Osuch EA, Noll JG, Putnam FW. The motivations for self-injury in psychiatric inpatients. Psychiatry 1999;62:334-46.
Nonsuicidal self-injurious behavior (SIB) occurs in both culturally appropriate and culturally inappropriate forms. It is one of the diagnostic criteria for borderline personality disorder, but it occurs in several psychiatric and neurological populations. The personal intent of SIB in psychiatric populations is incompletely understood. A self-report scale (Self-Injury Motivation Scale; SIMS) to assess motivation for self-injury was developed. Relationships among motivation for SIB, characteristics of SIB, and psychopathology were explored. A semistructured interview and the SIMS, Dissociative Experiences Scale, Beck Depression Inventory, Davidson Trauma Scale, and Millon Clinical Multiaxial Inventory-II were given to 99 consecutively admitted inpatients. The SIMS had good reliability and validity. A high SIMS score suggested distinct psychopathology. Several factors on the SIMS differentiated motivations for SIB. Patients with different SIMS factor profiles had different psychopathology.

Cardena E. “You are not your body”: commentary on “The motivations for self-injury in psychiatric inpatients.” Psychiatry 1999;62:331-3.

Wallace MD, Iwata BA, Zhou L, et al. Rapid assessment of the effects of restraint on self-injury and adaptive behavior. J Appl Behav Anal 1999;32:525-8.
We evaluated the effects of restraint on occurrences of self-injurious behavior (SIB) and adaptive responses exhibited by 2 individuals across eight response-effort conditions: baseline (no restraints); restraint sleeves without stays; restraints with 5, 10, 15, 20, or 25 thin metal stays; and restraints with five thick metal stays. From this analysis, we identified a restraint level for each participant that reduced SIB but did not inhibit adaptive responding.

Fowler JC, Hilsenroth MJ. Some reflections on self-mutilation. Psychoanal Rev 1999;86:721-31.

Prasad LR, Gantley MM, Underwood MR. Management of deliberate self harm in general practice: A qualitative study. Br J Gen Pract 1999;49:721-4.
BACKGROUND: It has been estimated that the incidence of deliberate self harm (DSH) is at least 10 times that of suicide. Accident and emergency discharge figures also point to an almost doubling of reported cases of DSH in the early 1990s. AIM: To assess general practitioners’ (GPs’) views on, and educational requirements for, managing patients following an episode of DSH. METHOD: A qualitative study with 14 GPs (seven male and seven female) from two outer-London boroughs, selected in order to provide a maximum variety sample. Interviews took place between February and April 1997, and data were analyzed using the principles of grounded theory. RESULTS: Most GPs felt that all patients presenting with DSH should be assessed by a psychiatrist. They expressed a preference for working with a community psychiatric nurse rather than a counsellor. Suggestions to improve their working relationship with community mental health teams included provision of one centralized point of referral and ease of access to the service in times of crisis. GPs were sceptical of guidelines, emphasizing that they needed joint ownership in writing them, but most importantly that they needed adequate resources to implement them. Specific changes to postgraduate education were suggested, such as individual educational portfolios. CONCLUSION: Improved working relationships between GPs and community mental health teams are needed in order to provide a more efficient and effective service for patients. Lifelong learning needs to be adapted in a style and approach to suit GPs’ individual requirements.

No authors listed. [Self-injury in the young related to early abuse]. Fortschr Neurol Psychiatr 1999;67:A10,A12. [Article in German.] No abstract available.

Kapur N, House A, Creed F, et al. General hospital services for deliberate self-poisoning: an expensive road to nowhere? Postgrad Med J 1999;75:599-602.
This study was designed to investigate the clinical and economic aspects of deliberate self-poisoning services in four teaching hospitals in Leeds, Leicester, Manchester, and Nottingham. We investigated the management of the current self-harm episode, including direct in-hospital costs, in 456 individuals who presented to hospital on a total of 477 occasions with deliberate self-poisoning during a 4-week period in 1996. Fewer than half of the patients received specialist psychosocial assessment or follow-up. Patients were more likely to receive an assessment if they were already in contact with psychiatric services, had a history of previous overdoses, if they presented during working hours, or if they lived near the hospital. Patients who were admitted were nearly twice as likely to receive specialist assessment, and those who received a specialist assessment were nearly three times as likely to be offered follow-up. In-patient days and days on the intensive care unit accounted for 47% and 8% of the total costs, respectively. This study suggests that general hospital services are disorganised, with evidence of inequitable access to specialist assessment and after-care. This state of affairs cannot be justified on financial or clinical grounds.

