What is pathomimia and why people injure themselves. The main signs of self-injurious behavior. Basic diagnostic methods and the most effective treatments. Pathomimia is a condition in which a person deliberately hurts himself, but sincerely considers the traces of his "crime" to be a skin disease. That is why it received such a name, which literally means "the image of suffering, pain" from Greek. Most often, pathomimia is of a mental nature and manifests itself in the form of skin lesions - scratching, wounds, cuts, burns, bites. Localization of such "marks" - arms, chest, face, legs, neck, that is, places where a person can reach on their own.
Description and mechanism of development of pathomimia
According to statistics, 0.8% of the inhabitants of our planet already suffer from pathomimy, most of whom are women. And thanks to the modern rhythm of life, which constantly provides food for the occurrence of mental disorders, depression and addictions (alcoholic, drug), this number is steadily growing.
The mechanism for the development of self-injurious behavior lies in the fact that at first the process of inflicting wounds is a kind of reaction to a certain stressful or psycho-traumatic factor of sufficient strength. Further, developing, the disorder forces a person to mutilate himself even with the slightest experience. At the same time, he experiences a whole palette of feelings: before the very act of injury, the patient experiences a strong emotional shock, panic, anxiety, and after it - a feeling of physical satisfaction, relief. So the vicious circle of disorder is closed and does not allow his captive to get out of the captivity of this mental state.
If we consider pathomimy from the side of in-depth analysis, it is one of the ways to avoid emotional overload - scandals, conflicts, worries, life troubles. In this way, a person replaces the usual feelings for such states - anxiety, fear, a sense of his own inferiority, unfulfillment. Sometimes, by inflicting pain and wounds on himself, the "self-torturer" tries to return the feeling of life, sensitivity, emotionality. Often this method of "feeling at least something" is chosen by people who have finally lost faith in everything and everyone - with a strong post-traumatic syndrome, prolonged depression, apathy.
Most often, "self-torturers" choose a variety of methods of self-harm: they scratch themselves, bite, pull out their hair, inflict wounds and burns on themselves, and bite heavily on their nails and the skin around them. Depending on this, pathomimia has several varieties:
- Dermatomania - the desire to injure the skin, hair and mucous membranes;
- Onychophagia - craving for nail damage;
- Dermatotlasia - the desire to injure the skin around the nail bed;
- Cheilofagia - a tendency to damage the lips, inner surface of the cheeks;
- Trichotillomania - the urge to pull out hair.
Most often in clinical practice, neurotic excoriation occurs - one of the forms of dermatomania, which manifests itself in the patient's uncontrollable desire to scratch his skin. The range of results of such "manipulations" can be varied - from superficial abrasions to deep inflamed wounds with bloody crusts. Sometimes pathomimia can be complicated by dermatozoal delirium, in which a person is manic devoted to his "disease".
Causes of pathomimia
Self-injurious behavior is always based on auto-aggression - a mentally normal person will not intentionally harm himself. That is, the main cause of pathomimia is mental disorders caused by psychogenic factors. At the same time, the actions of a person with such behavior have two directional vectors: he seeks to injure the skin (mucous membranes) and initiate diseases of a dermatological profile. Given this nature of self-harming behavior, the most fertile ground for its development is created by:
- Mental disorders … Most often, hysteria, depression, schizophrenia, various phobias and manias, dissociative, obsessive-compulsive disorders, autism, psychosis and neurotic conditions can lead to the occurrence of pathomimia.
- Dependencies … No less dangerous in terms of the appearance of desires to harm oneself, addiction to bad habits - alcoholism, drug addiction.
- Post-traumatic syndrome … Self-injurious behavior can be a response to one or repeated traumatic situations: violence, including sexual violence, participation in hostilities, severe physical injury, etc.
- Organic brain damage … An uncontrolled desire to injure oneself can appear in the presence of Alzheimer's disease, atherosclerosis, alcohol intoxication, heavy metals, the consequences of chronic renal and / or heart failure.
- Intellectual development problems … The tendency to engage in self-injury can be observed in people with mental retardation, imbecility.
- Behavioral disorders … The effect on the body, including the brain, of the intake of psychoactive substances, physiological disorders can also cause a person to want to injure himself. Disorders of drives and sexual preference can also be attributed to this.
- Personality features … Infantilism, hypersensitivity, anxiety, aggressiveness, emotional instability can push a person to such an extraordinary manifestation of internal experiences.
There is evidence that diseases that do not relate to the mental sphere - somatic (endocrine, professional pathologies), as well as genetic abnormalities, can provoke the desire to injure oneself.
