Self-injurious and suicidal behaviour in a transsexual adolescent and young adult population, treated at a specialised gender identity unit in Spain.

INTRODUCTION: Nonsuicidal self-injury (NSSI) and suicidal behavior (SB) have a significant prevalence in transsexual people. The published data is confusing as it does not distinguish between ideation and realization, age groups, gender, or the degree of medical intervention. Their actual prevalence in Spain is unknown. OBJECTIVE: Our objective was to investigate the prevalence of NSSI behavior and SB in adolescents and young transsexual adults, differentiating between ideation and consummated behavior, prior to their receiving any type of gender-affirming medical treatment. MATERIAL AND METHODS: We retrospectively reviewed the medical history of a cohort of transsexual people aged between 10 and 35 years, treated at the Gender Identity Unit of the Valencian Community. We analyzed the data collected regarding the presence of four variables: NSSI ideation, NSSI behavior, ideas of suicide and suicide attempts, as well as differences according to age group and gender. RESULTS: The final sample consisted of 110 transsexual men and 90 transsexual women. Of these, 21% had made a suicide attempt, 50% had had suicidal ideas, 31% had a history of NSSI behavior and 35% had had NSSI ideas. No differences were found based on gender. Regarding age, subjects under 20 years of age presented a significantly higher prevalence regarding suicidal ideas compared to young adults (43% vs. 25%), while in the remaining variables, no statistically significant differences were found. CONCLUSIONS: The prevalence of a history of suicidal ideas and behavior in the Spanish adolescent and young transsexual population is significant and does not differ according to gender or age range. The prevalence of NSSI ideas and behavior differs and is more frequent in adolescent transsexuals.

Self-injurious and suicidal behaviour in a transsexual adolescent and young adult population, treated at a specialised gender identity unit in Spain. / Antecedentes de comportamientos autolesivos y autolíticos en población adolescente y adulta joven transexual, atendida en una unidad especializada en identidad de género en España.

INTRODUCTION: Nonsuicidal self-injury (NSSI) and suicidal behavior (SB) have a significant prevalence in transsexual people. The published data is confusing as it does not distinguish between ideation and realization, age groups, gender, or the degree of medical intervention. Their actual prevalence in Spain is unknown. OBJECTIVE: Our objective was to investigate the prevalence of NSSI behavior and SB in adolescents and young transsexual adults, differentiating between ideation and consummated behavior, prior to their receiving any type of gender-affirming medical treatment. MATERIAL AND METHODS: We retrospectively reviewed the medical history of a cohort of transsexual people aged between 10 and 35 years, treated at the Gender Identity Unit of the Valencian Community. We analyzed the data collected regarding the presence of four variables: NSSI ideation, NSSI behavior, ideas of suicide and suicide attempts, as well as differences according to age group and gender. RESULTS: The final sample consisted of 110 transsexual men and 90 transsexual women. Of these, 21% had made a suicide attempt, 50% had had suicidal ideas, 31% had a history of NSSI behavior and 35% had had NSSI ideas. No differences were found based on gender. Regarding age, subjects under 20 years of age presented a significantly higher prevalence regarding suicidal ideas compared to young adults (43% vs. 25%), while in the remaining variables, no statistically significant differences were found. CONCLUSIONS: The prevalence of a history of suicidal ideas and behavior in the Spanish adolescent and young transsexual population is significant and does not differ according to gender or age range. The prevalence of NSSI ideas and behavior differs and is more frequent in adolescent transsexuals.

Social Representations about the Functions of Deliberate Self-Harm from Adults and Adolescents: A Qualitative Study / Representações Sobre as Funções dos Comportamentos Auto-Lesivos de Adolescentes e Adultos: Um Estudo Qualitativo / Representaciones Sociales Sobre las Funciones de Comportamientos Autolesivos de Adultos y Adolescentes: Un Estudio Cualitativo

Abstract This study aimed to describe the social representations about the functions of deliberate self-harm and to compare these representations from adolescents with and without a history of deliberate self-harm and adults without a history of these behaviours. We conducted a qualitative study involving the thematic analysis of forty-one semi-structured interviews. The participants consisted of 11 adolescents with a history of deliberate self-harm, 15 adolescents without a history of deliberate self-harm and 15 adults also without a history of behaviours. The interviewees mentioned eight functions of deliberate self-harm consistent with the existing literature, namely interpersonal functions (Communication Attempt, Interpersonal Boundaries, Interpersonal Influence, and Peer Bonding) and intrapersonal functions (Affect Regulation, Anti-Dissociation, Escape Mechanism, and Self-Punishment). Also, two new functions not described in the literature were mentioned (Introspective Mechanism and Replacement of Suffering). Regarding the differences between the three groups, several disparities emerged. Overall, results revealed that the group of adults referenced more interpersonal functions, while both groups of adolescents emphasized intrapersonal functions. This study provides insight regarding the social representations about the functions of deliberate self-harm, also focusing on the differences between adolescents with and without a history of these behaviours and adults without a history of deliberate self-harm.

