Self-mutilation as a manifestation of sexual abuse in adolescent girls

Self-Mutilation in Adolescents

Self-mutilation is not a new trend or phenomenon in adolescents. Self-mutilation can be divided into three categories: major, stereotypic, and moderate/superficial. Moderate/superficial self-mutilation is the most common type in adolescents and includes cutting, burning, and carving. School nurses are positioned to identify, to assist, and to educate adolescents who are self-mutilating, as well as those who may be at risk. A crucial intervention by school nurses is referral of students who are self-mutilating, because it is a gateway to treatment. Treatment, which includes therapy and medication, may be a difficult and lengthy process. The adolescent who self-mutilates may find the school environment difficult during treatment. School nurses must become educated about adolescent self-mutilation in order to care for those who engage in this behavior. Prevention of self-mutilation should focus on increasing coping mechanisms, facilitating decision-making strategies, encouraging positive relationships, and cultivating self-esteem.

The Relationship between Childhood Maltreatment and Emotional Dysregulation in Self Mutilation: An Investigation among Substance Dependent Patients

INTRODUCTION

The present study aims to examine the role of emotion dysregulation and childhood maltreatment in self mutilation (SM) of substance dependent patients. Specifically, the present study examined whether emotion dysregulation and its dimensions, and childhood maltreatment and its dimensions were associated with SM. The relationship between emotion dysregulation and childhood maltreatment was also investigated.

METHODS

The sample of study consisted of 55 alcohol dependent and 24 opiate dependent patients (n=79). Substance dependence was diagnosed by means of the Structured Clinical Interview for DSM-IV-TR (SCID-I), Turkish version. Childhood Trauma Questionnaire (CTQ) and Difficulties in Emotion Regulation Scale (DERS) were used.

RESULTS

Findings indicated that substance dependents with SM and without SM were differentiated in terms of overall emotion dysregulation. Results also suggest the relevance of three specific dimensions of emotion dysregulation to SM: Difficulties engaging in goal-directed behaviors when experiencing negative emotions, difficulties controlling impulsive behaviors when experiencing negative emotions, and limited access to effective emotion regulation strategies. These dimensions were predicted from childhood emotional maltreatment and neglect. It is also revealed that substance dependents with SM had higher points than those without SM on emotional childhood maltreatment and neglect, physical childhood maltreatment.

CONCLUSION

Results were supported by the literature suggested that self-mutilation functions as a emotional regulation strategy. Findings also suggested that self- mutilation is related to early relationships take place in family environment in which individuals grow up.

Multiple self-inserted pins and nails in pericardium in a patient of schizophrenia: Case report and review

This report is the case of multiple self-inserted pins and nails in chest and pericardial cavity in a young male suffering from schizophrenia. This act of self-mutilation was done to get relief from burning sensation in chest and palpitations. Review of the relevant literature revealed that self-inflicted intra-cardiac needle injuries occur mainly in young and middle-aged adults suffering from psychiatric disorders, commonly depression, schizophrenia, and substance use disorders. In one-fourth of the patients, it is due to deliberate self-harm. About 70% use a single needle but 30% may use multiple needles. Second attempts are rare. Majority of the patients (85%) are managed by surgery and recover from the injury. The condition has a low mortality rate of 5%.

Bilateral testicular self-castration due to cannabis abuse: a case report

Introduction

The self-mutilating patient is an unusual psychiatric presentation in the emergency room. Nonetheless, serious underlying psychiatric pathology and drug abuse are important background risk factors. A careful stepwise approach in the emergency room is essential, although the prognosis, follow-up, and eventual rehabilitation can be problematic.

We present a unique and original case of bilateral self-castration caused by cannabis abuse.

Case Presentation

We report a case of a 40-year-old Berber man, who was presented to our emergency room with externalization of both testes using his long fingernails, associated with hemodynamic shock. After stabilization of his state, our patient was admitted to the operating room where hemostasis was achieved.

Conclusion

The clinical characteristics of self-mutilation are manifold and there is a lack of agreement about its etiology. The complex behavior associated with drug abuse may be one cause of self-mutilation. Dysfunction of the inhibitory brain circuitry caused by substance abuse could explain why this cannabis-addicted patient lost control and self-mutilated. To the best of our knowledge, this is the first case report which presents an association between self-castration and cannabis abuse.

A systematic literature review: self-mutilation among adolescents as a phenomenon and help for it-what kind of knowledge is lacking?

