Aggression directed towards others vs. aggression directed towards the self: clinical differences between intermittent explosive disorder and nonsuicidal self-injury

Objective: To investigate the clinical differences between intermittent explosive disorder (IED) (disorder of aggression primarily directed towards others) and nonsuicidal self-injury (NSSI) (disorder of aggression predominantly directed towards the self) in order to better understand the different clinical subtypes of aggression. Methods: We used treatment-seeking samples to compare demographic and clinical correlates between 82 participants with IED and 55 participants with NSSI. Results: The IED group was older, more likely to be male, in a relationship, and employed than the NSSI group. With respect to clinical variables, the NSSI group had more severe depressive symptoms and more social adjustment difficulties. Regarding psychiatric co-morbidities, the IED group had higher rates of generalized anxiety disorder. On the other hand, the NSSI group had higher rates of major depressive disorder, agoraphobia, substance use disorder, and bulimia nervosa. Conclusions: Individuals with NSSI may benefit from better management of psychiatric comorbidities, specifically depressive symptoms and social adjustment difficulties. Conversely, the treatment of individuals with IED may be improved by targeting comorbid generalized anxiety disorder. Our results provide important insight for the development of tailored interventions for specific subtypes of aggression.

Treatment options and outcomes of penile constriction devices

ABSTRACT Purpose: To study the effect of penile constriction devices used on a large series of patients who presented at our emergency facility. We explored treatment options to prevent a wide range of vascular and mechanical injuries occurring due to penile entrapment. Materials and Methods: Between January 2001 and March 2016, 26 patients with penile entrapment were admitted to our facility and prospectively evaluated. Results: The time that elapsed from penile constrictor application to hospital admission varied from 10 hours to 6 weeks (mean: 22.8 hours). Non-metallic devices were used by 18 patients (66.6%) while the other nine (33.4%) had used metallic objects. Acute urinary retention was present in six (23%) patients, of whom four (66.6%) underwent percutaneous surgical cystotomy and two (33.4%) underwent simple bladder catheterization. The main reason for penile constrictor placement was erectile dysfunction, accounting for 15 (55.5%) cases. Autoerotic intention, psychiatric disorders, and sexual violence were responsible in five (18.5%), five (18.5%), and two (7.4%) cases, respectively. The mean hospital stay was 18 hours (range, 6 hours to 3 weeks). Conclusion: Penile strangulation treatment must be immediate through the extraction of the foreign body, avoiding vascular impairments that can lead to serious complications. Most patients present with low-grade injuries and use penile constrictors due to erectile dysfunction. Removal of constrictor device can be challenging. The use of specific tools for achieving penile release from constrictors is a fast, safe and effective method. Patients with urinary retention may require urinary diversion.

O psicoterapeuta diante do comportamento suicida / The psychotherapist facing suicide behavior / Le psychotérapeute face au comportement suicidaire / El psicoterapeuta frente el comportamiento suicida

A lida com o suicídio exige do psicoterapeuta um olhar atento aos fatores de risco e aspectos relacionados à morte e ao desespero humano. O objetivo deste artigo é oferecer possibilidades de instrumentalização ao psicoterapeuta com clientes em situação de crise suicida, fornecendo reflexões sobre o suicídio, sobre procedimentos e estratégias utilizados em psicoterapia, tanto em relação à prevenção quanto à prevenção do suicídio. O método utilizado foi o levantamento bibliográfico de estudos realizados no Brasil e nos Estados Unidos sobre o tema suicídio, bem como a experiência de 20 anos em atendimentos a clientes em crises suicidas. Embora o ato de se matar deva ser visto como problemática de saúde pública, considera-se que uma das maneiras de se prevenir o suicídio é compreender e enxergar a pessoa suicida como um ser singular e que suas inúmeras motivações para tal comportamento pertencem ao domínio privado...

The dealing with suicide demands from the psychotherapist a watchful look at the risk factors and aspects related to death and human despair. The bjective of this article is to offer possibilities of instrumentation to the psychotherapist with clients in suicidal crisis, providing thinking on suicide, about some procedures and strategies used in psychotherapy, both in relation to the prevention and posvention of suicide. The method used was a literature review of studies that took place in Brazil and in the USA regarding the theme of suicide, as well as the experience of 20 years in dealing with clients in suicidal crisis. Although the act of killing itself should be seen as a public health problem, it is considered that one of the ways of preventing the suicide is to comprehend and see the suicidal person as a unique being and that its numerous motivations for such behavior belong to the private domain...

Le travail avec le suicide exige d’un psychothérapeute un regard attentif sur les facteurs de risque et sur les aspects liés à la mort et au désespoir humain. Le but de cet article est d’offrir au psychothérapeute des possibilités d’instrumentalisation avec des clients en situation de crise suicidaire, en fournissant des réflexions sur le suicide, sur certaines procédures et stratégies utilisées en psychothérapie, aussi bien en ce qui concerne la prévention du suicide que pour la postvention. La méthode utilisée est une collecte ibliographique des études menées au Brésil et aux Etats-Unis sur la question du suicide, ainsi que l’ expérience acquise en 20 ans de consultation avec des patients en crise suicidaire...

El manejo del suicidio exige del psicoterapeuta una mirada atenta a los factores de riesgo y aspectos relacionados a la muerte y la desesperación humana. El objetivo de este artículo es ofrecer posibilidades de instrumentalización al psicoterapeuta con clientes en situación de crisis suicida, proporcionando reflexiones sobre el suicidio, sobre procedimientos y estrategias utilizados en psicoterapia, tanto en relación a la prevención como a la posvención del suicidio. El método utilizado fue el levantamiento bibliográfico de estudios realizados en Brasil y en los Estados Unidos sobre el tema suicidio, así como la experiencia de 20 años en consultas de clientes en crisis suicidas. Aunque el acto de atarse a sí mismo deba ser visto como problemática de salud pública, se considera que una de las maneras de prevenir el suicidio es comprender y ver a la persona suicida como un ser singular y que sus innúmeras motivaciones para tal comportamiento pertenecen al dominio privado...

Deliberate self harm and the surgeon: report of two cases

Deliberate Self Harm [DSH], formerly known as parasuicide, is commonly diagnosed in hospital emergency rooms, typically presenting with self poisoning and less often with self induced lacerations mostly of the wrists and forearms. We report two cases of atypical presentation that posed a diagnostic challenge for the surgeons in our hospital and discuss the epidemiology, psychopathology and treatment options