Ogundipe LO. Suicide attempts v. deliberate self-harm. Br J Psychiatry 1999;175:90. No abstract available.

House A, Owens D, Patchett L. Deliberate self harm. Qual Health Care 1999;8:137-43. No abstract available.

Hawton K, Kingsbury S, Steinhardt K, et al. Repetition of deliberate self-harm by adolescents: The role of psychological factors. J Adolesc 1999;22:369-78.
The aim of this study was to examine the relationship between psychological variables and repetition of deliberate self-harm by adolescents (n=45) aged 13-18 years who had been admitted to a general hospital having taken overdoses. Standardized measures of depression, hopelessness, suicidal intent, impulsivity, trait and state anger, self-esteem and problem-solving (both self-report and observer-rated) were administered to the adolescents while still in the general hospital. Repetition was assessed on the basis of previous overdoses (n=14) and repetition of self-harm (self-poisoning and self-injury) during the subsequent year (n=9). Adolescents with a history of a previous overdose and/or who repeated self-harm during the following year (n=18) differed from non-repeaters in having higher scores for depression, hopelessness and trait anger, and lower scores for self-esteem, self-rated problem-solving and effectiveness of problem-solving rated on the basis of the Means End Problem Solving test, all measured at the initial assessment. These differences largely disappeared when level of depression was controlled for. Similarly, differences found between repeaters and non-repeaters in the year following the index overdoses for problem-solving were much reduced when account was taken of differences in depression scores.Depression is a key factor associated with risk of repetition of adolescent self-harm (and hence of suicide risk). In the management of adolescents who have harmed themselves, careful assessment of depression and appropriate management of those who are depressed is essential.

Nijman HL, Dautzenberg M, Merckelbach HL, et al. Self-mutilating behaviour of psychiatric inpatients. Eur Psychiatry 1999;14:4-10.
In the present study two broad hypotheses about the origins of self-mutilation in psychiatric patients were evaluated. The first hypothesis states that self-mutilation originates from child abuse and experiences of neglect and is connected to dissociation in later life. The second hypothesis views self-mutilation as the consequence of impulse control problems. To test these two hypotheses, data concerning traumatic childhood experiences and dissociative symptoms (hypothesis 1), as well as data concerning aggressiveness, obsessive-compulsiveness and sensation seeking (hypothesis 2) were collected in a sample of 54 psychiatric inpatients. Twenty-four out of 54 patients (44%) reported having engaged in self-mutilation. Mean age of onset of this behaviour was 23 years. Self-report measures of self-mutilators were more in line with the first than with the second hypothesis. That is, patients who engaged in self-mutilation reported more traumatic childhood experiences and dissociative symptoms than did control patients. The two groups did not differ in terms of aggressiveness, obsessive-compulsiveness, and sensation seeking. In line with earlier studies, the current results indicate that self-mutilating behaviour is linked to a history of abuse and neglect.

Perego M. Why A&E nurses feel inadequate in managing patients who deliberately self harm. Emerg Nurse 1999;6:24-7. No abstract available.

McElroy A, Sheppard G. The assessment and management of self-harming patients in an accident and emergency department: an action research project. J Clin Nurs 1999;8:66-72.
The Government, in Health of the Nation (DoH, 1992), set targets for health authorities to introduce specific interventions intended to reduce the rates of suicide in the districts for which they are responsible. Those who deliberately harm themselves are an important group for interventions aimed at suicide prevention. Self-harming individuals are known to seek help from a range of care providers, not just those specifically intended to meet their needs. Individuals with problems of self-poisoning and self-injury have placed increasing pressure on general hospital staff involved in their care. There should therefore be adequate services for suicide attempters in every general hospital. Policies and protocols must be introduced and evaluated, to ensure that the self-harmer’s experience during crisis is not a catalogue of unhelpful encounters. This paper is an account of an action research project concerned with the assessment and management of self-harming patients in one accident and emergency department. The project aimed to enhance departmental policies and procedures for managing this group of patients. Practical problems can inhibit the introduction of even the most desirable of innovations. Action research provides a way of overcoming these problems whilst doing research at the same time.