Resumo Este estudo teve como objetivo descrever as representações sociais sobre as funções dos comportamentos auto-lesivos e comparar as representações de adolescentes com e sem uma história de comportamentos auto-lesivos e de adultos sem uma história destes comportamentos. Foi realizado um estudo qualitativo que envolveu a análise de conteúdo de 41 entrevistas semi-directivas. Os participantes consistiram em 11 adolescentes com uma história de comportamentos auto-lesivos, e 15 adolescentes e 15 adultos sem uma história destes comportamentos. Os participantes referiram oito funções dos comportamentos auto-lesivos consistentes com a literatura existente, nomeadamente funções interpessoais (Influência Interpessoal, Ligação com os Pares, Limites Interpessoais, e Tentativa de Comunicação) e funções intrapessoais (Auto-Punição, Auto-Regulação do Afecto, Anti-Dissociação, e Mecanismo de Fuga). Duas novas funções não descritas na literatura foram também mencionadas (Mecanismo Introspectivo e Substituição do Sofrimento). No que se refere às diferenças entre os três grupos, no geral, o grupo de adultos referenciou mais funções interpessoais, enquanto os grupos de adolescentes destacaram as funções intrapessoais. Este estudo contribui para a compreensão das representações sociais sobre as funções dos comportamentos auto-lesivos, focando igualmente as diferenças entre adolescentes com e sem uma história destes comportamentos e adultos sem uma história de comportamentos auto-lesivos.

Resumen Este estudio tuvo como objetivo describir las representaciones sociales sobre las funciones de comportamientos autolesivos y comparar las representaciones de adolescentes con y sin antecedentes de comportamientos autolesivos y adultos sin antecedentes de estos comportamientos. Realizamos un estudio cualitativo que incluía el análisis de contenido de 41 entrevistas semiestructuradas. Los participantes fueron 11 adolescentes con antecedentes de comportamientos autolesivos, y 15 adolescentes y 15 adultos sin antecedentes de estos comportamientos. Los entrevistados mencionaron ocho funciones de autolesión deliberada coherentes con la literatura existente, a saber, funciones interpersonales (Influencia Interpersonal, Intento de Comunicación, Límites Interpersonales, y Vinculación entre Pares) y funciones intrapersonales (Anti-Disociación, Autocastigo, Mecanismo de Escape, y Regulación del Afecto). Además, se mencionaron dos funciones nuevas no descritas en la literatura (Mecanismo Introspectivo y Reemplazo de Sufrimiento). Respecto a las diferencias entre los tres grupos, en general, los resultados revelaron que el grupo de adultos hizo referencia a más funciones interpersonales, mientras que ambos grupos de adolescentes destacaron las funciones intrapersonales. Este estudio proporciona información sobre las representaciones sociales acerca de las funciones de los comportamientos autolesivos, y también se enfoca en las diferencias entre adolescentes con y sin antecedentes de estos comportamientos y adultos sin antecedentes de comportamientos autolesivos.

Comportamentos autolesivos e administração das emoções em adolescentes do sexo feminino / Self-harming behavior and emotional management in female adolescents / Comportamientos autolesivos y administración de las emociones en adolescentes del sexo femenino

Uma das manifestações de sofrimento psíquico associada à depressão, ao suicídio e a outras psicopatologias que têm despontado na atualidade em adolescentes são os comportamentos autolesivos (CA). Este estudo foi desenvolvido com o propósito de caracterizar a prática de comportamentos autolesivos em adolescentes por meio da investigação da expressão e administração das emoções. Para isso, desenvolveu-se um estudo de casos múltiplos, do qual participaram quatro meninas com idades entre 13 e 15 anos, que responderam à Escala de Avaliação de Sintomas-90-R e a uma entrevista semiestruturada. Os eixos de análise foram a caracterização dos CA e a administração das emoções. Constatou-se a precocidade do início dos comportamentos autolesivos, seu caráter aditivo e sua utilização para expressar sentimentos, especialmente a raiva. Indica-se a necessidade de preparo dos profissionais para atender adolescentes que manifestam tais comportamentos, face à sua complexidade e proximidade com o suicídio.