The aim of this review article is to present current knowledge of self-mutilation among adolescents as a phenomenon and to define what kind of knowledge is lacking based on existing literature. The literature searches were executed in the CINAHL and Medline databases in 2010. The analysed data consisted of 126 articles and inductive content analysis was carried out. Existing knowledge of self-mutilation was categorized into the following two classes: (1) self-mutilation as a phenomenon and (2) caring for persons who self-mutilate or self-harm.

Childhood sexual abuse and non-suicidal self-injury: meta-analysis

BACKGROUND

Many theorists posit that childhood sexual abuse has a central role in the aetiology of self-injurious behaviour. Studies that report statistically significant associations between a history of such abuse and self-injury are cited to support this view.

AIMS

A meta-analysis was conducted to determine systematically the magnitude of the association between childhood sexual abuse and self-injurious behaviour.

METHOD

Forty-five analyses of the association were identified. Effect sizes were converted to a standard metric and aggregated.

RESULTS

The relationship between childhood sexual abuse and self-injurious behaviour is relatively small (mean weighted aggregate phi=0.23). This figure may be inflated owing to publication bias. In studies that statistically controlled for psychiatric risk factors, childhood sexual abuse explained little or no unique variance in self-injurious behaviour.

CONCLUSIONS

Theories that childhood sexual abuse has a central or causal role in the development of self-injurious behaviour are not supported by the available empirical evidence. Instead, it appears that the two are modestly related because they are correlated with the same psychiatric risk factors.

Descriptions of self-mutilation among Finnish adolescents: a qualitative descriptive inquiry

The purpose of this study was to describe self-mutilation from the perspectives of self-mutilating adolescents. A qualitative descriptive design was adopted. Self-mutilating adolescents were asked to write descriptions of their self-mutilation. Data analysis revealed three major categories: descriptions of the factors contributing to self-mutilation, descriptions of the act of self-mutilation, and descriptions of the sequels of self-mutilation. This study adds to our understanding of self-mutilation and the experiences of self-mutilating adolescents. In nursing practice and education, self-mutilation should be discussed based on existing knowledge to make nurses more familiar with it. Nurses should understand this phenomenon as a challenge for developing effective nursing practices.

Self-mutilation induced by cocaine abuse: the pleasure of bleeding

INTRODUCTION

Self-mutilation is direct and deliberate harm to one's body without conscious intent to die. It is observed in both men and women with various psychiatric disorders, but most of those who self-mutilate are women diagnosed with borderline personality disorder. Cocaine addiction is a significant worldwide public health problem, associated with somatic, psychological, psychiatric, socioeconomic and legal complications. Amphetamine use, but not cocaine use, has previously been associated with severe self-injurious behavior.

CASE

We report here a case of a female patient with recurring self-injurious behavior ("the pleasure of bleeding") induced by cocaine abuse.

DISCUSSION

The clinical characteristics of self-mutilation are manifold and there is a lack of agreement about its etiology. The complex behavior associated with cocaine abuse may be one cause of self-mutilation. Dysfunction of the inhibitory brain circuitry caused by drug addiction could explain why this cocaine-addicted patient loses control and self-mutilates during cocaine use.

[Victims of sexual assault: a routine protocol for better management]

Caring for victims of sexual assault is a difficult situation where the physician has to simultaneously evaluate the psychological impact and conduct a complete and precise physical examination. To make sure every step of the examination is completed and all samplings are done in the correct order by all physicians, it is useful to have a written routine protocol. We describe step-by-step management procedures for victims of sexual assault, taking into consideration the psychological aspect, the physical examination, the different samplings, and the different emergency treatments. Free download of the entire protocol, with the booklet containing examples of prescriptions, is available at http://www.agof.net/constatviol/.

Living on the Edge

The purpose of this article is to share current knowledge about adolescent self-mutilation (SM), and to discuss treatment approaches for affected teens and young adults. One in eight American teenagers experiences depression or anxiety. The growing phenomenon of SM is a particularly worrisome coping mechanism used by teens and young adults to deal with stress and sadness. The incidence of SM is increasing, and might be fueled by current trends in music and media that highlight violent and self-injurious behaviors. SM represents a "cry for help" by adolescents who are suffering. Self-mutilators who repeatedly cut themselves with razors, scissors, knives, or sharp glass are not attempting suicide, but are seeking to relieve extreme anxiety, tension, or pain. Medical literature regarding SM is limited, and evidence-based treatment approaches have not been documented; however, early discovery of SM and the development of a multifaceted treatment approach that incorporates the child, family, and trusted practitioners could be instrumental in managing SM. There is hope that antidepressant medications may also be beneficial. Research is needed to identify successful treatment approaches, and to discover the best ways to educate teens, families, educators, and community leaders about the prevalence of SM in our youth.