Early maladaptive schemas as common and specific predictors of skin picking subtypes.

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.

Post-surgical evisceration with or without autocannibalism in 333 dogs-a survey of veterinarians.

Background: Few reports of post-surgical evisceration, with or without autocannibalism, in dogs exist. Aims: To collect a large case series of dogs experiencing post-surgical evisceration, with or without autocannibalism. Methods: We surveyed practicing veterinarians who were members of the Veterinary Information Network about their experiences with post-surgical evisceration in dogs, variably accompanied by autocannibalism (ingestion of eviscerated organs or tissues). Responses were analyzed using descriptive statistics. Results: We identified 333 cases with sufficient information for analysis: 221 with evisceration and autocannibalism, and 112 with just evisceration. Most cases occurred following surgery for reproductive reasons (desexing, cesarean section, and pyometra). Most occurred in young adult or adult dogs. Most dogs received analgesia perioperatively had routine closure (simple interrupted or simple continuous muscle layer closure) and most did not wear an E-collar post-surgically. Most dogs eviscerated within 3 days of the initial surgery. Approximately 64% underwent surgical repair and survived long-term without complications, more frequently if the evisceration was not accompanied by autocannibalism. Conclusion: Our study suggests that post-surgical evisceration and autocannibalism can generally be successfully managed by practitioners and do not confer a uniformly poor outcome for the dog.

Male genital self-mutilation: a systematic review of psychiatric disorders and psychosocial factors.

OBJECTIVE: To identify psychiatric diagnoses and psychosocial factors associated with intentional male genital self-mutilation (GSM) of specific injury subtypes. METHODS: A search of MEDLINE, EMBASE, PsycINFO, PubMed, Web of Science and CINAHL for cases of GSM was conducted until December 2015, based on GSM and related terms. Cases were examined for injury subtype, psychiatric diagnosis and psychosocial factors. Chi-square analyses were employed to determine differences in frequency of such factors across injury subtypes. RESULTS: Data were obtained from 173 cases: genital mutilation (n=21), penile amputation (n=62), castration (n=56) and combined amputation/castration (n=34). Common psychiatric disorders included schizophrenia spectrum (49%), substance use (18.5%), personality (15.9%) and gender dysphoric disorders (15.3%). Chi-square analyses revealed that schizophrenia spectrum disorders occurred significantly more often among auto-amputates as compared with self-castrators or mutilators. Gender dysphoria occurred significantly more often among self-castrators than auto-amputates. No significant differences emerged regarding psychosocial factors across GSM subtypes. However, associations were observed between psychosocial factors and psychiatric diagnoses. Although altogether not commonly reported, experiential factors were reported in 82% of psychotic individuals. Treatment inaccessibility was noted among 71% of gender dysphorics engaging in auto-castration. CONCLUSION: Clinicians must consider the diverse range of psychiatric disorders and psychosocial factors underlying GSM.

The construction of self-injury in the clinical literature: a sociological exploration.

This article presents a sociologically informed critique of a range of academic literatures relating to self-injury. It is noted how a lack of consensus on definitional issues, together with the inaccurate portrayal of the "typical self-injurer" in the clinical literature, has impeded the development of a sound understanding of self-injury. Some of the more problematic explanations for self-injury are explored. The individualistic focus of existing research is found to be inadequate, since it fails to account for the social context in which self-injury occurs. Social scientific approaches critically examine psychiatric and psychological constructions of self-injury, explore wider social and cultural meanings of the behavior, and examine its distribution across different social groups. The inclusion of social scientific perspectives into current debates will greatly improve understanding of self-injury.

Severe morbid onychophagia: the classification as self-mutilation and a proposed model of maintenance.

OBJECTIVES: The aim of this review is to make a distinction between a mild and a severe form of onychophagia (nailbiting) that has not been adequately recognised in clinical research. Furthermore, the aim is to emphasise the need for greater understanding of the motivation for such self-injury as occurs in the severe form. The purpose of making the distinction is to evaluate whether a label of self-mutilation can be applied to the severe form. If this is the case, the tension-reduction model of self-mutilation can be proposed as the mechanism which may maintain the behaviour in the face of serious social and physical consequences. METHOD: Examination was made of the literature relating to onychophagia and to self-mutilation. Treatment studies of onychophagia were examined to evaluate the mechanisms by which the behaviour may be maintained. RESULTS: Considering the self-mutilative nature of the severe form and the common theme of tension reduction in the literature on onychophagia, application of the tension-reduction model of self-mutilation is warranted. CONCLUSION: There is a need for empirical research as to the tension-reducing nature of severe onychophagia.

