce food into small pieces, especially vegetables and fruits.
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Affiliation(s)
- M Lehsnau
- Klinik für Urologie und Neuro-Urologie, Unfallkrankenhaus, 12683, Berlin.
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32
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Abstract
BACKGROUND Throughout history, garlic has been used to treat a large variety of illnesses. One of garlic's adverse local effects is contact dermatitis. METHODS We present three patients treated in the Department of Plastic Surgery for suspected self-inflicted lower extremity burns. RESULTS The burns had unique features, not consistent with the etiology first claimed by the patients. All were soldiers with low motivation who confessed to using garlic to cause the burns. CONCLUSIONS Garlic application usually results in local inflammation, but, if applied under a pressure bandage, or if there is poor wound care or a secondary infection, it can cause a severe dermal reaction and a deep chemical burn. We present these cases to increase physician awareness of the characteristics of self-inflicted garlic burns, and review the dermatotoxic effect.
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Affiliation(s)
- Tal Friedman
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel.
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33
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Abstract
This study examined characteristics associated with mildly injurious (fingernail biting, skin picking, etc.) and more injurious (cutting, burning, etc.) self-harm (SH) in an undergraduate sample (N = 280); 31% reported mildly injurious SH within the past 3 years with no more injurious SH, whereas 20% reported more injurious SH within the past 3 years. SH was not associated with significant general negative affect or history of physical or sexual abuse, although more injurious SH was associated with a history of emotional abuse. A portion of both groups reported negative affect regarding their histories of SH. Both types of SH were associated with other impulsive and disordered eating behaviors, some obsessive-compulsive characteristics, and more somatic symptoms. Similarities and differences with clinical SH are discussed, as well as implications for further research and treatment. Arguments for and against a continuum view of self-harm, as ranging from mild to severe in injuriousness or clinical significance, are also discussed.
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Affiliation(s)
- Kristin L Croyle
- Department of Psychology and Anthropology, University of Texas-Pan American, Edinburg, TX 78541-2999, USA.
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34
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Abstract
Although often used as synonyms, "self-injury" and "self-harm" may refer to different behaviors with different meanings. Because the literature is quite confusing in this respect, we propose a more specific delineation of the notion of self-injurious behavior (SIB), differentiated from other self-harming behaviors. For this purpose, we present a flowchart for differential diagnosis. This brings us to the question: are we dealing here with a sign of pathology or a meaningful behavior? We compare the structuralist approach, in which SIB is viewed as either a syndrome or a symptom, with the functionalist approach, focusing on the psychosocial functions of SIB.
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Affiliation(s)
- Laurence Claes
- Department of Psychology, Catholic University Leuven, 3000 Leuven, Belgium.
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35
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Martiniuc G, Trifina A, Trifina L. [Partial oedipism: case report]. Oftalmologia 2007; 51:41-48. [PMID: 17937033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We present the case of a schizophrenic patient in acute psychosis, with religious delusions, and autoaggressive acts, resulting amaurosis of the right eye and impairment of the other, and showing the difficulties of managing and therapy, as the crucial importance of the team work between the ophthalmologist, the neurologist and the psychiatrist.
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36
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Abstract
OBJECTIVE To investigate if parent-teacher discrepancies in reports of behavioral/emotional problems in children predict poor outcome. METHOD A total of 1154 4- to 12-year-old children from the general population were followed up. At the first assessment, parent and teacher ratings were obtained with the Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF). Fourteen years later, DSM-IV diagnoses were assessed, and ratings of self-reported and parent-rated behavioral and emotional problems were obtained. RESULTS CBCL and TRF scores predicted most of the outcomes, but in general, discrepancies between CBCL and TRF scores did not. There were some exceptions. For instance, higher parental vs. teacher ratings of aggressive behaviors increased the risk of suicide attempts/self-mutilation. CONCLUSION Risk factors for self-mutilating behaviors may be supplemented with parent-reported aggressive behaviors that are not observed by the teachers. In general, whereas CBCL and TRF scale scores were useful predictors of outcome, parent-teacher discrepancies were not.
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Affiliation(s)
- R F Ferdinand
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center Rotterdam/Sophia Children's Hospital, The Netherlands.
