History Of Self-injurious Behavior Research Articles

Emotional reactivity and past self-injurious behavior moderate the association between trauma exposure and fearlessness about death.

As suicide remains a global public health concern, recent work has sought to characterize mechanisms underlying the transition from suicidal ideation to action. Acquired capability for suicide, or fearlessness about death, has been identified as one key factor underlying this transition; however, understanding how this capability emerges remains limited. This study sought to extend previous work on the correlates of fearlessness about death by examining its relationship with painful and provocative events and emotional reactivity. We tested the extent to which trait emotional reactivity and past self-injurious behavior moderated the relationship between assaultive trauma exposure and fearlessness about death in a diverse sample of 273 community adults (aged 18-55, M/SD = 32.77/10.78). A three-way interaction emerged, such that among individuals with heightened emotional reactivity and a history of self-injurious behavior (suicide attempt or non-suicidal self-injury), assaultive trauma was associated with increased fearlessness about death. In contrast, among adults with low emotional reactivity and a history of self-injurious behavior, assaultive trauma was associated with reduced fearlessness about death. Results suggest that emotional reactivity may be a key dispositional factor that influences how trauma exposure and self-injurious behavior impact fearlessness about death.

The role of trauma services in intentional self-harm at a regional level 1 trauma center

IntroductionSuicide claims many lives globally, each year. For every person that dies by suicide, multitudes more attempt it. A national shortage of psychiatrists may prevent many individuals from receiving timely mental health care. For many individuals, the primary entry point into the healthcare system is through the emergency department. The trauma service frequently treats patients with severe self-inflicted injuries and for many this is not the first time. This represents an opportunity for intervention to disrupt the cycle and prevent future death. MethodsWe conducted a retrospective chart review of all patients with self-inflicted injuries, admitted to the trauma surgery service between 2012 and 2021. All patients above 10 years old were included. ResultsFour hundred forty-one patients were admitted due to self-injurious behavior in the period under study. The majority of patients (71.9%) had a pre-existing mental health disorder. Fifty six patients suffered fatal injuries; the majority were White (78.6%), males (80.3%), and were inflicted by gunshot (71.4%). Nearly one third of patients with self-inflicted injuries had a history of self-injurious behavior with the average number of attempts being 2.7 (SD: ±3.8). ConclusionsWe need interdisciplinary and innovative solutions for this public health crisis. Perhaps telemedicine can be used to buttress the access to adequate mental health care. More research needs to be done to better identify the barriers individuals encounter in accessing mental health care, both pre- and post-crisis. The goal is that, by identifying the gaps, we can collaboratively bridge them to prevent a preventable death.

Early-life behavioral features are associated with chronic emesis in rhesus macaques (Macaca mulatta).

Chronic emesis (CE) is a poorly understood condition in human and nonhuman primates that negatively impacts the quality of life. Early identification of risk factors for the development of CE is likely to improve the ability to manage CE cases successfully and is, therefore, desirable. Using a case-control study, we reviewed the necropsy records of the California National Primate Research Center and identified 24 animals with recorded CE, defined as five or more incidents of emesis in 1 month. A group of 89 healthy rhesus macaques (Macaca mulatta), comparable in age and percent time housed indoors, was similarly identified. Next, we investigated the association between the occurrence of CE during later stages of life after infancy and the behavioral temperament scores attained in infancy, age, sex, birth location, rearing condition, history of self-injurious behavior (SIB), and the number of lifetime sedation events. Our analysis revealed that CE was associated with degrees of temperament constructs obtained in infancy (data was available for n = 113), such as Confidence (odds ratio (OR) = 0.45, 95% CI: 0.18, 1.08, p = 0.07), Gentleness (OR = 0.47, 95% CI: 0.23, 0.96, p = 0.03), Nervousness (OR = 2.04, 95% CI: 0.98, 4.23, p = 0.05), and Vigilance (OR = 0.36, 95% CI: 015, 0.87, p = 0.02), suggesting that CE is linked to behavioral phenomenon measured in early life, long before it becomes a medical concern. Our data suggest that CE was positively correlated with a history of SIB (OR 4.26, 95% CI: 0.98, 18.47, p = 0.04). Accurate prediction of CE can then assist behavioral and colony management professionals in making informed decisions regarding the care of animals at risk of developing CE. Moreover, the novel information we reported here could have valuable implications in human medicine, where gastrointestinal distress is a common complaint affecting a person's quality of life.

