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Other Problems

(11-18-09)

Deliberate Self-Harm

“Deliberate self-harm is defined as the intentional injuring of one’s own body without apparent suicidal intent.”

(Klonsky, Oltmanns, & Turkheimer, 2003, p. 1501).
  • superficial-moderate self-mutilation
  • self-injurious behavior
  • parasuicide
  • self-wounding

In their review of previous literature, Klonsky et al. note that reports that approximately 4% of the general population & 14% of a college population report a history of deliberate self-harm (Klonsky, Oltmanns, & Turkheimer, 2003, p. 1501).

Klonsky evaluated 1,986 Air Force recruits, 62% male. Mean age was 20 years (s.d. 5), mean IQ was 104, 99% were high school graduates. 65% were Caucasian, 17% were African American, 4% were Hispanic, 3% Asian, 1% Native American, 10% listed race as “other.” 25 recruits who reported a history of a suicide attempt were excluded.

The Klonsky et al. study results found that approximately 4% of a nonclinical population had harmed themselves at least once, and that less than 1% had chronically engaged in self-harm. The prevalence rates were similar for males and females.

Individuals with a history of self-harm had more traits of the borderline, schizotypal, dependent, and avoidant personality disorders as measured by both self- and peer reports.

Their data suggested that, “self-harmers are better characterized as anxious than depressed.” (p. 1506).

This DSH is probably different from the self-injurious behavior seen in individuals with autism and other developmental disabilities.

  • Breau, Camfield, Symons, Bodfish, McKay, Finley, & McGrath (2003) looked at 101 nonverbal children between 3 and 18 years of age. They concluded that data did not support the hypothesis of less sensitivity to pain. Concluded that children with SIB have pain reactions similar to those without SIB. Their data suggested there might be two forms of SIB: 1) one form is less frequent, associated with chronic pain, and involves SIB directed near the site of pain. 2) less related to chronic pain and is directed at the head and hands.

DSH may play a role in affect regulation (especially in clients with “borderline” characteristics and adolescents); this self-injurious behavior is often carried out in secret and the individual attempts to avoid detection; DSH may also be use as an operant to effect the individual’s social environment (“manipulative” self-injurious behavior, also seen in individuals with “borderline” characteristics). Occasionally DSH may be seen in individuals with antisocial characteristics in an attempt to established the legitimacy of a “suicide attempt”; this usually represents deliberate malingering in an effort to avoid or minimize responsibility for prior behavior or actions.

Abuse

  • Consequences:
    • Jackson, Philp, Nuttall, & Diller (2002) suggest that mild TBI may be a “hidden consequence” for many battered women. In a sample of 53 battered women, they found 92% reporting having received blows to the head and 40% reporting loss of consciousness; and found a significant correlation between reported frequency of being hit in the head and postconcussive symptoms.
  • Partner Abuse
    • A history of early behavior problems was the developmental anticedent of partner abuse most consistently identified in multivariate analyses by Magdol, Moffitt, Caspi, & Silva (1998)
    • In a primary care setting Oriel & Fleming (1998) found prevalence rates of mild violence (6-11%) and severe violence (3-4%) reported by males. Self-reported symptoms of depression, drinking more than two drinks on average, and any history of abuse as a child increased a man’s probability of violence from a baseline of 7% to 41% if all three risk factors were present. Witnessing parental violence and living with children from a partner’s previous relationship were also associated with violence.

Adolescent Sex Offenders

  • Ryan et al. (1996) analyzed data from more than 1,600 juveniles in 30 states referred for sexual offense; found 27.8% identified with three or more nonsexual offenses.
  • Butler & Seto (2002) recommend distinguishing between adolescent sexual offenders with and without criminal histories of non-sexual offenses
    • conduct disorder subtype
    • nonconduct disorders subtype (possibly with more deviant sexual interests)
  • Multiple victims may be associated with greater risk of recividism of sexual offenses (Rasmussen, 1999)
  • Adult dangerous sexual offenders usually commit their first offense during adolescence, and usually have 2 to 5 times as many reported offenses than those apprehended for (Groth, Longo, & McFadin, 1982)

Malingering

Appendix B, criterion sets and axes provided for futher study

  • Postconcussional disorder
  • Mild neurocognitive disorderCafeine withdrawal
  • Alternative dimensional descriptors for Schizophrenia
  • Postpsychotic depressive disorder of Schizophrenia
  • Simple deteriorative disorder (simple Schizophrenia)
  • Premenstrual dysphoric disorder
  • Alternaive Criterion B for Dysthymic Disorder
  • Minor depressive disorder
  • Recurrent brief depressive disorder
  • Mixed anxiety-depressive disorder
  • Factitious disorder by proxy
  • Dissociative trance disorder
  • Binge-eating disorder
  • Depressive personality disorder
  • Passive-aggressive personality disorder (negativistic personality disorder)
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