From the urge to see one's own blood to the urge to drink it: Can hemomania be specified as an impulse control disorder? Two case reports.

At least half of self-mutilative individuals report that seeing their own blood is comforting, while a quarter report that they have tasted it. Bloodletting and blood-drinking behaviors have been discussed in case reports of disorders such as borderline personality disorder, bulimia nervosa, dissociative identity disorder, and psychotic disorder. The role of blood-drinking behavior, however, needs to be clarified in the psychiatric literature. This paper is the first to discuss blood-drinking behavior as a possible impulse control disorder that progresses from a desire to see or taste one's own blood. It presents the cases of two patients who report drawing blood from their own arms via syringe and drinking it. The first patient began to suck her own blood by removing scabs at age 8. The second started cutting his arm during his middle school years to reduce tension. Both eventually began to drink their own blood by draining it impulsively. This paper presents two cases with blood-drinking behavior diagnosed as impulse control disorder not otherwise specified according to the Diagnostic and Statistical Manual of Mental Disorders. We propose the term "hemomania" to describe an impulse control disorder characterized by impaired functioning due to at least one of the following urges: seeing one's own blood, self-bloodletting, and tasting/drinking one's own blood. We argue that hemomania progresses from an urge to see one's own blood to the urge to drink it, though randomized controlled studies are needed to support this claim.

Selected biochemical parameters of blood serum in soldiers committing self-mutilation.

OBJECTIVE: This project attempts to establish a possible link between selected biochemical parameters (cholesterol and triglyceride concentrations and levels of malonyl dialdehyde and superoxide dismutase) in soldiers with autoaggressive behaviors. MATERIALS AND METHODS: The study involved 33 soldiers treated for self-aggressive behavior from July 1, 1998, to June 30, 1999. Average patient age was 20.7 years. The control group consisted of 21 soldiers hospitalized for mental disturbances but not showing autoaggressive tendencies. Total cholesterol and activity of platelets, considering the generation of free radicals and triglyceride concentration levels, were determined in the blood serum of members of both groups. RESULTS: The results indicate significantly lower concentrations of total cholesterol in the serum of soldiers showing self-aggressive behaviors. Also, increased concentrations of malonyl dialdehyde in blood platelets and decreased superoxide dismutase activity were found in individuals prone to autoaggression. CONCLUSION: The results suggest that the dysfunction of oxidation-reduction processes in brain tissue leads to excessive generation of free radicals, which can cause brain cell damage and disturb metabolic processes, resulting in mental disturbances that may constitute a background for self-aggressive behavior. The decreased activity of superoxide dismutase is a major factor in the observed oxidation-reduction disturbances.

The effect of testosterone on psychopathology and sexual function in a paranoid schizophrenic self-castrate.

It has been suggested that the administration of androgens to paranoid schizophrenics who castrate themselves because of religious delusions and sexual guilt might exacerbate the psychosis and increase the risk of further self-mutilation. We administered testosterone enanthate to such a case intermittently during his 12 week hospital stay and studied simultaneously, psychopathology (Brief Psychiatric Rating Scale and clinical assessment), hormone levels and sexual behaviours. Sexual behaviours increased in line with increased serum testosterone levels; psychopathology declined. Following his discharge, he was managed on a regime of phenothiazines and monthly testosterone injections. After one year, he was enjoying normal heterosexual activities (without guilt) although his extreme religiosity had not declined.

Plasma B-endorphin levels in patients with self-injurious behavior and stereotypy.

B-endorphin and cortisol concentrations were examined in the plasma of mentally retarded patients who displayed symptoms of self-injurious behavior (SIB) (n = 9), stereotypy (n = 17), or SIB plus stereotypy (n = 14). Morning and evening samples were compared with a matched patient control group (n = 13) and a group of nonretarded controls (n = 17). Compared with nonretarded controls, the retarded control group had significantly lower b-endorphin concentrations for the morning sample and nonsignificantly lower concentrations for the evening sample. The combined patient groups had lower b-endorphin levels than did nonretarded controls for both samples. Patients with SIB and stereotypy had significantly higher morning levels of b-endorphin than the retarded controls. The evening levels of the SIB plus stereotypy group also were higher than retarded controls but were not significant. Levels in the SIB and stereotypy group were slightly elevated compared with retarded controls. Cortisol levels were identical for all groups. B-endorphin and cortisol significantly covaried for the nonretarded controls but not the patients. Results indicated that compared to a matched control group, patients with SIB plus stereotypy have elevated b-endorphin plasma.

Raised plasma metenkephalin in patients who habitually mutilate themselves.

Mean plasma metenkephalin concentration was significantly higher in ten patients who habitually mutilated themselves than in matched, healthy controls. No differences were found in corticotropin, N-lipotropin or C-lipotropin (beta-endorphin). Plasma metenkephalin was raised only in the five patients receiving hospital treatment because of their behaviour disorder. It was not raised in those patients sufficiently well to have been discharged from hospital.