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Social isolation (timeout) was successfully used to control self injurious behavior in a profoundly retarded institutionalized 15-year-old girl. (DB)

Presented is the case history of a severely mentally retarded patient with a 49, XXXXY chromosome pattern. (DB)

Reviewed are methods of treating self injurious behavior in mentally retarded persons with emphasis on the ethical considerations and the justification for aversive therapy. (DB)

A particularly severe case of self-injurious behavior in a multiply (visually, mentally, and emotionally) handicapped 10-year-old girl was successfully treated by response contingent shock, combined with rewards. (DB)

A multidisciplinary team at a hospital special devices clinic designed multiple use wheelchair and car seats with unique tabletop or arm enclosures for two educable mentally retarded brothers (11 and 14-years-old) afflicted with Lesch-Nyhan syndrome, a purine metabolic disorder characterized by an insatiable urge for self-mutilation. (LH)

The long-term treatment program and follow-up of a case of chronic, severe, multiple self-injurious behavior is presented. Contingent electric shock and differential reinforcement of other behavior were the primary techniques utilized. Total suppression was achieved in the laboratory setting, but extending control to the natural environment proved only moderately successful. (Author)

Research supported by Grant GS-951 from the National Science Foundation.

Prior to treatment, a nonverbal, 8-year-old severly retarded child was confined in an enclosed crib 17 hours a day to prevent hazardous voluntary falling. (Author)

Discussed from a behavioral perspective are theoretical approaches and recent educational and research developments in the field of childhood autism. (CL)

Literature on sensory deprivation is reviewed to provide a theoretical basis for treating the self-abusive mentally retarded. Treatment procedures and progress are presented in a case study. (Author)

This article analyzes some of the statistics available on self-destructive behavior. (PB)

The treatment program for the modification of self-destructive behavior of an institutionalized mentally retarded boy who needed constant physical restraints employed a variety of approaches and emphasized the development of an interpersonal relationship. (KW)

Development of a measurement technique for recording observations of head banging in an institutionalized mentally handicapped boy is discussed. (CD)

An abnormal but apparently successful sexual posture was observed in an adult male rhesus monkey in which the subject bit its hands and leg in the process of dismounting. This behavior followed each of several mounts but ceased toward the end of the series, culminating in ejaculation. The animal's rearing history is included, suggesting that early partial isolation may produce long-lasting abnormalities which, while unusual, need not seriously affect successful copulation.

Amygdaloidotomy was performed bilaterally on 15 and unilaterally on three patients exhibiting severe aggressive or self-mutilating behaviour. Nine subjects (50%) were improved a year after operation; improvement was maintained in seven (39%) for periods ranging from 27 months to nearly six years. Four non-epileptic cases had convulsions during the period of review; one of them has a persistent mild hemiparesis dating from the postoperative period. There was a tendency for epileptics to respond better than non-epileptics and for mentally retarded patients to respond poorly, but none of the differences was statistically significant.

The discrepancies between experts' criteria for hospitalization of suicide attempters with actual clinical practice were explored to develop utilization review criteria which reflect current clinical thinking and which could form guidelines for the assessment of clinical care. Experts' criteria predicted that a hospitalized group of suicide attempters did not require hospitalization and that a nonhospitalized group of suicide attempters required hospitalization. Examination of the discrepancies between clinical practice and experts' criteria not only revealed that incorporation of clinical measures of depressive symptomatology could improve the experts' criteria for hospitalization but also showed that clinicians did not hospitalize a group of markedly symptomatic and socially impaired white suicide attempters. Clinician and patient factors that may have contributed to this decision making and the application of these findings for utilization review are discussed. Language: en

Forty-three patients, 38 women and 5 men, with self-inflicted skin lesions were studied. Thirty-three were followed up for up to 22 years. In most cases dermatitis artefacta was only one incident in a long history of psychogenic illness. Of the 43 patients, 13 (30%), 12 women and one man, continued to produce lesions or were disabled with other psychiatric disorders more than 12 years after the onset of symptoms. Prognosis was difficult but recovery seemed to occur when the patient's life circumstances changed rather than as a result of treatment.

A detailed case report of female genital self-mutilation associated with dysorexia and the hysterical personality is presented. This lends support to recent literature that has suggested the possibility that these clinical features may comprise a discrete syndrome. The usefulness of considering this triad as a syndrome is illustrated by its facilitating the recall of two previous patients who in retrospect appear to fulfil these criteria. It is suggested that the name Caenis syndrome be given to this triad of behaviour. Language: en

Punishment with aromatic ammonia was used to eliminate self-injurious behavior of an autistic woman during experimental sessions. The effects were reversible but were limited to experimental sessions until staff used the ammonia on the ward at all times.

