[Self-injury in hospitalized patients: Concerning 19 cases].

INTRODUCTION: Self-mutilating behaviour is expanding, especially among adolescents and patients with a psychiatric disorder.

CLINICAL MATERIAL: We have tried to describe the self-mutilating behaviour in Moroccan inpatients of the psychiatric department of Mohammed V Military Hospital of Rabat, through a prospective and descriptive longitudinal study over a period of four months, based on a questionnaire prepared according to the literature data to allow discussing its results.

RESULTS: The rate of participation was 90.4%, or 19 patients. All patients were male. The age of onset of self-injury was between 14 and 62 years with an average of 26.3 years. Only two patients had an age of onset in adolescence, before age 20, the majority (57.8%) in a young adult age. Eight patients (42.1%) report having experienced physical abuse while only four patients were sexually abused, especially by relatives. The number of episodes varied from one episode in twelve cases (63.15%), to seven cases (37%) with repetitive self-mutilation. The most common type of self-injury was cuts (16 cases), twelve patients inflicted burns, and two patients inflicted fist blows. The forearm was the most common location. All patients were unable to resist the pressing need to self-harm after various reasons, often in a relational or professional frustration state. The use of concomitant substances to self-mutilation was reported in nine episodes, alcohol in seven episodes (24.1%) and cannabis in three episodes (10.3%). Only five patients reported receiving medical care for physical consequences of self-harm. Only two patients underwent a psychiatric care following their self-mutilation and admitted to our service. Personality disorders was the psychiatric disorder most diagnosed in our sample, followed by mood disorders. Borderline personality disorder was the pathological personality disorder most commonly diagnosed in our study with nearly two thirds of cases, followed by antisocial personality.

DISCUSSION: The size of our population and the prevalence of self-harm are comparable to most studies on self-mutilation in clinical populations. The low prevalence of patients beginning this behaviour early was low in our population, explained by the pre-commitment visits, which limit their integration into the military body. The role of physical and sexual abuse in childhood in the development of self-harm behaviour in adolescence is still a subject of discussion, but shame and fear of the breakdown of the family union have significantly limited the mention of such a history by our patients. The use of self-harm to relieve an intolerable anger thus the absence of suicidal intent, confirms the difference between self-harm and suicide. The intolerant nature of the military environment to self-behaviour limits its repetition and allows their early management. The high frequency of personality disorders in our sample is consistent with studies indicating high levels in patients who self-harm, including borderline personality, and supports that the DSM-IV considers self-harm to be a diagnostic criterion of this personality disorder.

CONCLUSION: Self-injury is a common pathological behaviour and serious in its relational impact. Our present data collected mainly similarities with that of the literature. For cultural reasons, the self-mutilation in our sample is more linked to an impulse control problem than to childhood abuse. So the establishment of a system of care adapted to preserve the privacy of patients, understanding of self-harm, informing the general public and the early treatment of victims of abusive families seems essential to reduce expansion of this behaviour.