Manifestations of pathomimia in humans
Self-injurious behavior is characterized by the systematic and conservative method of traumatization. That is, the patient injures himself regularly and in the same way. At the same time, he can do it secretly, unconsciously, which is most often found in mental and behavioral disorders. But there are cases when a person suffering from pathomimy injures himself, fully understanding his behavior, even demonstratively (in borderline states). There are also incidents when people self-mutilate in order to simulate the disease. The main symptoms of pathomimia can be divided into several groups:
- By the nature of the damage … Such skin lesions have no apparent cause and are of the same type in most cases.
- By location of damage … Pathomimetic injuries are localized exclusively in places accessible to the patient himself and, since they are inflicted on purpose, are placed in the correct order, linearly.
- For the treatment of injuries … Dermatological methods of treating injuries do not work, as the patient inflicts new injuries on himself over and over again. Thus, they fall into the "chronic" or "untreatable" section.
- By the behavior of the patient … Often a person who suffers from pathomimia complains of itching, pain in the places of self-torture. At the same time, he denies any attempts to link his condition with mental problems, and even more so to seek help from a psychiatric specialist.
The visible results of such self-destructive tactics of behavior can be the following injuries on the patient's body:
- Superficial skin lesions … The most common signs of self-injury are scratches, scratches, abrasions. Often on the skin of patients, you can find traces of teeth bites, cuts, punctures.
- Damage to the skin by fire, aggressive substances … Following their uncontrollable desires or beliefs, "self-torturers" can leave burns on their skin (open fire, cigarettes, iron, etc.), which, due to lack of treatment or continued trauma, can turn into erosion.
- Consequences of skin damage … Often, a specialist who examines the skin of a patient with pathomimy can see not only fresh traces of self-harming behavior, but also its consequences - ulcers, necrotic changes, vesicular rashes, deep wounds, scars, dermatitis, subcutaneous hemorrhages.
- Hair damage … If a patient suffers from a mania of damage to his hair, then on his body you can find areas of torn hairs with redness, abrasions, scars, atrophy.
At the same time, patients can carefully monitor their appearance - squeeze out non-existent acne and pimples, open bubbles, etc. If a person develops dermatozoal delirium, he can persistently demonstrate his terrible skin "disease" to others and doctors, meticulously collect its evidence (hairs, scales and crusts, pieces of nail plates) into boxes and jars and insist that they be examined. This self-damaging behavior forces them to devote a lot of time to hygiene and personal care: they often and thoroughly wash themselves, constantly wash and boil linen and clothes. They spend a long time looking at their "problem" on the skin under a magnifying glass, trying to get rid of it. For example, if they are sure that some kind of parasites live in the skin, they can use their nails, stabbing and cutting objects, acids in order to get them out of there. Some people with a self-injurious disorder are so “professional” in imitating dermatological pathologies that even an experienced specialist can find it difficult to immediately recognize the “catch”. The most common diseases that are "exploited" by patients with pathomimia are hemorrhagic vasculitis, seborrheic pemphigus.
Diagnosis of pathomimia
Given that the vast majority of people with self-injurious behaviors do not understand the real cause of their skin problems, it is not easy to diagnose pathomimy. The task is further complicated by the fact that often patients do not even remember the moment of inflicting damage to themselves. They do it “on the machine”, with their consciousness turned off. It is quite natural that when they visit a doctor, they will in every possible way deny the mental side of the problem.
This specificity of the disorder determines an integrated approach to its diagnosis and includes 3 main methods: psychological conversation, histological examination of the skin, ultrasound scanning of the skin.
The first violin among the listed methods of diagnosing pathomimia is played by the psychological conversation with the patient. It helps the specialist to reveal the true cause of dermatological problems, and the patient - to realize it. After all, it is not uncommon for patients with pathomimy to be perplexed and indignant at the fact that instead of real treatment of skin problems, they are sent for consultation to a psychiatrist. Moreover, they can immediately name the culprits of their condition - from banal microbes to intentional influences of other people (poisoning, damage, evil eye, etc.), but not themselves. Therefore, psychological communication with the patient is built on the principle of tactful and consistent questioning.
As additional methods of confirmation or refutation of the psychogenic nature of dermatological problems, histological and ultrasound studies are used. With the help of these methods of additional research, it is possible to establish the real nature and nature of the damage.
Important! The extreme difficulty of diagnosing self-injurious behavior often makes this pathology "invisible". So, in practice, there is a case when pathomimia was successfully masked for 18 years.
