Self-injurious behavior (pathomimy)

There are many reasons why patients self-harm. In each case, all sorts of motives compel them to act. It is based on a different psychopathology, which requires a differential approach to treatment.

To prescribe the right treatment, the doctor must understand not only the causes of self-harm, but also determine the nature of psychopathology. Distinguish:

  • deliberate self-harm for profit (simulation);
  • conscious self-harm in response to delusional beliefs;
  • self-harm as a result of compulsive actions, such as picking, scratching, rubbing;
  • conscious or unconscious self-harm to suppress psychological problems that are unconscious to the patient;
  • unconscious damage done to another person in order to satisfy the psychological need of the offender (Munchausen’s disease by proxy).

The disability of the malinger is more of a moral and ethical problem than a psychiatric one; the simulator is a sociopathic person. More often there are male simulators of middle age. The goal, which is external, understandable and conscious, may be the achievement of material benefits or the avoidance of professional difficulties. To achieve his goals, a criminal can create certain living conditions, forge medical documents, imitate the symptoms of a disease, and cause damage.

Patomimia (from the Greek pathos – suffering, disease + mimёsis – imitation, image) or Munchausen’s syndrome is characterized by overly dramatic, implausible complaints about an imaginary somatic disease (skin, neurological, cardiological, etc.) and a tendency to self-harm to stage its symptoms. Disorders of this circle belong to the number of psychosomatic and therefore it is no coincidence that they were first identified in general medicine. Thus, Munchausen’s syndrome was described by the English surgeon M. Asher in 1951. One of the particular variants of pathomymia is manifested mainly by self-injuries that mimic diseases of the skin and its appendages.

Self-damaging skin diseases include:

  • dermatomania (irrepressible desire to damage the skin, its appendages, mucous membranes);
  • trichotillomania (compulsive hair pulling);
  • onychophagia (nail biting);
  • cheilophagia (lip biting);
  • dermatotlasia (biting the skin within the nail bed).

The most common form of dermatopathomimia is the so-called neurotic excoriations – damage that occurs as a result of repeated scratching of the skin by the patients themselves. This phenomenon is also defined by the concepts of “psychogenic excoriations”, “compulsive scratching of the skin”, “pathological scratching of the skin”. The proportion of patients with neurotic excoriations is 2% of all patients with dermatological disorders and 9% among patients with pruritus. More often (52-92%) neurotic excoriations occur in women. The dermatological picture of neurotic excoriations is extremely diverse: from minor abrasions with erythematous edges to deep excoriations with bloody crusts; from small pink scars to deep scars.

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