Reece J. Female survivors of abuse attending A & E with self-injury. Accid Emerg Nurs 1998;6:133-8.
Accident and Emergency departments are concerned with trauma whatever the source or client age. This mixed trauma culture can be a distressing place, not least for women whose self-injury is ‘self-inflicted’ rather than accidental in nature. The women, who might be survivors of childhood sexual abuse, are sometimes viewed as service abusers, on occasions subjected to misinterpretation, labeled as ‘time-wasters’ and consequently stigmatized. The misunderstanding based on misinterpretation of language and theory is explored briefly, as is some appropriate literature on self-injury and abuse. The definitions of self-injury and some of the myths associated with self-injuring women are developed. The relationship of self-injury with suicide is briefly explored, as are issues related to distress and self-injury. The demand on nurses and the case for the development of an appropriate non-medical theory is explored. Areas of positive practice, some of which were visited while the author was on a Nightingale Scholarship, are noted as is the need for nurses to learn from voluntary and survivor groups who work with and for self-injuring women. Client needs and staff awareness is examined in brief. Literature from the survivor perspective is utilized and the conclusion is drawn largely from the recommendations made by this literature.

Fisher WW, Bowman LG, Thompson RH, et al. Reductions in self-injury produced by transcutaneous electrical nerve stimulation. J Appl Behav Anal 1998;31:493-6.
Transcutaneous electrical nerve stimulation is used to reduce pain but also may be useful for self-injurious behavior (SIB). In the current investigation, a microcurrent electromedical device, classified as a transcutaneous electrical nerve stimulator (TENS), was applied with a man with Down syndrome who displayed SIB that persisted in the absence of social contingencies. Although clinically significant results were not maintained, a clear difference in the rates of SIB during active and inactive TENS was observed.

Briere J, Gil E. Self-mutilation in clinical and general population samples: prevalence, correlates, and functions. Am J Orthopsychiatry 1998;68:609-20.
Self-mutilation, examined in samples of the general population, clinical groups, and self-identified self-mutilators, was reported by 4% of the general and 21% of the clinical sample, and was equally prevalent among males and females. Results suggest that such behavior is used to decrease dissociation, emotional distress, and posttraumatic symptoms. Childhood sexual abuse was associated with self-mutilation in both clinical and nonclinical samples.

Bergantino A. [The ingestion of foreign bodies for the purpose of self-injury. The conservative treatment of 2 clinical cases]. Minerva Chir 1997;52:1519-21. Review. [Article in Italian.]
Although not rare, the ingestion of foreign bodies becomes uncommon when it is done with intent to cause self-damage. When used for this purpose, foreign bodies usually take the form of liquid substances, such as caustic agents, detergents, poisons, etc. It is less rare in certain situations like psychiatric and prison settings. The author reports two cases of foreign bodies voluntarily swallowed by patients in prison.

Waska RT. Self-mutilation, substance abuse, and the psychoanalytic approach: Four cases. Am J Psychother 1998;52:18-27.
While self-injury and substance abuse are difficult symptoms for both analyst and patient to cope with, and relapses are frequent, the emphasis does not have to be on managing crisis. The initial ego support and therapeutic boundary setting in these difficult cases must be matched by psychoanalytic exploration. In working with these patients, I find that, through mutual projective identification processes, the analyst and the patient are frequently resurrecting certain aspects of the patient’s archaic phantasy life as defined by various self and object representations. Therefore, the continuous analysis of the transference and the countertransference is certainly essential. However, the additional willingness on the part of the analyst and the patient to explore the frequent and mutual interpersonal/intrapsychic acting out is paramount.

No authors listed. Making sense of self-mutilation. J Psychosoc Nurs Ment Health Serv 1998;36:8. No abstract available.