Eating disorders in sexual minority adolescents and young adults: examining clinical characteristics and psychiatric co-morbidities in an inpatient medical setting

BackgroundSexual minority adolescents and young adults are at higher risk of eating disorders compared to heterosexual peers. However, little is known about the clinical and psychiatric presentation of this population requiring inpatient medical stabilization. Given the increased risk for eating disorder behaviors in sexual minority individuals amidst increased rates of medical hospitalizations secondary to eating disorders, it is important to understand presenting characteristics of this population. The objectives of this study were to (1) describe the clinical characteristics of sexual minority adolescents and young adults with eating disorders admitted for medical instability and (2) compare psychiatric co-morbidities and suicidality of sexual minority adolescents and young adults to heterosexual peers.MethodsA retrospective chart review was conducted of 601 patients admitted to a large inpatient eating disorders medical stabilization unit between 2012 and 2020. Data collected included demographics, medical data including vital signs, and psychiatric characteristics. Chi square or t-tests were used to examine potential differences in clinical characteristics and psychiatric co-morbidities between groups. Modified Poisson regression was used to assess associations between sexual orientation and psychiatric co-morbidities.ResultsOver one fifth (21.1%, n = 103) of our inpatient sample identified as a sexual minority individual. The average age of participants was 15.6 years (2.7). Sexual minority adolescents and young adults had higher percent median body mass index compared to heterosexual peers and yet equally severe vital sign instability on admission. Sexual minority adolescents and young adults were almost 1.5 times more likely to have a psychiatric comorbidity with higher rates of depression, anxiety, and post-traumatic stress disorder. Sexual minority adolescents and young adults were approximately two times more likely to have a history of self-injurious behaviors and/or suicidality.ConclusionsSexual minority adolescents and young adults with eating disorders have equally severe vital sign instability despite higher percent median body mass index on admission for medical stabilization. Sexual minority adolescents and young adults hospitalized for medical complications of eating disorders are far more likely to have an additional mental health disorder and a history of self-harm and/or suicidality, which may portend a less favorable long-term prognosis.

The Florida Violent Death Reporting System 2019 Data Findings Including a Qualitative Focus on Suicide Deaths of Young Black Males

The Florida Violent Death Reporting System (FLVDRS) includes violent death data abstracted from death certificates (DC), medical examiner (ME) reports, and law enforcement (LE) records. Abstractors also produce narratives from the ME and LE information. This manuscript focuses on the findings from the 2019 FLVDRS. Quantitative data were reviewed using SPSS and STATA and MAXQDA was used for the qualitative analysis. Results showed that most deaths were suicides (69.0%). Males comprised most of all the violent deaths (77.4%). Qualitative analysis focused on available narratives of Black males regardless of ethnicity, ages 10–24 years, who died of suicide (n = 19). The most prominent codes from the qualitative analysis included scene location, suicide method, engagement with LE, known history of psychiatric conditions, known history of self-injurious behavior, and recent life events. Subcodes related to the parent codes are also provided for further explanation of the findings. Future research will allow confirmation of findings and development of targeted intervention programs.

The Blue Whale Challenge, Social Media, Self-Harm, and Suicide Contagion.

This report describes an adolescent with a history of self-injurious behavior who was hospitalized for suicidal ideation, who was inspired by the Blue Whale Challenge to engage in self-injurious behavior and post it on social media.

