著者

多羅尾 陽子 兼本 浩祐

出版者

愛知医科大学

雑誌

愛知医科大学医学会雑誌 (ISSN:03010902)

巻号頁・発行日

vol.35, no.1, pp.1-6, 2007-03-15

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In this retrospective study, we examined clinical settings and associated symptoms in patients with episodes of deliberate self-harm in order to investigate pertinent therapeutic approaches for subtypes of self-mutilators. A total of 55 patients with such episodes were randomly selected as a study sample from case records of outpatients treated directly by the authors from 2003 to 2005. The average observation period and age at examination were 2.1±3.1 and 24.9±11.3 years, respectively. Eighty nine percent of the study subjects were female, and more than 40% had experienced eating disorders, suicidal attempts by drug abuse, and doctor shopping. Fewer than 60% of the subjects were diagnosed with a DSM axis I mental disorder, of which 20% were mood disorders, while greater than 60% were categorized with personality disorders, including borderline personality disorders in 55%. Surprisingly, 38% of the subjects had an axis II diagnosis alone and not axis I. The average age of onset of self-mutilation was 22.7±11.0 years old and 65% of the subjects injured themselves without a definite precipitating event. Approximately one-third felt no pain during the self-mutilation, while amnesia to the episode and ecstasy accompanied self-injury in 13% and 29%, respectively. Factor analysis revealed late onset, marriage, and mood disorder as closely associated (first factor), which suggested the existence of a treatable subgroup of patients with mood disorders among the self-mutilators studied. In addition, analysis showed that high frequencies of self-injurious episodes, episodes of transient ecstatic feelings along with no pain following self-injury, and suicidal attempts associated with drug abuse were associated (second factor), which we speculated to be clinical hallmarks of addiction to self-mutilation. Based on our findings, we recommend that trials of medical treatment for treatable self-mutilators with hallmarks of the first factor be conducted and psychological support for patients with addiction to self-mutilation who demonstrate the second factor clinical constellation.