Suyemoto KL. The functions of self-mutilation. Clin Psychol Rev 1998;18:531-54.
While pathological self-mutilating behavior has been clinically examined for over 65 years, and much of the literature hypothesizes some function for the behavior, there has been little attempt to integrate or differentiate between different functional ideas. This review uses six functional models extracted from the literature to organize a discussion of the multiple functions of self-mutilation, acknowledging the overdetermined nature of the behavior and attempting to understand how self-mutilation can serve multiple functions simultaneously. Contextual information about the definition, prevalence, phenomenology, patient characteristics, associated diagnoses, and associated symptoms of self-mutilation is first presented. Six functional models are then presented: the environmental model, the antisuicide model, the sexual model, the affect regulation model, the dissociation model, and the boundaries model. Support for these models in the empirical and theoretical literature is presented and treatment implications are explored.

Pembroke L. Only scratching the surface. Nurs Times 1998;94:38-9. No abstract available. (NB: Louise Pembroke is the chair of Britain’s National Self-Harm Network. I met her in May 1999 and she is a wonderful, knowledgeable, compassionate, understanding person. I have a copy of this article and will mail or fax a copy to you if you wish.)

Murray I. At the cutting edge. Nurs Times 1998;94:36-7. No abstract available. (Ian Murray is also active in the National Self-Harm Network and is a fantastic resource of information. I have a copy of this article as well.)

Favaro A, Santonastaso P. Impulsive and compulsive self-injurious behavior in bulimia nervosa: prevalence and psychological correlates. J Nerv Ment Dis 1998;186:157-65.
A specific link between self-injurious behavior and bulimia nervosa has been observed. In affective spectrum disorders, some authors propose a distinction between impulsive and compulsive self-injurious behavior. One of the aims of the present study is to examine how different kinds of self-injurious behavior, including purging behavior, may be classified in bulimia nervosa. The clinical impact of the different types of self-injury will be studied. The subjects of the study were 125 consecutive patients with bulimia nervosa, diagnosed by DSM-IV criteria. Subjects were evaluated by means of a semistructured interview and self-report questionnaires (Eating Disorders Inventory and Hopkins Symptom Checklist). In our sample, the distinction between compulsive and impulsive self-injurious behavior appeared to be confirmed by a principal component analysis. Self-induced vomiting loaded on the compulsive dimension and laxative abuse on the impulsive dimension. To study the clinical impact of the two kinds of behavior, bulimic subjects were divided according to their position in the two dimensions. The presence of impulsive self-injurious behavior is associated with a history of sexual abuse and with higher scores on the Symptom Checklist. The presence of both impulsive and compulsive behavior is associated with greater depression, whereas the presence of impulsive features in the absence of compulsive ones seems to be linked to a longer duration of illness and to a higher dropout rate. Both compulsive and impulsive self-injurious behaviors are associated with a greater lack of interoceptive awareness.

Hogg C, Burke M. Many people think self-injury is just a form of attention-seeking. Nurs Times 1998;94:53. No abstract available.

Wewetzer G, Friese HJ, Warnke A. [Open self-injury behavior with special reference to child and adolescent psychiatry. A review of the literature and first study findings]. Z Kinder Jugendpsychiatr Psychother 1997;25:95-105. Review. German.
The present investigation combines a review of the literature on self-mutilation and our own findings. The literature on this topic is extensive, but there are very few reports on self-mutilation in children and adolescents with a psychiatric diagnosis. In our study we explored the symptoms and psychopathological features of 64 children and adolescents with self-mutilative behavior who had been seen at an inpatient psychiatric facility. The topic is presented from a phenomenological and nosological point of view. We identified a subgroup of adolescents with both self-mutilative and suicidal behavior. The implications for the use of longitudinal studies are discussed.