Biosignature of self-injury behaviors in adolescence: Role of β-endorphin in an acute inpatient unit.

Self-injurious behavior (SIB) (either non-suicidal self-injury, NSSI; or suicide attempts, SA) is a common reason for adolescent psychiatric emergency hospitalizations. Altered basal serum β-endorphin (BE) levels have been reported in adults with a history of SIB, but information is lacking in adolescents. We analyzed the psychoclinical profile and serum BE level of 39 adolescents admitted to the acute unit at a hospital in Spain due to SIB. The Mean (SD) serum BE level was high (190.53 ± 74.83). Regarding time sequence, the onset age of NSSI and SA were related (p < 0.001). The older the onset age of NSSI, the shorter the transition between NSSI and the onset of SA behavior (p = 0.05), but this difference does not lead the variation of BE (p = 0.81). Patients diagnosed with depression had lower serum BE levels than adolescents with other diagnoses (p = 0.03). Although adolescents who seem to be addicted to SIB had higher levels of BE, this finding was not statistically significant. The relationship between serum BE levels and SIB in adolescents requires further investigation.

Trauma-Informed Care on CAMHS ID Unit. Case Study of a Child with Neurodevelopmental Disorder and Self-Injurious Behaviour

AimsCrystal House is a specialist CAMHS ID inpatient 5-bedded unit based in the Kingswood Centre, North West London - for children aged between 13 and 18 years with primary diagnosis of Intellectual Disabilities with or without additional concerns that warrant admission to hospital for purpose of assessment and management. Reporting this case, we wanted to highlight complexities of management of children presenting with neurodevelopmental conditions and history of trauma.MethodsThis is a case of a fourteen-year-old girl with established diagnoses of Moderate Intellectual Disability, Childhood Autism, Foetal Alcohol Syndrome and childhood trauma. She was admitted to our CAMHS ID Assessment and Treatment Unit with a nine- year history of self-injurious behaviour, suicidal ideation and voice-hearing experiences – after failed treatment in the community and in-patient treatment (including under restrictions of long-term segregation) on generic CAMHS unit. Her current treatment includes a person-centred Trauma- Informed Positive Behaviour Support Plan; individual and family therapy psychology sessions based on the principles of trauma-informed care and consultation with staff on trauma-informed care. She also undertook ADHD assessment, and we are in the process of optimising ADHD medication.ResultsTrauma-Informed Positive Behaviour Support Plan was a new concept for the team. Therefore, this was supported by training and consultations with staff. The latter was introduced to create a psychologically oriented environment using trauma-informed care principals and helping the team understand what trauma means and how it affects the individual. ADHD assessment confirmed the diagnosis of ADHD which was followed by optimising ADHD medication.ConclusionSystemic and a person-centred approach is used for this child with concerning presentation and history of neurodevelopmental disorder and childhood trauma.

Case Report: Multiple Courses of Electroconvulsive Therapy for Treatment Resistant Depression in a 68 year old male with a Cardiac Resynchronization Therapy Device with Defibrillator

