The motivation of self-injurious behavior: A review of some hypotheses.

The literature on self-injurious behavior suggests 5 major hypotheses concerning the motivation of such behavior: (a) Self-injurious behavior is a learned operant, maintained by positive social reinforcement (positive reinforcement hypothesis); (b) self-injurious behavior is a learned operant, maintained by the termination of an aversive stimulus (negative reinforcement hypothesis); (c) self-injurious behavior is a means of providing sensory stimulation (self-stimulation hypothesis); (d) self-injurious behavior is the product of aberrant physiological processes (organic hypothesis); and (e) self-injurious behavior is an attempt to establish ego boundaries or to reduce guilt (psychodynamic hypotheses). Data bearing on each hypothesis are reviewed and evaluated. It is suggested that effective treatment may depend on a recognition of the different motivational sources of self-injurious behavior and the developmental relationships existing among these sources. Animal analog experiments may provide clues to the motivation of self-injurious behavior in cases in which human experimentation is ethically indefensible. (88 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On the use of aversive techniques in controlling self-injurious behavior.

Responds to G. P. Koocher's (1976) interpretation of B. G. Tate and A. S. Baroff's (1966) study on the use of shock in controlling self-injurious behavior and expresses appreciation for Koocher's concern about the use of aversive techniques in controlling difficult behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Case study: paradoxical response to naltrexone treatment of self-injurious behavior

Opioid receptor antagonists have been studied in the management of self-injurious behavior (SIB) in developmentally disabled individuals. The authors present a case of a severely retarded, autistic man whose SIB increased dramatically during a trial of naltrexone. A paradoxical increase in SIB, attributed to the extinction burst phenomenon during the initial period of nonreward, is known to occur during treatment with naloxone, a short-acting parenteral opioid antagonist. It has only once been reported during treatment with naltrexone, a long-acting orally administered agent. Opioid analgesic effects and learning theory can explain both increases and decreases in SIB after opioid blockade.     

A study of self-injurious and suicidal behavior in a veteran population.

This patient safety improvement study was conducted (1) to establish a database of intentional patient self-injuries and suicidal behavior among veterans in a large urban VA health care system, and (2) to investigate whether there were demographic and/or clinical characteristics of veterans who self-injure that might predict seriousness of suicidal intent and aid in future efforts at prevention. A total of 175 clinician-administered, post self-injury interviews were completed between 2006 and 2008 in a VA health care system in the Northeast. Findings suggest that self-injuries with high suicidal intent were characterized by male gender, older age, planning of self-injury, no wish to be saved, and a negative feeling about having survived. Additional results indicated that staff ratings of patient intent to die were significantly lower than patient self-rated intent to die, a finding that gives rise to questions of whether staff may tend to underestimate patient suicidal intent. Also, although more than 80% of the veterans in this sample considered their self-injurious actions impulsive, planning of self-injury was significantly associated with higher intent to die. Veterans who completed suicide during the study time period were significantly more likely than those who had nonfatal self-injuries to have experienced combat. The implications of these findings are discussed, including whether combat exposure may lead to an acquired capacity for lethal behaviors such as suicide (Joiner, 2005). (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Different types of self-injurious behavior in bulimia nervosa

This study introduces a new method of determining sex based on four morphological features of the posterior, distal humerus. The technique was developed on a 20th century anatomy series, the University of Toronto Grant Skeletal Collection, and was tested on 35 known individuals from the University of New Mexico Documented Collection and 93 individuals from the William M. Bass Donated Skeletal Collection. Four statistically significant characteristics relating to the carrying angle of the arm are identified (p < 0.05). Together, they are capable of determining sex with 92% accuracy.     

Client locus of control, problem perception, and interview behavior.

Administered Rotter's Internal–External Locus of Control Scale to 50 21–27 yr old clients at a university counseling center and asked Ss to list all their problems in order of priority. Problems were subsequently classified on an external–internal dimension. Analysis of the relationship of Ss' locus of control (LOC) and interview initiative was based on a subsample of 20 Ss whose initial interview was recorded. Findings show that Ss' LOC was related to the extent to which they assumed initiative and became behaviorally involved in directing the interview process. However, contrary to expectations, counselor control did not moderate this relation. It is suggested that internally oriented clients are more likely to assume initiative in the interview and attempt to redirect the treatment process in a direction preferred by them. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Verbal control of behavior: The effects of shouting.