Self-mutilating behavior.

TOPIC: The phenomenon of self-mutilating behavior. PURPOSE: Self-multilating behavior (SMB) creates serious management problems in psychiatric settings and typically begins in adolescence. In order to plan and provide effective nursing interventions, it is necessary nurses be knowledgeable about the phenomenon. This paper provides definitions, historical views, and types of SMB, along with a description of current research and speculations about intent. This framework offers a background to nursing interventions focused on identifying at-risk adolescents and treating this bewildering behavior. SOURCES: Published literature. CONCLUSIONS: Mental health professionals find treatment of SMB a challenge and nursing is in a unique position to provide effective interventions.

Self-injurious behaviour. Psychopathological and nosological characteristics in subtypes of self-injurers.

This study explored the symptoms of self-injurious behaviour (SIB) in a consecutive sample of 54 mostly female psychiatric inpatients. The phenomenological analysis presented SIB as quite a uniform syndrome that starts latest in early adulthood, is often committed impulsively, is used in the function of releasing tension and occurs in patients with eating and psychoactive substance use but also schizophrenic disorders. The quality of mood preceding SIB was best characterized as dysphoria and was qualitatively not different from patients' longstanding affective traits. Two subgroups were differentiated, those with borderline personality disorder and those without; there was some evidence that patients with borderline personality disorder present a quite homogeneous core group of SIB, whereas others show a higher variety of psychopathological features. The hypothesis is proposed that poor affect regulation is the underlying psychopathological dimension.

Diagnostic issues in self-mutilation.

OBJECTIVE: Pathological self-mutilation--the deliberate alteration or destruction of body tissue without conscious suicidal intent--was examined both as a symptom of mental disorders and as a distinct syndrome. METHODS: Data from more than 250 articles and books were reviewed, as well as data obtained by the authors from their extensive clinical experience in treating self-mutilating patients. RESULTS AND CONCLUSIONS: The diverse behaviors that constitute pathological self-mutilation can be categorized into three basic types: major--infrequent acts that result in significant tissue damage, usually associated with psychoses and acute intoxications; stereotypic--fixed, rhythmic behavior seemingly devoid of symbolism, commonly associated with mental retardation; and superficial or moderate--behavior such as skin cutting, burning, and scratching associated with a variety of mental disorders. The authors propose that a syndrome of repetitive superficial or moderate self-mutilation should be regarded as an axis I impulse disorder. In most cases, the syndrome coexists with character pathology.

[The types of self-injuries in those sentenced to prisons]. / Vidy samopovrezhdenii u osuzhdennykh v mestakh lisheniia svobody.

A classification of self injuries of condemned subjects is suggested, based on analysis of the literature data and the author's own findings. The etiopathogenetic sign (the method of self injury infliction) underlies this classification.

The deliberate self-harm syndrome.

Recent research has differentiated several distinct classes of self-destructive behavior. This paper describes the clinical characteristics of one class, the deliberate self-harm syndrome. Analysis of 56 published case reports of self-harm revealed a typical pattern of onset in late adolescence, multiple recurrent episodes, low lethality, harm deliberately inflicted upon the body, and extension of the behavior over many years. Since the clinical characteristics of the deliberate self-harm syndrome differ substantially from those of other classes of self-destructive behavior, the authors propose that DSM-IV classify deliberate self-harm as a separate diagnostic syndrome.

Suicidal intent in self-injury.

The difficulties in measuring suicidal intent in cases of self-injury are discussed, and a scale is described to measure this intent. This scale has been used in 500 cases of self-injury. It is practical and reliable. Results show that the scores derived from it are closely related to the similar Beck Scale; they are also related to age, sex, social isolation method of self-injury, previous history of self-injury or of psychiatric treatment, physical health at the time of self-injury and alcohol abuse. These results are discussed with particular reference to suicide prediction and the future validation of the scale by long-term follow-up.