One manifestation of psychic affliction associated with depression, suicide and others psychopathologies that has emerged among teenagers is self-harming behavior. This study was carried out with the aim of characterizing the practice of self-harming behavior in teenagers through the investigation of the expression and administration of emotions. To this end, a multiple-case study was devised, in which four teenage girls aged 13 to 15 took part. They went through a symptom assessment scale-90-R and a semi-structured interview. The analysis axes were SB characterization and emotion management. An early inception of the self-harming behavior was observed, as well as its addictive quality and its use in expressing emotions, mainly anger. There is a clear need for the training of professionals in the care of teenagers who evince this sort of behavior, in view of its complexity and affinity to suicide.

Una de las manifestaciones de sufrimiento psíquico asociada a la depresión, al suicidio y a otras psicopatologías que vienen despuntando en la actualidad en adolescentes son los comportamientos autolesivos (CA). Este estudio ha sido desarrollado con el intento de caracterizar la práctica de comportamientos autolesivos en adolescentes por medio de la investigación de la expresión y administración de las emociones. Para eso, se ha desarrollado un estudio de casos múltiples, de lo que participaron cuatro niñas con edades entre 13 y 15 años, que contestaron la Escala de Evaluación de Sintomas-90-R y una entrevista semiestructurada. Los ejes de análisis fueron la caracterización de los CA y la administración de las emociones. Se ha constatado la precocidad en el comienzo de los comportamientos autolesivos, su carácter adictivo y utilización para expresar sentimientos, en especial la rabia. Se puntúa la necesidad de preparación de los profesionales para atender los adolescentes que manifiestan tales comportamientos, frente a su complexidad y cercanía con el suicidio.

[Report of a case of penile self-amputation]. / A propósito de un caso de autoamputación peneana.

INTRODUCTION: Motivated by a clinic case, this report introduces some issues related with genital self-amputation in terms of descriptions, epidemiological and clinical issues. METHODOLOGY: Case report describing a clinic case of genital self-amputation. The description is followed by a discussion based on the information available in the scientific literature. A man, 32 years old, with no history of mental disorder, who amputates his penis with a cutting object after quarreling with his mate for infidelity reasons. RESULTS: Several characteristics imply risk factors for genital self-mutilation, such as gender identity disorders, rejection to male genitals, guilt feelings related to sexual activity and a history of previous self-injuries. More common diagnoses include schizophrenia and affective disorders followed by disorders induced by psychoactive substances. CONCLUSION: Genital self-amputation is not a frequent situation and has been under-recorded; however, bearing in mind the high association with psychopathology and recurrence reported in worldwide literature, it is necessary to carry out a proper study and following up of patients exhibiting this conduct.

A propósito de un caso de autoamputación peneana / Report of a case of penile self-amputation

Introducción: Motivados por un caso clínico, en el presente reporte se comentan algunos aspectos relacionados con la amputación genital autoinfligida en términos de descripciones, aspectos epidemiológicos y clínicos. Método: Reporte de caso. Se describe un caso clínico de autoamputación genital; posteriormente se realiza una discusión al respecto, utilizando para ello la información disponible en la literatura científica. Se trata de un hombre de 32 años sin antecedente de trastorno mental que se amputa el pene con un objeto cortante luego de una discusión con su pareja por infidelidad. Resultados: Varias características denotan factores de riesgo para la automutilación genital, como los trastornos de identidad de género, rechazo a los genitales masculinos, sentimientos de culpa relacionados con la actividad sexual y antecedentes de intentos autolesivos previos. Los diagnósticos más frecuentes son las esquizofrenias y los trastornos afectivos, seguidos de trastornos inducidos por sustancias psicoactivas. Conclusión: La autoamputación genital no es una situación frecuente y se ha tendido a su subregistro; sin embargo, teniendo en cuenta la alta asociación con psicopatología y con recurrencia que se reporta en la literatura mundial, es necesario realizar un adecuado estudio y seguimiento en los pacientes que presentan esta conducta...

Introduction: Motivated by a clinic case, this report introduces some issues related with genital self-amputation in terms of descriptions, epidemiological and clinical issues. Methodology: Case report describing a clinic case of genital self-amputation. The description is followed by a discussion based on the information available in the scientific literature. A man, 32 years old, with no history of mental disorder, who amputates his penis with a cutting object after quarreling with his mate for infidelity reasons. Results: Several characteristics imply risk factors for genital self-mutilation, such as gender identity disorders, rejection to male genitals, guilt feelings related to sexual activity and a history of previous self-injuries. More common diagnoses include schizophrenia and affective disorders followed by disorders induced by psychoactive substances. Conclusion: Genital self-amputation is not a frequent situation and has been under-recorded; however, bearing in mind the high association with psychopathology and recurrence reported in worldwide literature, it is necessary to carry out a proper study and following up of patients exhibiting this conduct...