総合病院精神科外来におけるリストカットを報告した患者の実態調査 : リストカットを引き起こす臨床背景の検討

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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.
愛知医科大学の論文
2007-03-15

総合病院精神科外来におけるリストカットを報告した患者の実態調査 : リストカットを引き起こす臨床背景の検討

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