A high prevalence of self-injurious behavior has been reported in the forensic psychiatric population and the correctional psychiatric population. Severely and recurrently self-destructive patients pose great therapeutic challenges. The present study examined forensic patients who engaged in multiple acts of self-injury while hospitalized and compared them to forensic patients who engaged in a single act of self-injury. The groups did not differ on demographic or diagnostic measures, but the recurringly self-injurious patients were more frequently and more severely aggressive against others (verbally as well as physically), and required longer hospitalization. The results are interpreted to suggest that the high cost of recurring self-injury in human and financial terms may be reduced by a strategy of early and vigorous intervention.
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Pattison EM, Kahn J: The deliberate self-harm syndrome. American Journal of Psychiatry 140:867–872, 1983.
Linehan MM: Dialectical behavioral therapy: A cognitive behavioral approach to parasuicide. Journal of Personality Disorders 1:328–333, 1987.
Clayton PJ: Suicide. Psychiatric Clinics of North America 8:203–214, 1985.
Gardner DL, Cowdry RW: Suicidal and parasuicidal behavior in borderline personality disorder. Psychiatric Clinics of North America 8:389–403, 1985.
Coryell W, Noyes R: Excess mortality in panic disorders: a comparison with primary unipolar depression. Archives of Gereral Psychiatry 39:701–703, 1982.
Coryell W, Noyes R, House JD: Mortality among outpatients with anxiety disorders. American Journal of Psychiatry 143: 508–510, 1986.
Favazza AR: Why patients mutilate themselves. Hospital and Community Psychiatry 40:137–145, 1989.
Stocks R, Scott AIF: What happens to patients who frequently harm themselves: A retrospective one-year outcome study. British Journal of Psychiatry 158:375–378, 1991.
Winchel RM, Stanley M: Self-injurious behavior: A review of the behavior and biology of self-mutilation. American Journal of Psychiatry 148:306–317, 1991.
Hillbrand M, Krystal, JH, Sharpe, KS, et al: Clinical predictors of self-mutilation in hospitalized forensic patients. Journal of Nervous and Mental Disease 182:9–13, 1994.
Franklin RK: Deliberate self-harm: Self-injurious behavior within a correctional mental health population. Criminal Justice and Behavior 15:210–218, 1988.
Hillbrand M: Self-injurious behavior in correctional and non-correctional psychiatric patients. Journal of Offender Rehabilitation 19:95–102, 1993.
Bauer AM, Shea TM, Gaines H: A primer on self-injury. Education and Treatment of Children 11:157–165, 1988.
De Catanzaro DA: Self-injurious behavior. Motivation and Emotion 2:45–65, 1978.
Robertson MM, Trimble MR, Lees AJ: Self-injurious behavior and the Gilles de la Tourette syndrome: A clinical study and review of the literature. Psychological Medicine 19:611–625, 1989.
Schreibman L: Diagnostic features of autism. Journal of Child Neurology 3:57–64, 1988.
Korabek CA, Cuvo AJ: Children with spina bifida: Educational implications of their medical characteristics. Education and Treatment of Children 9:142–152, 1986.
Matas M, Robinson C: Diagnosis and treatment of monosymptomatic hypochondriacal psychosis in chronic renal failure. Canadian Journal of Psychiatry 33:748–750, 1988.
Gunderson J, Singer M: Defining borderline patients: An overview. American Journal of Psychiatry 132:1–10, 1975.
Hillbrand M, Hirt M: The borderline syndrome: An empirically developed prototype. Journal of Personality Disorders 1:299–306, 1988.
Favazza AR: Bodies under siege: Self-mutilation in culture and psychiatry. Johns Hopkins University Press: Baltimore, MD, 1987.
Roy A: Suicide and psychiatric patients. Psychiatric Clinics of North America 8:227–241, 1985.
Roy A: Suicide in chronic schizophrenia. British Journal of Psychiatry 141:171–177, 1982.
Copas J, Robin A: Suicide in psychiatric patients. British Journal of Psychiatry 141:503–511, 1982.
Walsh BW, Rosen PM: Self-mutilation and contagion: An empirical test. American Journal of Psychiatry 141:119–120, 1985.
Hillbrand M: Self-directed and other-directed aggressive behavior in a forensic sample. Suicide and Life-Threatening Behavior 22:333–340, 1992.
Apter A, Kotler M, Sevy S, et al: Correlates of risk of suicide in violent and nonviolent psychiatric patients. American Journal of Psychiatry 148:883–887, 1991.
Stone RK, Alvarez WF, Ellman G, et al: Prevalence and prediction of psychotropic drug use in California developmental centers. American Journal on Mental Retardation 93:627–632 1989.
Repp AC, Singh NN, Oliger E, et al: The use of functional analyses to test the causes of self-injurious behavior: Rationale, current status, and future directions. Journal of Mental Deficiency Research 34:95–105, 1990.
Aman MG, Singh NN, White AJ: Caregiver perceptions of psychotropic medication in residential facilities. Research in Developmental Disabilities 8:449–465, 1987.