Although the higher mortality rate among heroin addicts is well documented, comparatively little is known about self-destructive behaviour in this group. Also, few studies have been made of subjects dependent upon oral drugs. In the present study, the records of 97 consecutive admissions to a drug dependence unit were comprehensively examined. Two main variables were investigated, self-injury and self-poisoning. The results show a higher incidence of self-injury in the orally dependent group than in the intravenous group. On the self-poisoning variable, there was no difference between these two groups, although the incidence of self-poisoning was high for both. There was a significant positive correlation between self-injury and overdosing in the oral group, but not in the intravenous group. The results show no correlation between sex and self-injury. Three subjects, each of whom had a history of self-destructive behaviour, were known to have died from overdoses since the beginning of the study. It is suggested that the pharmacological action of the drugs abused by the two groups may account for differences in self-injury, although personality factors may also be involved. Finally, it is suggested that the risk to life associated with self-destructive behaviour in drug-dependent individuals must be taken seriously.

Clonidine (2-(2,6-dichlorophenylamino)-2-imidazoline hydrochloride, St155, Catapres), after administration of a single large dose, was found to induce automutilation in mice housed individually in the absence of objects to bite. This abnormal behavior was not significantly altered with chronic administration of the drug, and showed no sex difference. The mechanism underlying this automutilation seems to be different from that of the aggressive behavior induced by the same drug in mice caged in group.s

I have tried to describe just less than one year of learning experience on my part in one type of adolescent unit. Only 16 inpatients were treated at a time while I was there: there were only 25 discharges and 19 admissions in my time. We knew we were making little inroad into our whole regional problem of adolescent disturbance; but we believe that as a team, able to work closely with each other and with our patients and their relatives, in a therapeutic community of undogmatic ideology, we were able to give a little to almost all and, to those who did best, a great deal. Very few ex-inpatients lost all touch with us. Nearly all came back from scattered homes for our Christmas discotheque. Even our very modest aim, to reset and then foster the natural development of the personalities of our patients, rather than break them down in deep analysis and radically reconstruct them, required an intensity of psychotherapeutic effort which engaged all we had to offer, and often drained us at the end of the day. Yet those who joined us transiently, particularly student nurses and medical students, seemed to find the experience significant--occasionally deeply so--and came back to visit us. Our social worker has now departed to have a baby. Our three senior nurses have left, two to university as mature students, one to prepare for a no. 7 post. Possibly the intensity of the demand upon them would have made them leave, anyway. For myself, it was a year of development of my psychotherapeutic sensitivity and of close working with a valued team of colleagues in a setting new to me, which I shall never forget. Language: en

The aim of the present study is to investigate probable socio-cultural determinants in the epidemiology of attempted suicide in Trinidad and Tobago. In an earlier paper the author described the clinical features which were noted among those patients who attempted suicide and were admitted to the only psychiatric unit in these islands (Burke, 1974). During the period before this unit was in full operation other workers had noted a tendency for suicide attempts to be made more frequently by women of East Indian origin, who most often reside in rural areas, than among the more urban African ones (Haynes, 1966; Roberts and Russell, 1969). Since those studies a suicide prevention service has been established which admits all patients who attempt suicide. The present study was intended to re-investigate the ethnic sub-cultural findings which occur in the new service. It was hypothesized that there was no difference in the distribution of attempted suicide, between the two sub-cultural groups.

The authors present clinical material to illustrate the special treatment and management problems posed by different types of mentally ill offenders; they suggest that court-mandated hospital treatment is often destructive and unrelated to the needs of the patient, the community, and the mental institution. The failure to create new kinds of institutions, combining modalities derived from the hospital and correctional systems, is traced to poor communication among the disciplines involved. The "mentally ill offender" is caught in the interplay of these systems and is consequently both their victim and victimizer. Language: en

A controlled study of the clinical and biographical features of 22 female repeated self-cutters is described. The results of the assessment of these patients, using the Middlesex Hospital Questionnaire and the Obsessive-Compulsive section of the Tavistock Inventory, is presented. The marked obsessionality of these patients is emphasized and the possible implications of these findings for treatment is discussed.

The use of aversive stimuli with the retardate is controversial. This paper describes the successful application of electrical stimulation to eliminate self-abusive behavior. It is presented as an advocacy for a form of treatment which has its rightful place in our armamentarium and can be of benefit to many severely-profoundly retardates. To deny them this benefit is considered unethical, inhumane, unfair and absolutely wrong.

This article describes common life-history themes and intervention strategies with 25 patients who seemed overeager to regard themselves as mentally ill and had aggressively sought treatment for more than two years with little improvement. What they seemed to require was an approach that challenged this self-image, and helped them to organize their past experiences around a more constructive and satisfying identity.

In order to assess the relationship between severe cataracts and violent headbanging, ophthalmologic examinations were performed on a random group of institutionalized headbangers; it was found that the majority had cataracts of varying maturity. The authors describe two patients, eight and ten years old, with cataracts subsequent to chronic headbanging and review recent theories attempting to explain it.