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37
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Soong TKW, Soong V, Samsudin A, Soong F, Sharma V, O'Donnell N. Periocular dermatitis artefacta in a child. J AAPOS 2006; 10:585-6. [PMID: 17189158 DOI: 10.1016/j.jaapos.2006.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Revised: 08/23/2006] [Accepted: 08/23/2006] [Indexed: 10/24/2022]
Abstract
Dermatitis artifacta is a factitious dermatological disorder with many forms of presentation in any part of the body. It is commonly documented in dermatological cases but rarely presented as an ophthalmic condition. The diagnosis of dermatitis artifacta is often concluded after rigorous and repeated investigation. Histological sampling of skin lesions is usually required in these cases to exclude masquerading skin lesions such as basal cell carcinoma, vasculitis, or herpetic skin lesions.
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38
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Abstract
A wide range of intra-vesical foreign bodies have been described in the literature. Causes include iatrogenic, migration from adjacent organs, penetrating injuries and self-insertion, either due to eroticism, inquisitiveness or as a result of a psychiatric illness. We present an unusual case of fictitious bladder stones that proved unbreakable using all standard endourological techniques.
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Affiliation(s)
- S Lau
- Department of Urology, Lithotripsy and Stone Services, St. Bartholomew's Hospital, London, UK
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39
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Erdur B, Turkcuer I, Herken H. An unusual form of self-mutilation: tongue amputation with local anesthesia. Am J Emerg Med 2006; 24:625-8. [PMID: 16938608 DOI: 10.1016/j.ajem.2005.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2005] [Accepted: 12/21/2005] [Indexed: 11/17/2022] Open
Affiliation(s)
- Bulent Erdur
- Department of Emergency Medicine, Medical Faculty, Pamukkale University, Kinikli 20070, Denizli, Turkey.
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40
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Abstract
Deliberate self-injury is defined as the intentional, direct injuring of body tissue without suicidal intent. The present article reviews the empirical research on the functions of self-injury. This literature includes self-reports of reasons for self-injuring, descriptions of the phenomenology of self-injury, and laboratory studies examining the effects of self-injury proxies on affect and physiological arousal. Results from 18 studies provide converging evidence for an affect-regulation function. Research indicates that: (a) acute negative affect precedes self-injury, (b) decreased negative affect and relief are present after self-injury, (c) self-injury is most often performed with intent to alleviate negative affect, and (d) negative affect and arousal are reduced by the performance of self-injury proxies in laboratory settings. Studies also provide strong support for a self-punishment function, and modest evidence for anti-dissociation, interpersonal-influence, anti-suicide, sensation-seeking, and interpersonal boundaries functions. The conceptual and empirical relationships among the different functions remain unclear. Future research should address the measurement, co-variation, clinical correlates, and treatment implications of different functions.
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Affiliation(s)
- E David Klonsky
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500, United States.
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41
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Abstract
Male genital injury, although rarely life-threatening, demands prompt, appropriate management to prevent long-term sexual and psychological damage. However, because of the rarity and disparity of severe genital injuries, there is still no universal therapeutic strategy. Urethral injury, although rare, may be associated with substantial long-term morbidity such as fistulas and strictures. Injuries to the scrotum and its contents may cause impaired fertility, chronic pain, hypogonadism, and altered self-image. Penile injury may lead to pain, curvature, and erectile dysfunction. This article concentrates on reviewing the major etiologies and mechanisms of urethral and genital injuries in men and summarizes principles and strategies of treatment based on the guidelines of the European Association of Urology.
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Affiliation(s)
- A H Wille
- Klinik und Poliklinik für Urologie, Charité, Campus Mitte, Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin.