Kemperman I, Russ MJ, Shearin E. Self-injurious behavior and mood regulation in borderline patients. J Personal Disord 1997;11:146-57.
This article explores the hypothesis that self-injurious behavior (SIB) of the type associated with borderline personality disorder (BPD) has an important mood regulatory function. Thirty-eight female inpatients with an Axis II diagnosis of BPD and a history of SIB rated a variety of mood and affective states, using visual analog scales recalled over the course of usual SIB experiences. Subjects were additionally divided into two groups according to whether they typically experience pain during SIB (BPD-P group) or did not (BPD-NP group). For both groups, the visual analog scale ratings revealed significant mood elevation and decreased dissociation following self injury, with a peak in dissociative symptoms during self injury. The ratings of dissociative symptoms were found to be higher in the BPD-NP group when compared to the BPD-P group across all stages of SIB. The ratings of sexual arousal did not change over the course of SIB for either group. These findings are discussed in light of current knowledge of the relationship between SIB and mood.

Kemperman I, Russ MJ, Clark WC, et al. Pain assessment in self-injurious patients with borderline personality disorder using signal detection theory. Psychiatry Res 1997;70:175-83.
Signal detection theory measures of thermal responsivity were examined to determine whether differences in reported pain experienced during self-injurious behavior in female patients with borderline personality disorder (BPD) are explained by neurosensory factors and/or attitudinal factors (response bias). Female patients with BPD who do not experience pain during self-injury (BPD-NP group) were found to discriminate more poorly between noxious thermal stimuli of similar intensity, low P(A), than female patients with BPD who experience pain during self-injury (BPD-P group), female patients with BPD who do not have a history of self-injury (BPD-C group), and age-matched normal women. The BPD-NP group also had a higher response criterion, B (more stoical) than the BPD-C group. These findings suggest that ‘analgesia’ during self-injury in patients with BPD is related to both neurosensory and attitudinal/psychological abnormalities.

Karwautz A, Resch F, Wober-Bingol C, et al. Self-mutilation in adolescence as addictive behaviour. Wien Klin Wochenschr 1996;108:82-4.
Self-mutilation as addictive behaviour has been mentioned in a few studies in recent years. We present the case of a girl with narcissistic borderline personality disorder (DSM III-R: 301.83, 301.81), who undertook multiple, repetitive self-mutilating acts. Self-mutilation is discussed as addictive behaviour in this case. We emphasize the evaluation of repetitive self-mutilating acts by applying criteria for addictive and dependence disorders, in order to achieve additional adequate strategies for treating patients showing this behaviour.

Russ MJ, Clark WC, Cross LW, et al. Pain and self-injury in borderline patients: Sensory decision theory, coping strategies, and locus of control. Psychiatry Res 1996;63:57-65.
Fifteen women with borderline personality disorder who do not experience pain during self-injury were found to discriminate more poorly between imaginary painful and mildly painful situations, to reinterpret painful sensations (a pain-coping strategy related to dissociation), and to have higher scores on the Dissociative Experiences Scale than 24 similar female patients who experience pain during self-injury and 22 age-matched normal women. Analgesia during self-injury in borderline patients may be related to a cognitive impairment in the ability to distinguish between painful and mildly painful situations, as well as to dissociative mechanisms.

Bystritsky A, Strausser BP. Treatment of obsessive-compulsive cutting behavior with naltrexone. J Clin Psychiatry 1996;57:423-4.

Hawton K, Fagg J, Simkin S. Deliberate self-poisoning and self-injury in children and adolescents under 16 years of age in Oxford, 1976-1993. Br J Psychiatry 1996;169:202-8.
BACKGROUND. Deliberate self-harm (DSH) is common in adolescents in the United Kingdom and suicide has greatly increased in frequency in older male adolescents. There is, however, very little information about DSH in older children and young adolescents. METHOD. Analysis of data collected by the Oxford Monitoring System for Attempted Suicide between 1976 and 1993 for all cases of DSH in under 16-year-olds referred to the general hospital in Oxford. RESULTS. Seven hundred and fifty-five individuals were involved in 854 episodes of DSH. There were very few cases under 12 years of age but after that the behaviour increased greatly in frequency with each year of age, especially in girls. Eighty-five per cent were girls, the sex ratio being 5.7 girls to each boy. Most cases involved self-poisoning. During the final six years of the study period paracetamol was involved in 54.7% of overdoses, compared with 19.5% in 1976-1981. A minority of individuals had had previous psychiatric treatment. The most frequent problems were relationship difficulties with parents, followed by difficulties with friends, school and social isolation. Among those who reported previous episodes of DSH, in the majority of cases these had not come to medical attention. Repetition of self-harm occurred in 9.4% of cases within a year of an episode and 19.3% during the overall study period. There was some indication that repetition was most common in youngsters discharged from the Accident and Emergency Department without a psychiatric assessment. CONCLUSIONS. DSH in under 16-year-olds is not uncommon and there is evidence that it occurs far more frequently in the community than is reflected in general hospital figures. The problem of paracetamol self-poisoning in this age group needs to be addressed. A psychiatric assessment should be performed in all cases coming to the general hospital.

