Et forsog pa neuropsykologisk analyse af selvdestruktiv adfard i form af neurotiske ekskoriationer

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Abstract
Patienter med neurotiska hudexkoriationer kan förmodas ha varit mer utsatta för emotionell stress vilket leder till en större aktivitet i den högra än i den vänstra hemisfären, hävdar författarna till denna artikel. De kommer alla från Odense sygehus, där Henry Nielsen är psykolog vid neurologiska kliniken, Anders Hjortshøj 1. reservelæge vid dermatologiska kliniken och Kjeld Fruensgaard overlæge vid psykiatriska kliniken. Summary “Neurotic excoriations” is the term applied to excoriations which are self-inflicted compulsively or because of psychogenic itching, and without the intent to deceive. In order to draw up hypotheses concerning two rather established facts about neurotic excoriations, some pertinent research as to sex differences in non-verbal and verbal skills and the neuropsychology of emotions has been reviewed. First, it is argued that women tend to have more bilateral cerebral representation of non-verbal processes than men, and that consequently dysfunction of these processes -and of “right hemisphere processes” as a whole-will have greatest impact on women. Next, it is shown that impairment of the right hemisphere tends to lead to emotional flatness and regression or euphoria, while left sided cerebral impairment most often is accompanied by depression. There is evidence in support of the hypothesis that disturbance of normal emotionality is connected with an interruption of the balance or interaction between the two hemispheres which otherwise normally is changed in a diurnal rhythm, so that the right hemisphere is “sleep dominant” and the left hemisphere is “wakefulness dominant”. Research with normal subjects has shown that the right hemisphere tends to be hyperactive in emotional states. Patients with neurotic excoriations supposedly have been, or are, exposed to emotional stress that leads to greater activity of the right compared to the left hemisphere. Because of their greater bilateral cerebral representation of “right hemisphere processes” and lesser remaining unimpaired verbal capacity, more women than men will tend to react non-verbally, predominantly in the evening or night, because of the supposed right hemisphere “sleep dominance”. Self-destructive behaviour in the form of neurotic excoriations functions as a sort of compromise when inner or outer barriers are strong enough to prevent emotional abreaction. Testable predictions for neuropsychological testing of patients with neurotic excoriations are presented.