Disease patterns seen in self-mutilating patients

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Abstract
Fruensgaard K. Flindt Hansen H. Disease patterns seen in self-mutilating patients. An intensive anamnestic/catamnestic study was carried out on 15 of 17 patients consecutively referred to a department of dermatology for unacknowledged cutaneous selv-mutilation (factitious disorders). “Observation time” was on average 10 years. Four patients could be characterized as psychotic (schizophrenia, dementia), 6 as having borderline personality disorders and 4 as having histrionic personality disorder. Six in the latter two groups had had psychotic episodes. One or more suicide attempts were registered for 12 patients. Nine patients were found to have problems related to alcohol, medicine or substance abuse. So-matoform symptoms were registered for 14 patients. The unconscious motivation factors estimated as occurring most frequently were urge to escape, need for attention and solicitude, externalized aggression and selv-chastisement. The results of psychiatric treatment were slight. The relevance of concentrating treatment on basic personality defects (such as identity problems, interpersonal relations, alexithymia and defective management of aggression) while concurrently supporting efforts to improve the patient's social conditions and not least social relations is discussed. It is further contended that the psychopathology of these patients is similar to that of some groups of patients who freely acknowledge that they themselves have inflicted the skin lesions (the so-called wrist slashers), but generally that type of patient (i.e. patients with neurotic excoriations) presents a much less serious/complicated psychopathology.

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