<h3>Introduction</h3> Background: Electroconvulsive therapy (ECT) has been safely and successfully applied in patients with cardiac pacemakers and implantable cardiac devices, and reviewed in a number of case reports (1, 2). Cardiac Resynchronization Therapy Devices (CRT-D), available with and without defibrillation, benefit patients with Heart Failure with reduced ejection fraction (HfreF) by improving left ventricular function, optimizing ventricular filling, and confers benefits in quality of life and mortality (3). There are currently no case reports on the use of ECT in patients with cardiac resynchronization therapy devices. <h3>Methods</h3> Methods: Patient is a 68-year-old male with a history of major depressive disorder, PTSD, cluster B personality traits who presented in December 2019 for suicidal ideation in the context of a major depressive episode. His medical history is notable for atrial fibrillation on warfarin, DM2 on insulin, non-ischemic cardiomyopathy with HFREF. In 2015, patient's Implantable cardioverter-defribillator (ICD) was replaced with CRT-D. He has a history of 4 previous suicide attempts, most recently four years ago as well as a history of self-injurious behavior. His suicidal ideation on this admission was notable for newly observed command auditory hallucinations telling him to harm himself, suggestive of a mood-congruent psychosis. Patient was started on low-dose risperidone. His other psychotropic medications included bupropion, venlafaxine, and gabapentin with multiple failed medication trials in the past. Patient's initial MADRS was 30 on admission scoring highly for suicidal ideation. After initiation of risperidone, patient's MADRS lowered to 16 prior to first ECT session. Prior to ECT, anesthesia, cardiology, and electrophysiology were consulted. Patient's CRT-D device was interrogated and determined to be functioning and patient was medically optimized for ECT from cardiology standpoint. His ejection fraction was 30% approximately 6 months earlier. Anesthesia expressed concern about management of sympathetic and parasympathetic response to ECT. <h3>Results</h3> Results: Prior to first session, Electrophysiology reprogrammed device and patient had defibrillator pads placed. A brief seizure was achieved. Due to no observed bradycardia after first session, the electrophysiologist recommended patient can undergo further ECT with placement of magnet on CRT-D to disable defibrillator. For the following 3 sessions, an adequate seizure was obtained. Patient reported robust response with MADRS of 6 reported prior to his second session. During ECT therapy, patient underwent echocardiogram which indicated ejection fraction of 20-25%. Cardiology was again consulted and felt patient could continue with ECT if euvolemic and asymptomatic. After 4^th session, a collaborative decision was made with patient to forego further ECT given patient's improvement in mood. Patient returned for another course of 3 sessions of ECT 8 months later and one maintenance session 9 months later. For these sessions, a magnet was used exclusively to disable fibrillator with robust effect on depressive symptoms. <h3>Conclusions</h3> Conclusion: This case indicates ECT can be provided safely to patients with a CRT-D device over an extended period of time; placing device in electrocautery mode with defibrillator pads as well as disabling defibrillator function with a magnet both proved effective methods to provide ECT safely. Further study of ECT in patients with CRT is warranted, in particular, to observe patients who complete a number of sessions more typical in treatment resistant depression. ECT in patients with CRT-P devices have not been reported. <h3>This research was funded by</h3> none

Self-Injury in Adolescence Is Associated with Greater Behavioral Risk Avoidance, Not Risk-Taking.

Strategies to link impulsivity and self-injurious behaviors (SIBs) show highly variable results, and may differ depending on the impulsivity measure used. To better understand this lack of consistency, we investigated correlations between self-report and behavioral impulsivity, inhibitory control, SIBs, and rumination. We included participants aged 13–17 years with either current or remitted psychopathology who have (n = 31) and who do not have (n = 14) a history of SIBs. Participants completed self-report measures of impulsivity, the Rumination Responsiveness Scale (RRS), and two behavioral measures of impulsivity: the Balloon Analogue Risk Task (BART) and Parametric Go/No-Go (PGNG). Lifetime SIBs were positively associated with self-reported impulsivity, specifically positive and negative urgency. However, individuals with greater lifetime SIBs demonstrated greater risk aversion (lower impulsivity) as measured by the BART, whereas there was no relation between lifetime SIBs and PGNG performance. There was no relation between rumination and behavioral impulsivity, although greater rumination was associated with higher negative urgency. Future research examining the role of SIBs in the context of active versus remitted psychopathology is warranted. Because most adolescents were remitted from major depressive disorder at the time of study, follow-up studies can determine if lower risk-taking may aid individuals with more prior SIBs to achieve and maintain a remitted state.

