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Am J Psychiatry 1992; 149:221-226
Copyright © 1992 by American Psychiatric Association
Self-mutilation in personality disorders: psychological and biological correlates
D Simeon, B Stanley, A Frances, JJ Mann, R Winchel and M Stanley
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York.
OBJECTIVE: The goal of this study was to determine whether self- mutilators
with personality disorders differ from nonmutilators with personality
disorders in impulsivity, aggression, and other psychopathology and whether
serotonergic dysfunction contributes to self-mutilation. METHOD: Twenty-six
self-mutilators with personality disorders were matched to 26 control
subjects with personality disorders for gender, age, education, axis I
diagnosis of affective disorder, and axis II diagnosis of personality
disorder. Numerous indexes of psychopathology as well as CSF
5-hydroxyindoleacetic acid (5- HIAA) levels and platelet imipramine binding
sites (Bmax) and affinity (Kd) were determined. RESULTS: Self-mutilators
had significantly more severe character pathology, had greater lifetime
aggression, and were more antisocial than the control subjects. The
self-mutilators scored higher on the Hamilton Rating Scale for Depression
but not on the Beck Depression Inventory or the Beck Hopelessness Scale.
The two groups did not differ on the Buss-Durkee Hostility and Guilt
Inventory or on the Sensation Seeking Scale. The degree of self-mutilation
was significantly correlated with impulsivity, chronic anger, and somatic
anxiety. Both self-mutilation and impulsivity showed significant negative
correlations with Bmax, although the two groups did not differ in CSF
5-HIAA levels or in platelet imipramine binding. CONCLUSIONS: The results
demonstrate the contribution of severe character pathology, aggression,
impulsivity, anxiety, and anger to self-mutilation and provide preliminary
support for the hypothesis of underlying serotonergic dysfunction
facilitating self-mutilation.
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