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42
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Abstract
BACKGROUND The outcome for patients with dermatitis artefacta is not well known. The primary objective of this single-centre retrospective study was to describe the initial clinical aspects and the prognosis of the disease. The secondary objective was to describe the somatic and psychological management and long-term treatment of these patients. PATIENTS AND METHODS Records of patients with dermatitis artefacta followed in the dermatology department over the 15 last years were reviewed independently by 2 dermatologists. Diagnostic criteria consisted of evocative clinical pictures and the exclusion of other forms of dermatosis. Data collection included: file analysis, photographs, review questionnaires sent to general practitioner or completed during a phone call to patients (follow-up data). RESULTS Thirty-one patient files were selected: 23 women and 8 men, mean age 31 years (SD = 14.8). Clinical aspects included: erythema (50%), ulceration (37%), crust (23%) and blisters (17%). The main sites were the face (67%) and arms (43%). Topical treatment was prescribed in all cases and systemic treatment was prescribed in 23% of cases. Psychological support was offered to 65% of the patients and was accepted by 50%. A follow-up study was performed for 17 patients and showed serious complications in 4 cases consisting of psychosis (n=2) and/or severe self-mutilation (n=3) occurring over several years following diagnosis (5 years for one patient and 12 years for 2 patients). DISCUSSION The results confirm the usual and characteristics of dermatitis artefacta such as predominance in young female patients, with lesions affecting visible areas (face, upper legs). In contrastwith published studies, no cases of attempted suicide were observed in our series, although severe dermatitis artefacta was evidenced in only a minority of patients.
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43
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Faller-Marquardt M, Pollak S. Self-inflicted injuries with negative political overtones. Forensic Sci Int 2006; 159:226-9. [PMID: 16271289 DOI: 10.1016/j.forsciint.2005.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Revised: 05/18/2005] [Accepted: 08/31/2005] [Indexed: 10/25/2022]
Abstract
The report deals with two adolescents (a 17-year-old Turkish boy and a 15-year-old German girl) who simulated right-wing assaults by cutting National Socialist symbols into their own skin. The fact that Nazi symbols were chosen was obviously due to the idea that the alleged commission of the offense by right-wingers would not be doubted due to the negative image of this group. The alleged victims did not inform the police until the family or close friends urged them to report the incident. The rapid elucidation of the facts was possible because medicolegal experts were called in at an early stage of the investigations. The injuries showed typical morphological features of self-infliction (localization in easily accessible parts of the body, multitude of singular lesions with a linear or slightly curved course, equally shallow and non-penetrating cuts, arrangement in groups or over a defined area, lack of defense injuries, no corresponding damage to the clothing).
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Affiliation(s)
- M Faller-Marquardt
- Institute of Legal Medicine, University of Freiburg, Albertstrasse 9, D-79104 Freiburg, Germany
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44
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Nielsen K, Jeppesen M, Simmelsgaard L, Rasmussen M, Thestrup-Pedersen K. Self-inflicted skin diseases. A retrospective analysis of 57 patients with dermatitis artefacta seen in a dermatology department. Acta Derm Venereol 2006; 85:512-5. [PMID: 16396799 DOI: 10.1080/00015550510038250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022] Open
Abstract
We analysed clinical symptoms, gender, age and social relations among 57 patients for whom a final diagnosis of dermatitis artefacta was established. The study is retrospective and the patients were seen in our department from 1982 to 2002. We observed that the diagnosis was 2.8 times more common in females than males. Symptoms were most common in the age group 18-60 years, median age 39 years. The skin lesions were 'multiple' among 88% of the patients. When self-infliction was suggested as the cause, two-thirds of patients initially denied it and only one patient agreed to meet with a psychiatrist. Only one-quarter had a job, the rest were unemployed or on sick leave. Many patients (61%) received medical treatment with anxiolytica. Ten patients (18%) had a psychiatric diagnosis. Among our 57 patients, 11 were deceased at the time of our study, but none because of suicide. Four had died before the age of 70, of whom two suffered from alcoholism and two had diabetes mellitus. Therapy should include an optimal nursing relationship with the patient so that social problems can be discussed. Psychological or psychiatric intervention appeared unhelpful because of patient denial.
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Affiliation(s)
- Kristine Nielsen
- Department of Dermatology, University of Aarhus, Aarhus C., Denmark
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45
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Hildebrand E, Hitzer K, Püschel K. [Self-inflicted finger-amputation: insurance fraud or accidental injury?]. Versicherungsmedizin 2006; 58:29-33. [PMID: 16553224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
A 50-year-old surgeon was working with his electrical circle saw as a do-it-yourselfer. He was alone, nobody witnessed his mishap when he amputated his left index finger. He claimed high financial compensation from two accident insurance companies because of his disability. A long series of medical expertises followed. The juridical procedures took 12 years in total. All higher authorities had to deal with the forensic medical implications. Finally, the high court (Bundesgerichtshof) decided that the complainant would receive no compensation because he gave two very different descriptions. Concerning the reconstruction of the accident, the first version was unlikely from a biomechanical point of view. The decision of the court was solely based on the violation of the obligation to give a clear presentation of the course of events (Obliegenheitsverletzung).