Tested the implication of A. R. Luria's (1961, 1969) theory that children under 5 yrs of age would have more difficulty obeying instructions to inhibit a response the greater the intensity (loudness) of the instruction; this should not be true for children over 5 yrs of age. In the present study, 18 younger children (aged 3 yrs 6 mo to 4 yrs 9 mo) and 18 older children (aged 4 yrs 10 mo to 6 yrs 4 mo) played a game in which they were to follow instructions and either perform or refrain from performing simple acts. Instructions were loud, medium, or soft in intensity. Results for younger Ss were clear and significant in supporting Luria's theory. For older Ss, however, results do not neatly fit Luria's theory: Increased intensity facilitated compliance with instructions to inhibit a response. Data support the contention that an important aspect of language development is the decontextualization of meaning. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A study of human behavior: The clinical psychologist.

The psychologist "has derived some benefit by the mixture of being a doctor but not being identified with the mentally ill person." By reviewing personal and cultural forces the attempt was made to establish the variety of emphases current in clinical psychology. "Nearly every adjustment pattern observed among clinicians has occurred as a result of training and experience in some university, school or clinic. As yet, no completely satisfying or dominant component of needs has been discovered for the training and role of the clinical psychologist… . But it is a backward step to discard special curricular requirements for clinical psychologists." A prime requirement for a profession is "a disciplined and recognizable training program." The public that supports us will demand "a real and inexorable service contribution that we have implicitly promised… . We evolved on the impetus of service need." A number of current conflicts of the clinical psychologist are indicated. "The only way professional psychologists can hold to a responsible place is by partial separation from the academic, basic science psychologists." Leaders in clinical psychology should "be more than 80% in real clinical work with ill patients." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of self-injurious behavior maintained by access to self-restraint materials

Metastatic tumor is one of several etiologies of space-occupying masses in the orbit that accounts for 1%-13% of all orbital masses (1). In the adult patient population, breast cancer is the most common tumor to metastasize to the orbit followed by metastases from the lung, prostate and gastrointestinal tract (2). It is rare for carcinoid tumors to metastasize to the eye or to the orbit. Carcinoid tumors arise from Kulchitsky cells that originate in the neural crest. Histologically, these tumors resemble, but are not as aggressive as, adenocarcinomas. Most carcinoids arise in the gastrointestinal tract or the lung. The most common site for carcinoid metastases is the liver. On anatomical imaging studies, such as CT and magnetic resonance imaging, metastatic orbital carcinoid tumors appear as nonspecific tumor masses. Carcinoid tumors have an affinity for uptake of the radiopharmaceutical 131I-metaiodobenzylguanidine (MIBG) (3). We report a case of a patient with a known carcinoid tumor who developed a left orbital mass that demonstrated abnormal uptake of 131I-MIBG indicative of metastatic carcinoid tumor to the orbit.     

Sequential analysis of the effects of naltrexone on the environmental meditation of self-injurious behavior.

Accumulated evidence shows that biology and the environment can mediate self-injurious behavior (SIB) in persons with mental retardation. Whether pharmacological treatment alters the environmental mediation of self-injury is unclear. Opioid antagonist effects on sequential dependencies for self-injury were studied in the context of experimental single-subject double-blind placebo-controlled designs. Direct observational data were collected for 4 adult subjects in real time on daily rate of SIB and staff interactions. Clinically significant reductions (i.e., ≥ 33%) in SIB rate were observed for 3 of the 4 subjects. For all subjects, the magnitude of the sequential dependency between staff behavior and self-injury was significantly greater during treatment with naltrexone than during treatment with a placebo. Results are discussed in relation to behavioral mechanisms of action regulating medication effects for self-injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The behavior identity problem in generalizing from experiments.

R. Harré and P. F. Secord (1972) agree with L. Berkowitz and E. Donnerstein's (see record 1982-29293-001) contention that experiments aim at demonstrating the causal antecedents of behavior and show only that the behavior can but not necessarily does occur outside of the laboratory setting. However, Berkowitz and Donnerstein fail to see that Harré and Secord's criticism of the Byrne paradigm involving perceived similarity and liking for strangers is based on the question of whether behavior elicited in the lab is the same as behavior occurring in real life. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analysis of clinical trial data: The problem of outcome overlap.