— Self-inflicted, conscious, or subconscious oral mucous membrane changes caused by a biting or a sucking habit in 17 patients are presented. The name morsicatio mucosae oris et suctio mucosae oris is proposed for this entity. The biting type lesions are characterized by an irregular flaky desquamation of the epithelial layer intermingled with minute to small erosions. Histologically, this type of lesion is characterized by flattening of the superficial layers of the epithelium with retention of bacteria, presence of large faintly stained “swollen” cells in the upper part of the stratum spinosum and basophilic stained cells just below. This microscopic picture is considered pathognomonic. The sucking-type lesions are characterized by whitish-grayish patches of the mucosa with some degree of chagrination in direct light. Histologically, the lesion is characterized by a compression of all layers of the epithelium. Treatment with an oral screen resulted in cure in 50% of the patients treated. The importance of motivation as part of treatment is emphasized.

Aggressive and self-injurious behaviors of four retarded children were reduced by combining various techniques with the differential reinforcement of other behaviors (DRO). In one study, aggressive responses of a severely retarded child were reduced when DRO was combined with a 30-sec timeout. In a second study, various aggressive classroom behaviors were reduced when the child was told "no" for an inappropriate response but earned puzzle pieces for periods of time when inappropriate responses resulted did not occur. Exchangeable tokens were given to a third subject for every 15 min in which aggressive responding did not occur, while each inappropriate response resulted in the loss of all tokens accrued. Responding was decreased to a level far below baseline. For a fourth child, self-injurious responses were followed by "no", and intervals of time in which no self-injurious responding occurred earned candy. The rate of this behavior reduced significantly. In each case, the DRO procedure combined with the other techniques proved to be manageable for the teacher and successful in reducing the inappropriate behavior.

JUVENILE GOUT is acknowledged to be a rare disorder, and its association with a central nervous system disorder is an even more unusual occurrence. This fact is borne out by the paucity of reports despite the long-recognized clinical entity of gout. Only about 15 accounts of gout in children under 10 years of age have appeared in the world literature since the early 1920's. Prior to this, few isolated reports of juvenile gout were made, eg, those of Gairdner (1854) 1 and Garrod (1876). 2 Sydenham (1683) 3 indicated considerable interest in the disorder, probably engendered by his own affliction at the age of 25 years, but in his classical description he stated he had not encountered a case of gout with onset earlier than 25 years. Brochner-Mortensen (1858) 4 pointed out that in his own series of 100 cases and those of Scudamore (1866), 5 Williamson (1920), 6

The authors report their observations of five children with the Lesch-Nyhan syndrome and review the literature to describe the general characteristics of the disorder, the development and types of self-mutilative behavior, and the types of outward-directed aggression. The authors suggest that these children may have a very low threshold for the activation of a mechanism that controls repetitive, compulsive, pain-causing behavior. This factor may also explain other forms of self-destructive behavior in children and may represent the psychobiological basis for the development of masochistic behavior.

– A study of habitual self mutilation of the buccal and/or labial mucosa by biting was conducted on 8,589 persons attending the Royal Dental College, Copenhagen. Forty-two cases were found. The youngest patient was 5 years old and the oldest was 47. The condition occurred most frequently (1.77%) among persons aged 15–19 years. There was no difference in prevalence between males and females. Combined mutilation of cheek(s) and lip(s) was more frequent (62%) than isolated mutilation of the cheek(s) (24%) or isolated mutilation of the lip(s) (14%). Bilateral biting of the cheeks was more frequent than unilateral biting, and biting of the lower lip was more frequent than biting of the upper lip. Ninety-three per cent of the patients were aware of their habit, and most of them stated that they had been biting for years. Twenty patients were re-examined; in all but one patients the biting persisted but in 7 patients the location of the lesions had changed. In several cases a link could be traced to personal problems and mental stress. It was further noticed that many patients were students and white-collar workers, suggesting that “intellectual” work may predispose for the habit.

Conducting a follow-up study of 23 wrist slashers presented an ethical conflict between consideration of the patients' human and medical rights and the investigators' desire for knowledge to improve treatment. The authors feel that many difficulties now encountered in behavioral research can be avoided by improved confidentiality of hospital records, acquisition of patients' consent regarding possible follow-up contact, and well-planned studies in which ethical problems are more fully anticipated beforehand.

An appliance is described which is designed to control the self-injurious behavior of an autistic child. The appliance, which is worn like a bonnet or hat, delivers an adverse electric shock to the arm of the patient whenever the head is struck either by the patient himself or some extraneous inanimate object. Two methods of operating the switching mechanism and an inflatable, completely protective, device are also discussed.

A group of 23 patients, considered by the staff to be the most difficult in a large hospital, were rated on four scales and contrasted with another group (25 patients) said to be the least difficult. From the comparisons, as well as from examination of case records and staff opinions, certain characteristics of the difficult patient were described. 1. The difficult patient shows more psychopathic trends and neurotic symptoms than psychotic features. 2. Attention-seeking, making use of physical symptoms and overactivity, together with unco-operativeness with the staff and a poor response to treatment, were among the distinguishing marks of the difficult patient. 3. The hospital stay of the difficult patient is punctuated by frequent ward transfers. 4. The findings are in general agreement with other work; nevertheless, there were certain marked differences which may be due to prevalent staff attitudes and current ideologies of different hospitals.