Features of the treatment of pathomimia
Pathomimy is difficult not only in diagnosis, since not everyone is ready to hear that their health problem is of a mental nature. Some patients, after disclosing the true causes of their dermatological "problems", simply do not come for a second appointment, look for another specialist or other medical institution, or even stop trying to find help in official medicine and turn to alternative methods of treatment. Given this feature of the pathology, the treatment of pathomimia must be comprehensive.
Help of psychologists in the treatment of pathomimia
Since the root cause of self-harming behavior in most cases is psychogenic disorders and problems, psychotherapy is assigned a fundamental role in the treatment of pathomimia. The doctor is tasked with identifying the cause of the patient's aggressive attitude towards himself and finding the optimal auto-aggression treatment regimen for him.
In order to return to the patient with pathomimy internal psychological balance and self-love, specialists can use several techniques. Cognitive-behavioral therapy is most often used for this. In cases where the patient's consciousness does not record the moments of self-harm, psychoanalysis techniques can be used to improve his condition.
Generally hospitalization is not indicated here. If the "self-torturer" has serious mental and behavioral disorders, obsessive or delusional states, treatment is carried out in a hospital setting. This tactic helps not only to conduct effective therapy of conditions, but to keep this pathology under control. Including in relation to the further self-mutilation of patients.
Medicines against pathomimia
Prescription of medical devices for pathomimia is carried out when there is a need to treat skin lesions and / or psychological disorders.
In order to remove the consequences of self-injurious behavior, depending on the degree of trauma to the skin, the following topical preparations (gels, ointments, suspensions) can be used:
- Anti-inflammatory drugs … Most often, syntomycin, tetracycline, ichthyol ointment, Baneocin, Gentamicin, Erythromycin, Tyrozur are prescribed for the treatment of skin damage with elements of inflammation during pathomimia.
- Wound healing drugs … In order to stimulate regenerative processes in the skin, Solcoseryl, Argosulfan, Levomekol, D-panthenol, Baneocin may be included in the treatment regimen.
- Anti-scar drugs … If there are deep injuries and scars on the patient's skin, a specialist may prescribe special local dissolving agents - Contractubex, Zeraderm, Dermatiks, Mederma, Kelofibraza, Fermenkol, Regivasil.
- Recovery drugs … Often, complex ointments and gels are used to treat pathomimic damage, which include several directions of action at once - anti-inflammatory and regenerative. For example, Panthenol, Levomekol, Solcoseryl.
In order to correct mental and behavioral abnormalities, the treatment regimen includes neuroleptic, psychotropic drugs, antidepressants, sedatives.
Physiotherapy procedures for the treatment of pathomimia
The indication for the appointment of methods of physiotherapeutic treatment of self-injurious behavior is the presence of psychogenic dermatitis in the patient. These procedures are designed to complement local drug therapy, accelerate the healing and recovery processes of the skin, and improve the patient's condition as a whole.
Basic physiotherapy treatments for self-harming behavior:
- Laser therapy … The use of laser treatment gives a good result in terms of reducing inflammation, stimulating metabolic and regenerative processes in the skin, increasing tissue resistance to infection and external factors.
- Paraffin therapy … This type of physiotherapeutic treatment is effective for superficial skin lesions without pronounced inflammation and damage. It restores well the moisture balance of the skin, activates healing and recovery processes.
- Ultrasound … Ultrasonic action on damaged skin effectively relieves inflammation and swelling of the skin, restores its hydrobalance, cleanses and activates regeneration.
- Electrophoresis … Has a decongestant, analgesic, sedative effect, activates tissue metabolism in the skin.
- Ultraviolet … UV irradiation in therapeutic doses can quickly relieve inflammatory manifestations, stimulate immune and metabolic processes in the skin. Effective for shallow lesions and rashes.
The listed physiotherapeutic methods are prescribed for any type of injury, with the exception of fresh wounds and burns. Often, several specialists are involved in the treatment of pathomimia at once: a psychiatrist, a dermatologist and a cosmetologist (if necessary). If the desire to harm oneself does not lead to serious mental disorders, treatment of pathomimia at home is possible, provided that all the doctor's prescriptions are followed - both by the patient himself and by those around him. Otherwise, you cannot do without inpatient treatment of a psychiatric profile. The most difficult patients to treat are those who develop dermatozoal delusions as a result of schizophrenia. How to treat pathomimia - watch the video:
To summarize, pathomimia is a sign of a problem, the roots of which go back to our psyche. Therefore, it cannot be solved with ordinary ointments and tablets. The help of a neuropsychiatrist or psychotherapist is the only way out of this situation. A way out that you don't need to be ashamed or afraid of.