The immediate goal of any clinical trial is to determine to which of a specified set of treatments future patients are to be assigned, particularly when analyzing data from clinical trials. When the outcome distributions of Experimental (E) and Control (C) treatments overlap, differences between treatment group means are not conclusive and may not be very informative, so a display of the overlapped frequency distributions and a summary measure of the probability of a random patient in E doing better than a random patient in C are needed. When outcome distributions overlap, the question of statistical model becomes crucial even when there are very significant differences between group means and very large effect sizes. Determining what patient variables interact with treatments is the route to optimal assignment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impulsive and compulsive self-injurious behavior in bulimia nervosa: prevalence and psychological correlates

Acute ischemia in the complete territory of the carotid or the middle cerebral artery may lead to cerebral edema with raised intracranial pressure and progression to coma and death. Although clinical data suggest benefit for patients undergoing decompressive surgery for massive space occupying hemispheric stroke, little data about the effects of this procedure on morbidity and outcome is available. The experimental data support an early surgical approach. For early and probably most effective treatment of severe, space-occupying cerebral ischemia, the "malignant" character of the brain edema has to be recognized early after onset of vessel occlusion. Hereby magnetic resonance imaging (MRI) may allow to determine the clinical significance of brain edema early after onset, simultaneously allowing to monitor the evolution of ischemia. We performed serial SE-MRI in rats with acute hemispheric infarctions treated by decompressive craniectomy. Focal cerebral ischemia was induced in 36 rats using an endovascular occlusion technique. Decompressive craniectomy was performed 4 and 24 hours after vessel occlusion in groups of 12 animals each. Twelve animals were not treated by decompressive craniectomy (control group). Four, 24, 48, 72 and 168 hours after MCAO all animals were examined with conventional T1- and T2-weighted SE-MRI. Shift of the midline structures and compression of the ventricles were scored. Changes in weight and neurological performance were measured daily. The infarction volume was calculated by triphenyltetrazolium chloride staining 168 hours after MCAO. While mortality in the untreated group was 33.3%, none of the animals treated by a decompressive craniectomy died (mortality 0%). Neurological behaviour, weight loss and infarction volume were significantly better in the animals treated by early decompressive craniectomy (p < 0.05). Four hours after MCAO all untreated animals showed a massive shift of the midline structures and a massive compression of the ventricles; only 7 of 12 animals treated early by craniectomy showed mild mass effects. Correlation of the histological brain damage with T2-weighted MRI 4 hours after MCAO was poor (r = 0.41); later than 24 hours there was a good correlation (r > 0.7). Our results suggest that decompressive craniectomy in malignant cerebral ischemia reduces mortality and significantly improves outcome. If performed early after vessel occlusion, it also significantly reduces infarction size. In the acute phase of hemispheric infarction conventional SE-MRI is not sensitive in estimation of infarction size. Later than 24 hours, conventinal SE-MRI proved to be useful in monitoring brain edema and infarction size in this rat model of malignant hemispheric stroke.     

The normative development of child and adolescent problem behavior.

The aim of this study was to identify normative developmental trajectories of parent-reported problems assessed with the Child Behavior Checklist (CBCL; T. M. Achenbach, 1991) in a representative sample of 2,076 children aged 4 to 18 years from the general population. The trajectories were determined by multilevel growth curve analyses on the CBCL syndromes in a longitudinal multiple birth-cohort sample that was assessed 5 times with 2-year intervals. Most syndromes showed a linear increase or decrease with age or a curvilinear trajectory, except for thought problems. Trajectories for most syndromes differed for boys versus girls, except those for withdrawn, social problems, and thought problems. These normative developmental trajectories provide information against which developmental deviance in childhood and adolescence can be detected. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Momentum versus extinction effects in the treatment of self-injurious escape behavior

S. Enteritidis HY-1 isolated during quarantine from chicks imported from England was used. Laying hens at the age of 34 weeks were inoculated orally with 10(10) organisms (10 birds), intramuscularly with 10(9) (5 birds), and intravenously with 10(9) (5 birds). Egg production did not change in hens infected orally, although it was reduced in hens infected intramuscularly for 2-3 weeks post inoculation. For one month, internally infected eggs of which the shells were not contaminated were found: one out of 65 eggs in hens infected orally and three out of 36 eggs in hens infected intramuscularly. This experiment demonstrated the ability of S. Enteritidis isolated from chicks imported from England to cause transovarian infection.     