Interoceptive dysfunction indicates presence and severity of self-injurious behaviors in a clinically severe transdiagnostic sample

Interoceptive dysfunction (ID) is associated with self-injurious behaviors, as disconnection from the body is thought to enable bodily harm. This study tested differences in ID among those with and without history of self-injurious behaviors, as well as the relationship between ID and lethality of past suicide attempts. Adults (N = 344; 61.3% female; mean age 27.68) seeking psychological treatment completed self-report measures and clinical interviews during intake at a community-based clinic. Overall symptom severity was substantial (e.g., approximately 40% reported current suicidal ideation and two-thirds met a clinical cut-off score of ≥ 16 on the Beck Depression Inventory). Orthogonal contrasts were used to test whether mean levels of ID differed across lifetime self-injurious behavior groups. Attempt lethality was regressed on interoceptive dysfunction, covarying depressive symptom severity, age, and gender. Participants with suicide attempt history demonstrated greater ID than those without. Participants who had engaged in non-suicidal self-injury demonstrated greater ID than those with no history of self-injurious behaviors. Greater ID was associated with higher lethality of past suicide attempt, above demographic and clinical covariates. ID may have transdiagnostic relevance for risk assessment and management of self-injurious behaviors.

Emotional Reactivity and Family-Related Factors Associated With Self-Injurious Behavior in Adolescents Presenting to a Child and Adolescent Psychiatric Emergency Service.

Background: Adolescents presenting in a child and adolescent psychiatric emergency service show various psychiatric disturbances, most commonly suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI). It was postulated that especially disturbed emotion regulation contributes to self-injurious behavior of young people. This study aims to investigate the relevance of emotional reactivity (ER), as part of emotion regulation, during an acute crisis, how it relates to self-injurious behavior reinforcement and how a family as well as peers' history of self-injurious behavior are associated with self-injurious behavior of presenting adolescents. Additionally, crisis-triggering background factors were evaluated from the perspective of patients and their caregivers.Methods: A consecutive sample of 86 adolescents aged 11–18 years presenting to the emergency outpatient department due to self-injurious thoughts and behavior received a pretreatment psychiatric evaluation. Among other psychometric measures and structured clinical interviews, ER was measured via the Emotion Reactivity Scale (ERS). Family-related aspects were collected both through evaluation of history and through questionnaires filled in by custodians or parents.Results: Data analysis revealed that suicidal ideation was significantly related to family history with self-injurious behavior in comparison with a family background without such a history. A significant positive correlation was apparent between the ERS sensitivity score and occurrence of NSSI within the past year. A relationship between the ERS and distinct types of reinforcement as a motivation factor for NSSI was found. Post-hoc tests revealed a significant difference between boys and girls when no positive peers' history is present with boys having lower ERS scores than girls, but no difference when both groups had friends engaging in self-injurious behavior. There was only moderate agreement between parents and their children in naming reasons for the current crisis involving NSSI.Conclusion: Emotional regulation, especially ER, has an influence on patients' acute psychiatric symptomatology and when experiencing an acute crisis should be brought into focus early at psychiatric assessment. A history of self-injurious behavior taken from patient's family members and close circle of friends and agreement on reasons for the crisis should be routinely included in the exploration of a patient presenting with self-injurious behavior.

Not guilty by reason of insanity and dangerousness: A demographic, clinical and forensics description of the patients in the forensic inpatinent service of Coimbra

