[Self-destructive behaviour - occurrence and typological classification in an university psychosomatic unit]

The occurrence of self-destructive phenomena (direct self-harm; self-induced disease; self-harm delegated to medical staff) in all patients referred to the psychosomatic consultation service and all outpatients during 14 months and all discharged of the psychosomatic ward during 2 months (N=1057) is determined by the typological-descriptive assessment of Willenberg et al. (1997). Self-destructive behaviour was documented in n=79 cases (7.5%), in 40.5% of these on suspicion. 62% showed recurrent self-harm. In 15% there was a high risk to health, in 4% mortal danger. 51% hurt themselves overtly, 24% secretly. Direct self-harm occurred in 71%, self-induced disease in 48%, delegated self-harm in 35% of the cases (39% overlap). An average of 15 years passes between early precursor symptoms and the reference to the psychosomatic unit. Compared to the control group of psychosomatic patients, self-destructive patients are more often female (81%), younger, less frequently married (statistically confounded with age), more frequently medically certified and sick for more than one year. In sum, they have as many somatic diagnoses (M=0.75) but significantly more psychosocial diagnoses (ICD-10: F) (M=1.86 vs. M=1.40). Bulimia, addiction / substance abuse, and personality disorders proved to be more frequent co-diseases, anxiety disorders were underrepresented. Occurrence and relevance of self-destructive or facticious disorders are apparently underrated, so far. ICD-10 criteria are insufficient to cover all relevant types of self-destructive behaviour.