Dec 20

Self-mutilating behaviour: A study on 30 inpatients. – Baguelin-Pinaud A, Seguy Chemical, Thibaut F.


Inserm U614, UFR de médecine, service universitaire de psychiatrie, centre hospitalier du Rouvray, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France.


INTRODUCTION: Deliberate self-injury is defined as the particular intentional, direct injuring of entire body tissue without suicidal intent. There are different types of deliberate self-mutilating behaviour: self cutting, phlebotomy, bites, burns, or ulcerations. Sometimes, especially among psychotic inpatients, eye, tongue, ear or genital self-mutilations have been reported. Actually self-mutilation behaviour raises nosological and psychopathological questions. A consensus on the precise definition is still pending. Numerous authors consider self-mutilating behaviour being a distinct clinical syndrome, whereas others hold it to be a specific symptom of borderline personality disorder. Self-mutilating conduct has been observed in 10 to 15% of healthy children, especially between the age of 9 and 18months. These types of self mutilations are considered as pathological after the age of 3. Such conduct is common among adolescents, with a increased proportion of females, and among psychiatric inpatients. Patients use various locations and methods for self-mutilation. Deliberate self harm syndrome is often connected with addictive behaviour, suicide attempt, and personality disorder. CLINICAL MATERIAL: All of us report on an observational study including 30inpatients and we compared the data with the existing literature. As a matter of fact, until now, the majority of the papers deal with case reports or with very specific patterns of self-mutilation (eye, tongue or genital self-mutilations). Otherwise, papers report the particular relationships between self-mutilation and somatic or personality disorders (Lesh Nyhan syndrome, borderline personality disorder, dermatitis artefacta, self-mutilation in children following brachial plexus related to birth injuries, mental retardation… ). Our research included all self harmed sufferers who had been admitted to our psychiatric medical center (whatever the location and type of self-mutilation). Patients suffering from brain injury or mental retardation were excluded. OUTCOMES: In our sample, there was a higher portion of women (29women and 1man) and the mean age was 18 (12 to 37). More than half of the sufferers were aged under 18. Individual parent families were reported within 30% of cases. Thirty percent of patients had been physically or sexually abused during childhood. Sixty percent a new comorbid psychiatric disorder, 63% have been hospitalised previously (half of them two times or more). Seventy-three percent of patients had previously attempted committing suicide (notably deliberate self-poisoning and cutting) that was not considered as self-mutilating conduct by the patients themselves. Each individual had self harmed themselves at least twice and most often different methods and locations were used (deliberate self harm of forearms 90%, thighs 26. 7%, legs sixteen. 7%, chest 10%, belly 10%, hands 6. 9%, face 6. 9%, arms 6. 7%, and feet 3. 3%). Addictive problems, such as substance abuse (tobacco 46. 7%; alcohol 23. 3%; illicit medicines 16. 7% mostly cannabis or cocaine) and eating disorders (33. 3% and among them 50% of cases were restrictive anorexia nervosa) were often associated with a deliberate self harm syndrome. Three psychiatric diagnoses were often observed in our cohort: depressive disorder 36. 7%; character disorder 20%; psychosis 10% and depressive disorder associated with personality problem 33. 3%. In our sample, psychotic patients differed on several clinical aspects: the atypical location (abdomen, nails) and method (needles) of self-mutilating behaviour. None of them had been mistreated during childhood and none has been suffering from addictive disorders.

Language: Fre

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