IntroductionNon-Suicidal Self-Injury (NSSI) is considered a dysfunctional way of dealing with problem situations.ObjectiveThis study aimed to investigate the problem solving capacity in adults with NSSI compared to controls.MethodsThirty-three patients who sought treatment for NSSI (NSSI group) were compared with 33 individuals without psychiatric disorder (control group). We also investigated Axis I disorders, executive functions and problem solving capacity.ResultsIn both groups, the majority were women (77.25%) with a mean age of 30 years, and the beginning of NSSI behavior of 16 years. The most common NSSI behaviour was skin cutting, and the most common reason given for engaging in that behaviour was “to stop negative feelings”. The most common psychiatric comorbidities were major depressive disorder (60.6%). Compared to controls, the group with NSSI showed lower results in relation to problem solving capacity (P = 0.000) and mental flexibility (P = 0.007). Deficits in problem solving capacity may be a reflection of low mental flexibility of adults with NSSI. This may be a risk factor for the beginning of NSSI and the persistence of it in adulthood.ConclusionEarly identification and treatment focused on problem solving capacity during the adolescence may prevent the chronicity of NSSI.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Objective:To investigate the clinical differences between intermittent explosive disorder (IED) (disorder of aggression primarily directed towards others) and nonsuicidal self-injury (NSSI) (disorder of aggression predominantly directed towards the self) in order to better understand the different clinical subtypes of aggression.Methods:We used treatment-seeking samples to compare demographic and clinical correlates between 82 participants with IED and 55 participants with NSSI.Results:The IED group was older, more likely to be male, in a relationship, and employed than the NSSI group. With respect to clinical variables, the NSSI group had more severe depressive symptoms and more social adjustment difficulties. Regarding psychiatric co-morbidities, the IED group had higher rates of generalized anxiety disorder. On the other hand, the NSSI group had higher rates of major depressive disorder, agoraphobia, substance use disorder, and bulimia nervosa.Conclusions:Individuals with NSSI may benefit from better management of psychiatric comorbidities, specifically depressive symptoms and social adjustment difficulties. Conversely, the treatment of individuals with IED may be improved by targeting comorbid generalized anxiety disorder. Our results provide important insight for the development of tailored interventions for specific subtypes of aggression.

Self-mutilation behavior (SMB) is defined as all behaviors involving deliberate infliction of direct physical harm to one's own body without any intent to die. This case report describes the successful treatment of severe SMB in a 23-year-old woman, with multiple comorbidities. The patient was admitted to the multiple impulse-control disorder outpatient unit for treatment of SMB. This patient was submitted to the SCID-I/P, SCID-II/P, Y-BOCS, DY-BOCS, and Functional Assessment of Self-Mutilation (FASM) for diagnosis of SMB as well as comorbidities. The most frequently SMB presented was skin cutting which was associated with relief of intolerable affects. Others comorbidities presented by her were Obsessive-Compulsive Disorder(OCD), Social phobia, Bulimia, and Depression Disorder(DD) with high levels of anxiety. The patient was submitted to an interdisciplinary treatment. Treatment included cognitive-behavior therapy(CBT), nutritional orientation, and psychopharmacology which begun with venlafaxine (150mg/d) followed by fluoxetine(80mg/day), and carbamazepine(400mg/day), without success. After ten months of treatment the patient was stabilized in terms of DD, bulimic behaviors, and anxiety. OCD symptoms were mild, and SMB became rare. At this time the patient was taking ziprazidone(160mg/day), sertraline(200mg/day), and topiramate(100mg/day). These medications were maintained as well as CBT, with emphasis in social skill, and problem-solving techniques. After three more months of treatment she had stopped cutting herself and the OCD symptoms disappeared.Conclusion:the collection of treatment modalities implemented by multidisciplinary team may serve as a guide to treat severe SMB. In addition, the association of drugs with different site of action, but all for impulse control, may contribute for the efficacy observed here.

Self-injurious behaviors(SIB) may be described as a behavior compatible with obsessive compulsive disorder(OCD), as well as part of Impulse-Control Disorders(ICD).Aims:Compare obsessive compulsive symptoms(OCS) and impulsivity between two groups: OCD and SIB patients.Method:Five patients in outpatient treatment for SIB were compared to five OCD patients. The following instruments were applied:Y-BOCS, D-YBOCS, USP-SPS, FASM, SCID, BIS-11.Results:The SIBs were repetitive and occurred from 2 to 100 episodes during the last year. The behavior relief intolerable affects and the consequent pain were mild. The patients spent some time planning the acts, especially when it was not possible to do it immediately. The most common behavior found were: skin cutting(80%), self-hitting(60%), self-biting(60%), and the patients presented more than one type of SIBs. The motivation included: relieving feelings of "numbness" (80%); punishing themselves(80%); feeling something (even pain)(60%); feeling relaxed(60%); and stopping bad feelings(60%). SIB patients also presented OCS(100%) with more prevalence of sensory phenomena preceding repetitive behaviors(100%) than among OCD patients(60%), although they were not statistically significant. Despite the fact that there were no difference between the two groups in impulsivity according to BIS-11(66,20±18,10 SD for SIB and 68,40±11,10 SD for OCD, p=0,82), SIB patients had more diagnosis of others ICD(100%).Conclusion:This study raises the question: Would SIB be an OCS, that increases it severity, or a nosologic entity with its own characteristics, where OCD comobidity is frequent? The sample size is not large enough to answer these questions, although it seems that some symptoms are shared with both disorders.