Solomon Y, Farrand J. “Why don’t you do it properly?” Young women who self-injure. J Adolesc 1996 ;19:111-9.
Analysis of interviews with four self-injuring young women suggests that the meaning of self-injury is not the same as the meaning of attempted suicide, and that the two acts are related in the sense that self-injury is an adaptive alternative to suicide. The function of self-injury as a communicative act and the extent to which self-injurers can control their actions are also discussed. It is suggested that, within the context of self-injury as survival, issues of communication and control do not have the significance that they are frequently supposed to have. Implications for clinical practice are discussed.

Connors R. Self-injury in trauma survivors: 1. functions and meanings. Am J Orthopsychiatry 1996;66:197-206. Review.
Self-injury is increasingly linked to traumatic childhood experiences, and is identified in this paper as a means by which some trauma survivors cope with post-traumatic effects. It is proposed that self-injury serves a number of functions, organized here into four categories: re-enactment of the original trauma, expression of feelings and needs, reorganization of the self, and management of dissociative process.

Connors R. Self-injury in trauma survivors: 2. levels of clinical response. Am J Orthopsychiatry 1996;66:207-16. Review.
Responding effectively to trauma survivors who engage in self-injury can be challenging, even for experienced therapists. This paper outlines therapeutic goals and appropriate clinical responses, including remaining present at and open to communication about disclosures of self-injury, helping clients to intervene in their own process of self-injury, and working with clients to resolve underlying issues. Alternatives to self-injury are discussed and cautions are offered about common therapeutic responses likely to be particularly unhelpful.

Tameling A, Sachsse U. [Symptom complex, prevalence of trauma and body image of psychiatric patients with self-injury behavior]. Psychother Psychosom Med Psychol 1996;46:61-7. [Article in German.]
Within the group of in-patients the patients exhibiting self-injurious behavior (SIB) have a significantly more disturbed body image--as assessed by the Holtzman Inkblot Technique (HIT)--than the patients who do not have this symptomatology. The more disturbed the body image, the higher the frequency of SIB. The method of self-injury most frequently reported is cutting the skin of the extremities, followed by burning the skin with cigarettes or open flames. This behavior serves the purpose of alleviating diffuse internal tension, of directing aggression inward, i.e. toward the self, and of terminating depersonalization states. During the act of self-mutilation, the perception of pain is lessened appreciably or inactivated. 48 percent of the female patients in this group suffered sexual abuse during childhood.

Levavi H, Rabinerson D, Neri A. Self-inflicted vaginal bleeding. Int J Gynaecol Obstet 1995;49:337-8. No abstract available.

Barstow DG. Self-injury and self-mutilation. Nursing approaches. J Psychosoc Nurs Ment Health Serv 1995;33:19-22.
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.

Shearer SL. Phenomenology of self-injury among inpatient women with borderline personality disorder. J Nerv Ment Dis 1994;182:524-6. No abstract available.

Iwata BA, Dorsey MF, Slifer KJ, et al. Toward a functional analysis of self-injury. J Appl Behav Anal 1994;27:197-209.
This study describes the use of an operant methodology to assess functional relationships between self-injury and specific environmental events. The self-injurious behaviors of nine developmentally disabled subjects were observed during periods of brief, repeated exposure to a series of analogue conditions. Each condition differed along one or more of the following dimensions: (1) play materials (present vs absent), (2) experimenter demands (high vs low), and (3) social attention (absent vs noncontingent vs contingent). Results showed a great deal of both between and within-subject variability. However, in six of the nine subjects, higher levels of self-injury were consistently associated with a specific stimulus condition, suggesting that within-subject variability was a function of distinct features of the social and/or physical environment. These data are discussed in light of previously suggested hypotheses for the motivation of self-injury, with particular emphasis on their implications for the selection of suitable treatments.

