A four-year cohort study. Scores from the modified YBOCS demonstrated a significant decrease in self-injurious thoughts when comparing naltrexone treatment with post-treatment. Skin cutting is the most common form of self-mutilation, followed by skin burning and self-hitting. Although not mentioned by Soloff, naltrexone, clonidine, or omegafatty acids can also be considered in cases of self-mutilation refractory to the other treatment regimens. A review of the behavior and biology of self-mutilation. In contrast, compulsive self-mutilation is often habitual and more closely related to obsessive-compulsive disorder than disorders with prominent impulsivity, like borderline personality. Psychiatr Clin North Am. Only two of the initial 12 were still involved in cutting at the end of the 12 weeks, and the episodes occurred less than once a week, a nearly percent reduction. Despite some efficacy seen in double-blind, placebo-controlled trials of thiothixene 50 and haloperidol, 51 Hollander, et al. Positive effects of carbamazepine on behavioral dyscontrol in borderline personality disorder.
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Pathologic self-mutilation is difficult to adequately define, understand, and treat.
A homeless person with bipolar disorder and a history of serious self-mutilation.
Targeting the hypothesized neurobiological mechanisms of action, several open-label reports look specifically at the response of self-mutilation to pharmacotherapy. General Guidelines Based upon review of the available drug studies that target either self-mutilation directly or the impulsive aggression of personality disorders, the following recommendations for pharmacotherapy of self-mutilation can be made.
Dialectical behavior therapy DBTa variation of cognitive behavioral therapy, has the most empirical support from at least seven well-controlled trials as a psychosocial intervention for borderline personality disorder.
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|The successful use of clozapine in ameliorating severe self-mutilation in a patient with borderline personality disorder.
Finally, lithium or the anticonvulsant mood stabilizers may be considered. Brian Daniel SmithMD. A decrease in pain sensitivity after early traumatic experiences is reported in animals and humans.
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The Self-Harm Behavior Questionnaire SHBQ differentiates among variable levels of suicidality, assessing self-harm history, frequency, risk, disclosure, and treatment. For each individual self-mutilator the behavior may actually serve a number of functions seen in the different models. Three open-label trials of clozapine also find significant improvement in BPD patients, 52 with Chengappa, et al.
SelfMutilation and Pharmacotherapy
Comparison of self-poisoners and self-cutters in a community sample of adolescents. Psychopharmacology of borderline personality disorder. There are also similarly constructed controlled studies with the mood stabilizers, divalproex sodium, carbamazepine, lithium, and omegafatty acids. A functional approach to the assessment of self-mutilative behavior.
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|American Psychiatric Press, Inc; Borderline and schizotypal personality disorders treated with low-dose thiothixene vs placebo.
Only two of the initial 12 were still involved in cutting at the end of the 12 weeks, and the episodes occurred less than once a week, a nearly percent reduction.
There is at least one case report describing remission of self-mutilation, albeit of a compulsive nature, through the use of a SSRI. J Cons Clin Psychol. Affect regulation and addictive aspects of repetitive self-injury in hospitalized adolescents.
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Impulsive, superficial self-mutilation is commonly performed by nonpsychotic, normal intelligence patients.
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Johns Hopkins University Press; In addition to serotonin and opioids, dopamine is also implicated in self-mutilation. Studies should also further investigate new-generation antidepressants, naltrexone, clonidine, omegafatty acids, atypical antipsychotics, and mood stabilizers. In contrast, compulsive self-mutilation is often habitual and more closely related to obsessive-compulsive disorder than disorders with prominent impulsivity, like borderline personality.
As will be discussed later, dopamine antagonists may have some degree of success at decreasing self-mutilation.