IntroductionDespite being essential for the service quality improvement, empirical research on the characteristics of people hospitalized in forensic psychiatry units and the psychopharmacological treatment instituted in this care context is scarce in Portugal.ObjectivesTo describe the sociodemographic, clinical and criminological characteristics of the patients admitted to a forensic psychiatric unit in Portugal, as well as, the psychiatric drugs prescription pattern in this care context.MethodsA retrospective observational study was carried out, through the data analysis of patients admitted to the Sobral Cid Forensic Psychiatry unit of the Coimbra Hospital and University over the past 12 years.ResultsThe sample had 194 inpatients, 153(78.9%) male and 41(21.1%) females. The mean age was 43.3 years and 74.7% had no professional, school or occupational activity. The most frequent psychiatric diagnoses were psychotic disorders (56.7%) and neurodevelopmental disorders(33.5%). 24.2% had at least two psychiatric diagnoses and 38.7% had concomitant medical conditions. 77.8% had history of psychiatric hospitalizations and 21.6% had history of self-injurious behaviors. 37.1% of the sample had a criminal record. Crimes against people were the most frequent. The use of injectable antipsychotic formulations was frequent and 18.6% of the patients were medicated with Clozapine. The prescribed daily doses were above the defined daily dose. Psychotic disorders and addictive disorders were less frequent in women. Statistically significant differences were found in the frequency of homicide between females(41.5%) and males(22.2%).ConclusionsTailored solutions are crucial to accomplish the purpose of security measures, mostly by addressing the identified needs and rethinking the approach on this specific context.DisclosureNo significant relationships.KeywordForensic Psychiatry Units

Explicit and Implicit Hopelessness and Self‐injury

This study examined the relationship between explicit and implicit measures of hopelessness and self-injurious behavior (defined here as self-harming or suicidal actions and thoughts). A community sample of 267 participants completed explicit measures of hopelessness (Beck's Hopelessness Scale and a Feeling Thermometer), an implicit measure of hopelessness (Hopelessness Implicit Association Test), and a self-report measure of their history of self-injurious behavior. The results showed that high levels of hopelessness, measured both explicitly or implicitly, were associated with a past and recent history of self-injury. However, there was also an interaction between the implicit and explicit measures such that explicit hopelessness was more strongly predictive of self-injury in people with high levels of implicit hopelessness. The findings show that the implicit measurement of hopelessness can help predict past and recent self-injury beyond what explicit measures of hopelessness currently achieve and could be used in the assessment of risk of both self-harming and suicidal behaviors.

A multi-measure examination of interoception in people with recent nonsuicidal self-injury.

Self-injurious behaviors (SIB) are highly dangerous, yet prediction remains weak. Novel SIB correlates must be identified, such as impaired interoception. This study examined whether two forms of interoceptive processing (accuracy and sensibility) for multiple sensations (general, cardiac, and pain) differed between people with and without recent nonsuicidal self-injury (NSSI). Participants were adults with recent (n=48) NSSI and with no history of SIBs (n=55). Interoceptive sensibility was assessed with self-reports. Interoceptive accuracy for cardiac sensations was assessed using the heartbeat tracking task. Interoceptive accuracy for pain was assessed with a novel metric that mirrored the heartbeat tracking test. Participants with recent NSSI reported significantly lower interoceptive sensibility for general sensations relative to people without SIBs. Groups did not differ on interoceptive sensibility for cardiac sensations or pain. Groups also did not differ on interoceptive accuracy for cardiac sensations. The NSSI group exhibited significantly lower interoceptive accuracy for pain compared with the No SIB group. Interoceptive impairment in people with NSSI may vary by interoceptive domain and sensation type. Diminished interoceptive accuracy for sensations relevant to the pathophysiology of self-injury may be a novel SIB correlate.