Sachsse U. Overt self-injury. Psychother Psychosom 1994;62:82-90. Review. No abstract available.

Resch F, Karwautz A, Schuch B, et al. [Can self-injury be viewed as an addictive behavior in adolescents? Aspects of the pathogenesis of self-injury behavior]. Z Kinder Jugendpsychiatr 1993;21:253-9. Review. [Article in German.] No abstract available.

Yeo HM, Yeo WW. Repeat deliberate self-harm: a link with childhood sexual abuse? Arch Emerg Med 1993;10:161-6.
The purpose of this study was to identify whether a past history of childhood sexual abuse is a risk factor for repeated Deliberate Self-Harm (DSH). The study was a 6-month prospective study of 178 patients responsible for 190 consecutive cases of DSH seen during a 3-month censoring period. Patients were identified by review of the in-patient and accident and emergency (A&E) records of all cases of DSH at the A&E department of a major teaching hospital. Patients with a history of childhood sexual abuse showed a marked clustering of four major risk factors for repeat DSH (unemployment, past deliberate self-poisoning, self-injury and psychiatric illness) and were significantly more likely to repeat DSH within the 6-month follow-up period.

Ricketts RW, Goza AB, Matese M. A 4-year follow-up of treatment of self-injury. J Behav Ther Exp Psychiatry 1993;24:57-62.
We present 4-year follow-up data on a 28-year-old man whose severe self-injurious behavior was treated with brief contingent electric stimulation via the Self-Injurious Behavior Inhibiting System (SIBIS). Event data collected throughout follow-up showed reductions in head-hitting and head-banging from over 2,600 responses per hour to approximately 1 response per hour during much of the first 31 months of treatment. However, the rate of head-banging began increasing thereafter, with the SIBIS losing its effectiveness to such an extent that it was no longer clinically useful.

Van Houten R. The use of wrist weights to reduce self-injury maintained by sensory reinforcement. J Appl Behav Anal 1993;26:197-203.
The participant in this study was a boy with a long history of self-injurious face slapping. Following a functional analysis indicating that face slapping was maintained by sensory consequences, the participant was given soft wrist weights to wear for progressively longer periods. Data on the frequency of face slapping were collected 5 min before the weights were put on, while the weights were on, and 5 min after the weights were removed. At all other times a protective helmet was placed on the participant’s head for 30 min contingent on face slaps. When weights were worn for 30 min each day, face slapping decreased during 5-min observation periods before and after wearing the weights. The use of protective headgear was eliminated by the end of the study. Face slapping did not occur during a follow-up check conducted 5 months after completion of the study.

Eckhardt A, Hoffmann SO. [Depersonalization and self-injury]. Z Psychosom Med Psychoanal 1993;39:284-306. German.
Patients with deliberate self harm syndrome and with factitious disorders often describe depersonalisation phenomena, during which they have a diminished pain sensitivity or analgesia. The self-mutilating act can stop the depersonalisation temporarily. Concerning the psychodynamic processes there are common traits between depersonalisation and self-mutilation. The connections between depersonalisation and self-mutilating behaviour are described. Depersonalisation is understood as a defense mechanism, ranging between mature and immature defense mechanisms. An illustrative case is demonstrated.

Valente SM. Deliberate self-injury. Management in a psychiatric setting. J Psychosoc Nurs Ment Health Serv 1991;29:19-25.
Self-injury is a significant clinical problem of psychiatric patients, although the prevalence of self-injury in specific disorders is unclear. Nurses can assess and intervene in the psychological causes and behavioral sequelae self-injury. Each patient’s early history, dynamics, and motives for self-injury require evaluation. Behavioral techniques (eg, reinforcement) and psychodynamic techniques, such as exploring feelings and anxiety, can help patients understand their self-destructive tendencies. Patients can learn to anticipate anxiety-provoking situations, plan strategies to manage anxiety, cope with feelings, and reduce self-injury.