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Affiliation(s)
- E Hildebrand
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf
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46
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Abstract
The purpose of this study was to determine the percentage of borderline patients who first engaged in self-mutilation as children and to compare the parameters of their self-harm to those of borderline patients who first harmed themselves at an older age. Two hundred and ninety inpatients meeting both Revised Diagnostic Interview for Borderlines (DIB-R; Zanarini, Gunderson, Frankenburg, & Chauncey, 1989) and Diagnostic and Statistical Manual of Mental Disorders (3rd ed. ref.) (DSM-III-R; APA, 1987) criteria for borderline personality disorder were interviewed about their history of self-mutilation. Of the 91% with a history of self mutilation, 32.8% reported first harming themselves as children (12 years of age or younger), 30.2% as adolescents (13-17 years of age), and 37% as adults (18 or older). Using logistic regression analyses and controlling for baseline age, it was found that those with a childhood onset reported more episodes of self-harm, a longer duration of self-harm, and a greater number of methods of self-harm than either those with an adolescent or adult onset to their self-mutilation. The results of this study suggest that a sizable minority of borderline patients first engage in self-harm as children and that the course of their self-mutilation may be particularly malignant.
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Affiliation(s)
- Mary C Zanarini
- Laboratory for the Study of Adult Development, McLean Hospital, Belmont, MA 02478, USA.
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47
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Gosk JG, Rutowski RA, Urban MJ, Wiacek R. [Self-mutilation as a consequence of the perinatal brachial plexus palsy]. Wiad Lek 2006; 59:866-8. [PMID: 17427506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
In this study we presented 2 cases of the self-mutilation of the hand following obstetrical brachial plexus palsy. The mechanism of this behaviour was also discussed.
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Affiliation(s)
- Jerzy G Gosk
- Katedry i Kliniki Chirurgii Urazowej i Chirurgii Reki Akademii Medycznej we Wrocławiu.
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48
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Onacki M. Kids who cut: a protocol for public schools. J Sch Health 2005; 75:400-1. [PMID: 16313511 DOI: 10.1111/j.1746-1561.2005.00055.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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49
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Tumolo J. Slice at life. Teens who cut, burn and beat themselves to dull inner pain. Adv Nurse Pract 2005; 13:54-6. [PMID: 16342822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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50
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Abstract
OBJECTIVE To examine national patterns in the emergency department assessment and treatment during visits by young people, aged 7 to 24 years, who are seen following an episode of deliberate self-harm. METHOD An analysis was conducted of a nationally representative sample of hospital emergency department visits from the 1997-2002 National Hospital Ambulatory Medical Care Survey focusing on visits by persons aged 7 to 24 years related to deliberate self-harm. National census data were used to derive population-based rates of emergency department visits for deliberate self-harm overall and stratified by sex, age, race, and ethnicity. Demographic, clinical, and treatment characteristics of the visits are presented including comparisons of visits that resulted in an inpatient admission with those that resulted in discharge to the community. RESULTS Among young people aged 7 to 24 years, the annual rate of emergency visits with self-harm was 225.3 per 100,000. A mental disorder was diagnosed in 56.0% of these visits including depressive disorders in 15.1% and substance use disorders in 7.3%. Approximately one half of the visits (56.1%) resulted in an inpatient admission. As compared with visits resulting in discharge to the community, emergency department visits that resulted in inpatient admission were significantly more likely to result in the patients receiving a mental disorder diagnosis (63.8% vs 45.7%; P = .03), especially a depressive disorder (22.5% vs 5.8%; P = .005), and receiving psychotropic medications (18.0% vs 4.7%; P = .007), intravenous fluids (39.2% vs 22.3%; P = .02), gastric lavage (24.1% vs 9.8%; P = .02), and a specific antidote for poisoning (12.2% vs 1.3%; P = .02). CONCLUSIONS Mental disorders are diagnosed in roughly one half of emergency department visits by young people following an episode of deliberate self-harm. Systematic mental health assessments in the emergency department of young people following an episode of deliberate self-harm may improve detection of mental disorders.
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Affiliation(s)
- Mark Olfson
- New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, USA.
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