ЛИЧНОСТНЫЕ ОСОБЕННОСТИ ЮНОШЕЙ С САМОПОВРЕЖДАЮЩИМ ПОВЕДЕНИЕМ И С СУБКЛИНИЧЕСКОЙ ДЕПРЕССИЕЙ

The article presents the results of empirical research studying the personal characteristics of young men with self-injurious behavior and subclinical depression. Relevance of this topic is conditioned by the frequency of self-injurious behavior. A general hypothesis of the study was the statement that there are significant differences in the intensity of personality traits in young men with subclinical depression who have a history of self-injurious behavior as opposed to young men with subclinical depression but without self-injurious behavior, and also opposed to the test audience without the symptoms of depression and self-harm. The survey sample consisted of 169 young men aged from 18 to 22 years (average age — 19.2). We applied the methods of testing, polling, subjective scaling, statistical analysis. In the group with subclinical depression and self-harm were noted low self-esteem, high levels of situational anxiety, personal anxiety, proneness to conflict, neuroticism, spontaneous aggressiveness, irritability, and emotional lability. Young men from this group demonstrated lower rates of inherent worth, self-acceptance, self-attachment, mirror self, and sociability than those with subclinical depression but without self-harm. A positive correlation was revealed between the severity of self-harm and situational aggressiveness, proneness to conflict, self-accusation, neuroticism, spontaneous aggressiveness, depression, low self-esteem; a negative correlation was found between the severity of self-harm and inherent worth, self-acceptance, self-attachment and the mirror self. There is a positive correlation between depression and cynicism, hostility, aggressiveness, anxiety, proneness to conflict, irritability, and low self-esteem, and a negative correlation between depression and sociability and openness.

DSM-5 non-suicidal self-injury criteria in a clinical sample of self-harming Mexican adolescents

IntroductionThe DSM-5 diagnostic criteria for non-suicidal self-injury (NSSI) need to be validated in non-European populations. The aims of this study were to determine how common NSSI was in a sample of self-harming Mexican adolescents and examine the associated variables. MethodsWe examined the medical records of 585 adolescents with a history of self-injurious behaviour who attended a public hospital in Mexico City from 2005 to 2012. A group of experts established the diagnosis according to the DSM-5. The clinical and demographic characteristics of patients with and without NSSI were compared. ResultsNSSI was diagnosed in 351 patients (60%) with evidence of self-harm. The main reasons for not being diagnosed were a previous suicide attempt (criterion A, 158 subjects [26.87%]) and another diagnosis that better explained the self-injurious behaviour (criterion F, 60 subjects [10.25%]). The NSSI group had a higher proportion of males (26.5% vs 16.2%) and patients with behavioural disorders (28.5% vs 13.7%). These patients were also found to seek psychiatric support in relation to their self-harm more frequently (31.9% vs 14.1%). The associated clinical characteristics included behavioural disorder (OR=2.51; 95% CI, 1.62–3.90), personality disorders (OR=0.56; 95% CI, 0.33–0.97), hospital admission (OR=0.23; 95% CI, 0.16–0.33), depressive symptoms (OR=0.60; 95% CI, 0.42–0.85), anxiety symptoms (OR=2.08; 95% CI, 1.31–3.31) and self-harming to influence others (OR=2.19; 95% CI, 1.54–3.11). ConclusionsMore than half of the adolescents in the clinical sample with self-injury met DSM-5 criteria for NSSI. There are clinical and demographic characteristics which may be associated with this diagnosis.

Physical pain recruits the nucleus accumbens during social distress in borderline personality disorder.

Patients with borderline personality disorder (BPD) often engage in dangerous self-injurious behaviors (SIBs) as a maladaptive technique to decrease heightened feelings of distress (e.g. negative feelings caused by social exclusion). The reward system has recently been proposed as a plausible neural substrate, which may influence the interaction between social distress and physical pain processing in patients that engage in SIBs. Using functional magnetic resonance imaging (fMRI) in 20 adult BPD patients with a history of SIBs and 23 healthy controls (HCs), we found a hyper-activation of the nucleus accumbens (NAcc) and amygdala when painful stimuli were presented to BPD patients (but not HCs) in a state of heightened distress, induced via social exclusion. This differential NAcc activity was mediated by anxious attachment style, which is a key developmental feature of the disorder. Altogether, these results suggest a neural mechanism underlying the pathophysiology of SIBs in these patients, which is likely reinforced via the reward system.