Winchel RM, Stanley M. Self-injurious behavior: A review of the behavior and biology of self-mutilation. Am J Psychiatry 1991;148:306-17. Review.
OBJECTIVE: The authors describe the clinical characteristics of self-injurious behavior, giving special emphasis to self-injurious behavior occurring among individuals with character disorders. DATA COLLECTION: They review data suggesting the involvement of serotonergic, dopaminergic, and opiate neurotransmitter systems in the expression of self-injurious behavior. FINDINGS: Self-injurious behavior occurs among mentally retarded individuals, psychotic patients, prison populations, and individuals with severe character disorders. Although theoretical psychological models of self-injurious behavior are helpful in understanding the patient’s experience of self-injury, no generally useful therapeutic approach has yet evolved from these models. Data derived from animal models and treatment studies suggest the involvement of opiatergic and dopaminergic mechanisms in self-injury among the mentally retarded. Serotonergic influences on self-injurious behavior may be present in varying forms of this behavior. The scientific literature on the benefits of pharmacological agents for mentally retarded individuals is beset with a number of problems. Support is emerging, however, for the use of lithium and carbamazepine with self-injuring mentally retarded patients, and some behavioral interventions appear to be successful for mentally retarded individuals. Self-injuring patients with borderline personality disorder may benefit from milieu treatment. CONCLUSIONS: Although no form of treatment has yet been demonstrated to be of general benefit, the literature suggests that therapeutic trials with dopamine antagonists, serotonin reuptake inhibitors, and opiate antagonists may be of value.

Lena SM, Bijoor S. Wrist cutting: a dare game among adolescents. CMAJ 1990;142:131-2. No abstract available.

Lienemann J, Walker F. Naltrexone for treatment of self-injury. Am J Psychiatry 1989;146:1639-40. No abstract available.

Kashiwada T. [Studies on patients with “wrist cutting syndrome”—an application of imagination theory to the three factors of the motivations of 23 wrist cutters]. Seishin Shinkeigaku Zasshi 1988;90:469-96. [Article in Japanese.] No abstract available.

Tobias CR, Turns DM, Lippmann S, et al. Evaluation and management of self-mutilation. South Med J 1988;81:1261-3.
Instances of deliberate self-injury are observed in both psychotic and nonpsychotic individuals. Patients with command hallucinations, religious preoccupations, substance abuse, and social isolation are the most vulnerable. Persons who request unnecessary surgical procedures for bizarre reasons also are at high risk. Such behavior constitutes a medical, surgical, and psychiatric emergency. A thorough psychiatric evaluation is mandated in every case. Vigorous psychiatric treatment and follow-up care involving the full range of pharmacologic, somatic, and psychologic interventions are indicated.

Watkins PN, Cook EL. Multiple personality and self-injury. Psychosomatics 1987;28:156-7. No abstract available.

Takeuchi T, Koizumi J, Kotsuki H, et al. A clinical study of 30 wrist cutters. Jpn J Psychiatry Neurol 1986;40:571-81.
Thirty patients who committed wrist cuttings were divided into four groups according to the patients’ psychiatric diagnosis: hysteria group, depression group, adolescent behavioral disorder group and other diagnostic group. In the hysteria group, wrist cutting was considered as an expression of the patients’ unconscious intention to seek sympathy for themselves from other people. In the depression group, wrist cutting seemed to be a preliminary rehearsal of suicide. In the adolescent behavioral disorder group, internal conflicts in adolescence or discordance with the patients’ parents seemed to be the chief motivations of wrist slashing. The core groups were the hysteria and adolescent behavioral disorder groups, and the peripheral groups were the depression group and others.

Rosen LW, Thomas MA. Treatment technique for chronic wrist cutters. J Behav Ther Exp Psychiatry 1984;15:33-6.
A treatment technique is presented which has been developed to eliminate chronic self-induced wrist cutting behavior. The technique substitutes painful but non-injurious exercises for self-cutting behavior when the urge to self-cut emerges. The rationale for initiating this approach is described.

Rosenthal RJ, Rinzler C, Wallsh R, et al. Wrist-cutting syndrome: the meaning of a gesture. Am J Psychiatry 1972;128:1363-8. No abstract available.

Return to page one

Return to page two