Syndrome of problem behavior in adolescence: A replication.

An earlier study of ours that used data collected in 1972 found that a single common factor accounted for the positive correlations among a number of adolescent problem behaviors, including problem drinking, marihuana use, delinquent-type behavior, and precocious sexual intercourse. The present maximum-likelihood factor analyses replicated this finding on new samples of male and female 11th- and 12th-grade students tested 13 years later, in 1985. The findings lend further support to the concept of a syndrome of problem behavior in adolescence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

When interventions harm: Peer groups and problem behavior.

This article explored developmental and intervention evidence relevant to iatrogenic effects in peer-group interventions. Longitudinal research revealed that "deviancy training" within adolescent friendships predicts increases in delinquency, substance use, violence, and adult maladjustment. Moreover, findings from 2 experimentally controlled intervention studies suggested that peer-group interventions increase adolescent problem behavior and negative life outcomes in adulthood, compared with control youth. The data from both experimental studies suggested that high-risk youth are particularly vulnerable to peer aggregations, compared with low-risk youth. We proposed that peer aggregation during early adolescence, under some circumstances, inadvertently reinforces problem behavior. Two developmental processes are discussed that might accounts fro the powerful iatrogenic effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using analog baselines to assess the effects of naltrexone on self-injurious behavior

Healthy male and female human volunteers were exposed to 50 ppm or 100 ppm trichloroethylene (Tri) by inhalation for 4 h. Blood and urine samples were taken at various times before, during, and after the exposure period for analysis of glutathione (GSH), related thiols and disulfides, and GSH-derived metabolites of Tri. The GSH conjugate of Tri, S-(1,2-dichlorovinyl)glutathione (DCVG), was found in the blood of all subjects from 30 min after the start of the 4-h exposure to Tri to 1 to 8 h after the end of the exposure period, depending on the dose of Tri and the sex of the subject. Male subjects exposed to 100 ppm Tri exhibited a maximal content of DCVG in the blood at 2 h after the start of the exposure of 46.1 +/- 14.2 nmol/ml (n = 8), whereas female subjects exposed to 100 ppm Tri exhibited a maximal content of DCVG in the blood at 4 h after the start of the exposure of only 13.4 /- 6.6 nmol/ml (n = 8). Pharmacokinetic analysis of blood DCVG concentrations showed that the area under the curve value was 3.4-fold greater in males than in females, while the t1/2 values for systemic clearance of DCVG were similar in the two sexes. Analysis of the distribution of individual values indicated a possible sorting, irrespective of gender, into a high- and a low-activity population, which suggests the possibility of a polymorphism. The mercapturates N-acetyl-1,2-DCVC and N-acetyl-2,2-DCVC were only observed in the urine of 1 male subject exposed to 100 ppm Tri. Higher contents of glutamate were generally found in the blood of females, but no marked differences between sexes were observed in contents of cyst(e)ine or GSH or in GSH redox status in the blood. Urinary GSH output exhibited a diurnal variation with no apparent sex- or Tri exposure-dependent differences. These results provide direct, in vivo evidence of GSH conjugation of Tri in humans exposed to Tri and demonstrate markedly higher amounts of DCVG formation in males, suggesting that their potential risk to Tri-induced renal toxicity may be greater than that of females.     

Maternal ideology and adolescent problem behavior.

Assessed the relationship of maternal traditional ideology to adolescent problem behavior in a correlational study. Mothers of 184 junior and senior high school students were interviewed about their beliefs about society and morality and about their child-rearing practices; their sons and daughters responded separately to questionnaires that included reports of their own behavior with respect to alcohol and marihuana use, sex, and political activism. Results of the correlational analyses supported the main hypothesis that the more traditional the mother's ideology, the less the adolescent's involvement in problem behavior. A 2nd hypothesis, that maternal affectional interaction and controls, taken in conjunction with ideological beliefs, would account for more of the variation in adolescent problem behavior, was partially supported. In general, the associations between mother's ideology and adolescent behavior were stronger for daughters than for sons. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)