Lesiones autoinfligidas con fines no suicidas según el DSM-5 en una muestra clínica de adolescentes mexicanos con autolesiones

IntroductionThe DSM-5 diagnostic criteria for non-suicidal self-injury (NSSI) needs to be validated in non-European populations. The aims of this study were to determine how common NSSI was in a sample of self-harming Mexican adolescents and examine the associated variables. MethodsWe examined the medical records of 585 adolescents with a history of self-injurious behaviour who attended a public hospital in Mexico City from 2005 to 2012. A group of experts established the diagnosis according to the DSM-5. The clinical and demographic characteristics of patients with and without NSSI were compared. ResultsNSSI was diagnosed in 351 patients (60%) with evidence of self-harm. The main reasons for not being diagnosed were a previous suicide attempt (criterion A, 158 subjects [26.87%]) and another diagnosis that better explained the self-injurious behaviour (criterion F, 60 subjects [10.25%]). The NSSI group had a higher proportion of males (26.5% vs 16.2%) and patients with behavioural disorders (28.5% vs 13.7%). These patients were also found to seek psychiatric support in relation to their self-harm more frequently (31.9% vs 14.1%). The associated clinical characteristics included behavioural disorder (OR=2.51; 95% CI, 1.62–3.90), personality disorders (OR=0.56; 95% CI, 0.33–0.97), hospital admission (OR=0.23; 95% CI, 0.16–0.33), depressive symptoms (OR=0.60; 95% CI, 0.42–0.85), anxiety symptoms (OR=2.08; 95% CI, 1.31–3.31) and self-harming to influence others (OR=2.19; 95% CI, 1.54–3.11). ConclusionsMore than half of the adolescents in the clinical sample with self-injury met DSM-5 criteria for NSSI. There are clinical and demographic characteristics which may be associated with this diagnosis.

Prevalence and clinical correlates of intermittent explosive disorder in Turkish psychiatric outpatients

ObjectiveIntermittent explosive disorder (IED) is defined as the failure to resist aggressive impulses resulting in repeated acts of verbal and/or physical aggression. Although it is frequently encountered in clinical psychiatric practice, there is a paucity of data concerning IED in the scientific literature both internationally and in Turkey. The aim of this study was to evaluate the prevalence of IED and associated sociodemographic and clinical features in a clinical setting. MethodsA total of 406 patients who were referred to our psychiatry outpatient clinic for the first time in a six-month period were included in the study. The diagnosis of IED was made using both Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) and DSM-5 criteria. Axis I disorder and personality disorder diagnoses were made according to DSM-5 criteria. Diagnoses were based on information from the Structured Clinical Interview for DSM-IV (SCID I) and the Structured Clinical Interview for DSM-IV personality disorders (SCID II), Symptom Checklist-90 (SCL-90), Wender Utah Rating Scale, Adult Attention Deficit Hyperactivity Disorder (ADHD) DSM-IV Based Diagnostic Screening and Rating Scale, a clinical interview conducted by the researcher, and a sociodemographic data form. In addition, participants were administered the Buss-Perry Aggression Scale and Barratt Impulsiveness Scale Version 11 (BIS-11) to assess aggression and impulsivity. ResultsLifetime and 12-month prevalence of IED according to DSM-5 were 16.7% and 11.3%, respectively. Mean age at onset was 16.4 years. The prevalence of lifetime IED was 3.8 times higher in males than females (95% CI = 1.9–7.5); twice as high in individuals living in rural areas compared to those living in urban centers (95% CI = 1.1–3.7); 2.7 times higher among those with lifetime suicide attempt versus those without (95% CI = 1.3–5.6); 4.5 times higher in those with lifetime self-injurious behavior compared to those without (95% CI = 2.3–8.7); and 3 times higher in individuals reporting aggression/anger problems in the family compared to those without (95% CI = 1.5–5.9). The prevalences of childhood ADHD, conduct disorder, and oppositional defiant disorder were significantly higher in the IED group. ConclusionThe result of the current study has revealed that approximately one-sixth of respondents experienced lifetime IED according to DSM-5 diagnostic criteria. Statistically significant sociodemographic correlates of IED include gender, urbanicity, history of suicide attempt, history of self-injurious behavior, and family history of aggression/anger problems.