Self-destructive behaviour - occurrence and typological classification in an university psychosomatic unit

Author(s): Burkert, U., Danzer, G., Willenberg, H., Klapp, B. F.

Journal/Book: Z Psychosom Med Psychother. 2000; 46: Theaterstrasse 13, , D-37073 Gottingen, Germany. Vandenhoeck & Ruprecht. 286-303.

Abstract: The occurrence of self-destructive phenomena (direct self-harm; self-induced disease; self-harm delegated to medical staff) in all patients referred to the psychosomatic consultation service and all outpatients during 14 months and all discharged of the psychosomatic ward during 2 months (N = 1057) is determined by the typological-descriptive assessment of Willenberg et al. (1997). Self-destructive behaviour was documented in n = 79 cases (7.5%), in 40.5% of these on suspicion. 62% showed recurrent self-harm. In 15% there was a high risk to health, in 4% mortal danger. 51% hurt themselves overtly, 24% secretly. Direct self-harm occurred in 71%, self-induced disease in 48%, delegated self-harm in 35% of the cases (39% overlap). An average of 15 years passes between early precursor symptoms and the reference to the psychosomatic unit. Compared to the control group of psychosomatic patients, self-destructive patients are more often female (81%), younger, less frequently married (statistically confounded with age), more frequently medically certified and sick for more than one year. In sum, they have as many somatic diagnoses (M = 0.75) but significantly more psychosocial diagnoses (ICD-10: F) (M = 1.86 vs. M = 1.40). Bulimia, addiction/substance abuse, and personality disorders proved to be more frequent co-diseases, anxiety disorders were underrepresented. Occurrence and relevance of self-destructive or factitious disorders are apparently underrated, so far. ICD-IO criteria are insufficient to cover all relevant types of self-destructive behaviour.

Note: Article Fliege H, Standort Virchow Klinikum, Charite, Med Klin Mit Schwerpunkt Psychosomat & Psychother, Augustenburger Pl 1, D-13353 Berlin, GERMANY

Keyword(s): factitious disorder; self-destructive behaviour; self-inflicted wounds; epidemiology; classification; co-morbidity; FACTITIOUS DISORDERS; MUNCHAUSENS-SYNDROME; UNKNOWN ORIGIN; PERSONALITY; DIAGNOSIS; CRITERIA; ICD-10; UPDATE; FEVER

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