restricted access Self-Injury: Toward a Biological Basis
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SELF-INJURY: TOWARD A BIOLOGICAL BASIS IVOR H. JONES* Introduction The primary aim of this paper is to relate existing observations on self-injury in animals to self-injurious states in man. Several approaches to the substantial problem ofself-injury are to be found in the literature: Lester [1] examined it from a psychological point of view, Simpson [2] from a clinical one, and Carr [3] explored motivational hypotheses. Others have been concerned with the precise definition of the most common of these syndromes—attempted suicide [4-6]—and, within that syndrome, its relationship to personality and suicide intent [7]. Similarly, detailed studies have been carried out over the last decade into consummated suicide [8] and substantial but fewer studies of self-injury in mentally subnormal children [9]. However, most of the psychiatric work has been of an analytic rather than of a synthetic nature; that is, the various self-injurious syndromes have been examined separately. There has been much less interest in bringing them together by demonstrating features held in common and even less interest in establishing a biological basis. The approach adopted here suggests a search for biological roots for some human syndromes by examining the proposition that they are variations of a related but less complex behaviour shown by some animals . The limitation of this biological approach is that, in its most rigorous form, it cannot encompass affective, cognitive, and all social data, which are a substantial part of psychiatric formulations and cannot be examined directly in animals. In an attempt to overcome these limitations , this paper formulates biologically based hypotheses that can be The author thanks Lynn Alexander and Dorothy Frei for their critical appraisal of earlier drafts of this paper.»Department of Psychiatry, University of Melbourne, St. Vincent's Hospital, Fitzroy, 3065, Victoria, Australia.© 1982 by The University of Chicago. All rights reserved. 0031-5982/83/2601-0318$01.00 Perspectives in Biology and Mediane, 26, 1 ¦ Autumn 1982 | 137 extended to cognitive and affective aspects of the syndromes to allow testing and potential invalidation, albeit with less than total precision. Ideas will be developed in the following way: first, the types ofanimal self-injury will be outlined and the associated state of the animal and its social context will be described. This will be followed by a discussion of the problems of relating animal data to human syndromes. Accounts of human self-injurious syndromes to which the approach may be applied then follow. Animal Studies Evidence recently reviewed [10] establishes that primates and other mammals inflict nonaccidental injury on themselves in captivity. This injury occurs under recognizably similar conditions: long-term confinement or confinement combined with some immediate precipitant which engenders agitation, fighting behaviour, rage, or frustration. It is possible to distinguish two classes of injury. 1. Severe.—This class of injury is preceded by confinement and precipitated by an acute stress. The confined macaque inflicts severe injury with its teeth and claws, gashing limbs, trunk, and scrotum and making deep bites to accessible sites on its own body. The animal's state has been variously interpreted as "agitated," "aggressive," "sexual," or "frustrated " [11-14]. Severe self-injury also occurs in rodents during druginduced agitation in which they may bite off a limb, and this can lead to death [10]. Head banging may be seen in severe forms with similar accompaniments and similar antecedents [15]. 2.Mild.—This has been described in macaques and other mammals following confinement [12, 16], often without an obvious precipitant, such as acute agitation. It includes scratching of such severity as to induce excoriation, hair pulling, gnawing discrete areas, picking, and pinching. Once started, this injurious behaviour tends to become stereotyped. STATE OF THE ORGANISM In all known instances, the severe class of self-injury and some head banging is associated with acute agitation, while the milder self-injury and head banging may occur without observable signs ofacute agitation. Mason [17] has drawn attention to the extensive "fearfulness" of isolates. It is possible that this fearfulness leads to agitation that in turn induces self-injury. The apparent difference in the state of the animal in the two classes of injury may be construed in quantitative or qualitative terms: there...