Szymanski L, Kedesky JH, Sulkes S, et al: Naltrexone in treatment of self-injurious behavior: A clinical study. Research in Developmental Disabilities 8:179–190, 1987.
Luiselli JK, Beltis JA, Bass J: Clinical analysis of naltrexone in the treatment of self-injurious behavior. Journal of the Multihandicapped Person 2:43–50, 1989.
Lienemann J, Walker FD: Reversal of self-abusive behavior with naltrexone. Journal of Clinical Psychopharmacology 9:448–449, 1989.
Kars H, Broekema W, Glaudemans van Gelderen I, et al: Naltrexone attenuates self-injurious behavior in mentally retarded subjects. Biological Psychiatry 27: 741–746, 1990.
Markowitz PI: Fluoxetine treatment of self-injurious behavior in mentally retarded patients. Journal of Clinical Psychopharmacology 10:299–300, 1990.
Ratey JJ, Sovner R, Mikkelsen E, et al: Buspirone therapy for maladaptive behavior and anxiety in developmentally disabled persons. Journal of Clinical Psychiatry 50:382–384, 1989.
Hillbrand M, Scott K: Buspirone therapy of severe aggression in a treatment refractory autistic adult (letter). Journal of Autism and Developmental Disorders (in press).
Iawata BA: The development and adoption of controversial default technologies. Behavior Analyst 11: 149–157, 1988.
Matson JL, Keys JB: Contingent reinforcement and contingent restraint to treat severe aggression and self-injury in mentally retarded and autistic adults. Journal of the Multihandicapped Person 1:141–153, 1988.
Blankenship MD, Lamberts F: Helmet restraint and visual screening as treatment for self-injurious behavior in persons who have profound mental retardation. Behavioral Residential Treatment 4:253–265, 1989.
Bernard Opitz, R: Verhaltensanalyse und Interventions-methoden bei Selbstverletzungsverhalten. Zeitschrift fuer Kinder- und Jugendpsychiatrie 16:20–26, 1991.
Day RM, Rea JA, Schussler NG, et al: A functionally based approach to the treatment of self-injurious behavior. Behavior Modification 12:565–589, 1988.
Steege MW, Wacker DP, Berg WK, et al: The use of behavioral assessment to prescribe and evaluate treatments for severely handicapped children. Journal of Applied Behavior Analysis 22:23–33, 1989.
Federn E: The therapeutic management of violence. Residential Treatment for Children & Youth 7:5–15, 1989.
Eichelman B: Aggressive behavior: From laboratory to clinic—quo vadit? Archives of General Psychiatry 49:488–492, 1992.
Yudofsky SC, Silver JM, Jackson W, et al: The Overt Aggression Scale for the objective rating of verbal and physical aggression. American Journal of Psychiatry 143: 35–39, 1986.
Silver JM, Yudofsky SC: Documentation of aggression in the assessment of the violent patient. Psychiatric Annals 17:375–384, 1987.
Foster HG, Hillbrand M, Chi CC: Efficacy of carbamazepine in assaultive patients with frontal lobe dysfunction. Progress in Neuro-Psychopharmacology and Biological Psychiatry 13:865–874, 1989.
Waite BM, Hillbrand M, Foster HG: Reduction of aggressive behavior after removal of Music Television. Hospital and Community Psychiatry 43:173–175, 1992.
Hillbrand M, Waite BM: The social context of anger in violent forensic patients: An analysis via Experience Sampling Method. Journal of Offender Rehabilitation 18:81–89, 1992.
Lowenstein M, Binder RL, McNiel DE: The relationship between admission symptoms and hospital assaults. Hospital and Community Psychiatry 41:311–313, 1990.
Wong SE, Slama K, Liberman RP: Behavioral analysis and therapy for aggressive psychiatric and developmentally disabled patients. In L.H. Roth (Ed.), Clinical treatment of the violent person. U.S. Department of Health and Human Services DHHS Publication No. (ADM) 85-1425: Rockville, MD, 1985.
Madden DJ: Psychotherapeutic approaches in the treatment of violent persons. In L.H. Roth (Ed.), Clinical treatment of the violent person. U.S. Department of Health and Human Services DHHS Publication No. (ADM) 85-1425: Rockville, MD, 1985.
Dr. Hillbrand is Unit Director, Intermediate Treatment Unit, Whiting Forensic Institute, and Assistant Clinical Professor of Psychiatry, Yale University School of Medicine. Dr. Young is Service Chief, Intermediate Treatment and Diagnostic Units, Whiting Forensic Institute, and Associate Clinical Professor of Psychiatry, Yale University School of Medicine. Dr. Krystal is Director of the Schizophrenia Biological Research Project, West Haven V.A. Medical Center, and Associate Professor of Psychiatry, Yale University School of Medicine.
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Hillbrand, M., Young, J.L. & Krystal, J.H. Recurrent self-injurious behavior in forensic patients. Psych Quart 67, 33–45 (1996). https://doi.org/10.1007/BF02244273
- Public Health
- Therapeutic Challenge
- Diagnostic Measure
- Financial Term
- Vigorous Intervention