Emotional associations with skin: differences between burned and non-burned individuals.

INTRODUCTION: The appearance of skin is crucial for our physical and psychological integrity, and is strongly associated with our emotional self-awareness. Burn victims have to cope with negative and even threatening sensations resulting from the changed appearance of their skin after injury and also linked to experiences during the treatment. The aim of this study was to analyse differences regarding the emotional associations with skin in burn victims (burn group) to persons not having subdued any burn (control group). METHODS: In the first instance over 960 volunteers were recruited for the rating of emotional associations with skin in the control group and thereby a representative profile for non-injured individuals. In the second part, 44 burn patients of the Vienna Burn Center answered the same questionnaire. The quantitative rating of emotional associations with skin was performed with a newly designed questionnaire using a semantic differential on eight dimensions with a 5-point scale system. RESULTS: Both groups have positive associations with skin. One significant difference (p=0.0090, Chi-square test for trend) was the overall rating of the item "importance": for burn victims skin is more "important" than for controls. Patients with visible burns tended to put more emphasize on the possible exposure to danger ("threatened") of skin, and patients with >/=20% TBSA rated skin as more "noticeable" and "strong" as compared to small burns (<20% TBSA). Patients with burns to the face, hands and neck ("visible burns") were more likely to judge skin as threatened item. DISCUSSION: Our poll suggests that despite long treatment, rehabilitation and even near-death experiences burn patients continue to have positive associations with skin. This in turn, should encourage all specialists dealing with burns to engage in a continuous follow-up as well as enhance psychological and social support.

A new diagnostic tool for the classification of patients with self-inflicted burns (SIB): the SIB-Typology and its implications for clinical practice.

Although self-inflicted burns comprise a rather small percentage of patients treated in burn units, they represent a challenging subgroup for the specialist team. According to the literature, these patients, often with a past psychiatric history, remain in the hospital longer due to delayed wound healing, increased number of operative sessions and reduced compliance. The aim of this study was to analyse the incidence of psychiatric disorders and the overall outcome in patients with self-inflicted burns admitted to the Vienna Burn Centre in the past 11 years. We therefore reviewed the following parameters: past psychiatric history, burn extent, burn depth, mechanism of burn, treatment, length of hospital stay, and mortality. Based on our evaluation patients can be grouped into three distinct categories based on a simple two-axis diagram, the Self-Inflicted-Burns-Typology (SIB-T), including the parameters "psychiatric disorder" and "suicide attempt": "typical", "delirious" and "reactive". These three groups seem to differ in treatment outcome and later course of rehabilitation.