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Self-inflicted injuries - A forensic medical perspective
Abstract
Introduction: Deliberate self harm (DSH) is the term for self inflicted physical injury without suicidal intent. Among plethora of motivations, it is possible to distinguish between psychological, legal and material causes. Methods: Selective literature review and dicsussion. Results: Reliable incidence data on deliberate self harm, which ranges from cutting to limb amputation, are lacking in Germany. However, data emerging from academic departments of forensic medicine suggest that periodic clusters of so-called "copycat" DSH episodes arise, in response to episodes of self harm publicized in the media. Discussion: Self-inflicted injuries show characteristic features which can be used to distinguish them from injuries inflicted by third parties. The sooner self harm is recognized as such, the sooner medical help can be offered and possible judicial consequences avoided.
... The medicolegal examination of victims of violence is part of the daily routine of most forensic institutes. In these cases, the assessment involves differentiating between selfinflicted injuries and injuries inflicted by others [1][2][3][4][5][6][7]. It is estimated that 3-20 % of the alleged offenses are false [8] and as a result knowledge about recognizing self-inflicted injuries is essential. ...
... There are multiple reasons why people self-harm including psychiatric disorders, psychological gain, political reasons, malingering among prisoners, and insurance fraud [1][2][3][4][5]. Claims involving alleged sexual assaults are most commonly made by younger and middle-aged women with a psychiatric history, especially borderline personality disorders [4,7,9]. ...
... Claims involving alleged sexual assaults are most commonly made by younger and middle-aged women with a psychiatric history, especially borderline personality disorders [4,7,9]. The common motive behind these sorts of allegations include relationship conflict, revenge, deflecting or justifying poor personal behavior, unrequited love, and seeking attention [3,4,8,9]. Statistically, females hurt themselves twice as often as males [10] and up to 10 % of the alleged victims of sexual assaults present with self-inflicted injuries [1], which are predominantly caused by sharp tools [1,6]. ...
Self-inflicted injuries and their differentiation from inflicted injuries may have severe legal implications. The detection of these injuries is an important task in clinical forensic medicine. We present two cases of skin discolorations caused by using make-up and suction of the skin which have only rarely been reported. In the first case a 19-year-old woman asserted she was punched against her left clavicle and her right eye by a perpetrator, and that during the following forced sexual intercourse she had been bitten on the neck. On medicolegal examination 3 days later dark blue, shimmering discolorations at her right eyebrow, the left side of the neck and the left clavicle were seen. At first sight these discolorations appeared as bruises; however, they could easily be removed by a simple wipe with a finger. In the second reported case a 23-year-old woman reported she had been assaulted by two men who forcefully pressed her against a wall, partially undressed her and forced her to touch and rub one man’s penis. Medicolegal examination 32 h after the incident revealed several round to oval shaped, reddish to brown discolorations on both of her upper arms resembling so-called love bites created by suction. In both cases the preliminary investigation by the public prosecutor were closed. However, case 1 is still subject to legal investigations due to false incrimination. Self-infliction of injuries should always be considered in forensic examinations, even if they do not follow the classical pattern.
... Scratch injuries, body striking, and burns are less frequent (Martorana, 2015;Oumaya et al., 2008). Non-suicidal selfcutting acts are mostly performed on the extremities, especially the forearms (Whitlock et al., 2006(Whitlock et al., , 2011, and are characterized by parallel, superficial cuts with easily accessible parts of the body being preferred (i.e., usually the nondominant side of the arms) (Heide & Kleiber, 2006;Taghaddosinejad et al., 2009). The head, torso, and genitals are less commonly affected (Whitlock et al., 2006(Whitlock et al., , 2011. ...
... Pictures with cuts in the area of the wrist arteries were omitted because of the close relationship with suicidal acts. Because self-inflicted cuts differ from cuts inflicted by other means in terms of characteristic aspects (Heide & Kleiber, 2006;Taghaddosinejad et al., 2009), only pictures with symmetrical, parallel, superficial cuts were selected. The photographic quality (enlargeable to the format of the IAPS images, 1024 Â 768 pixels), the image background (no clinical environment such as doctor or hospital atmosphere, ideally uniformly white), and the absence of hidden ratings (no cuts in the form of words) also played a role in picture selection. ...
Self‐harming behavior is a core symptom of borderline personality disorder. Self‐report studies show a correlation between a lack of self‐reported negative feelings toward self‐cutting cues and the likelihood of future self‐destructive behavior. Despite these findings, there has so far been insufficient investigation into the implicit emotional processes evoked by this stimulus type. Forty patients with borderline personality disorder and 35 healthy controls between 20 and 50 years of age were confronted with pictures of self‐cutting cues and affective reference pictures. A startle reflex paradigm was used for measuring implicit emotional responses, and the Self‐Assessment Manikin was used for subjective responses. In line with previous studies, the patients rated the self‐cutting pictures significantly less negatively than healthy individuals. On the physiological level, a significant startle inhibition was observed, indicating an activation of the behavioral approach system. A more detailed analysis showed that this startle inhibition effect was specific to scary pictures, whereas no such effect was observed for bloody wounds and self‐cutting instruments. For pleasant standard pictures, in contrast, no startle reflex inhibition and no increase in emotional arousal parameters were found. The data replicate the findings of previous studies, demonstrating a generally diminished emotional reactivity to pleasant stimuli in patients with borderline personality disorder. In addition, a physiological approach reaction to self‐cutting pictures was found, especially for the scary pictures. These results might indicate a positive identification with the long‐lasting consequences of self‐cutting behavior in the patients. Implications for therapy are discussed.
... Self-inflicted injury is defined as an injury inflicted on oneself without suicidal intent. 1 In these habits, patients enjoy deliberately hurting themselves. Its prevalence has been reported in the range of 0.6%-0.8% of the population, mainly affecting individuals between 15 and 35 years of age. ...
... Spec Care Dentist XX(X): 1-4, 2017 *Corresponding author e-mail: aahad.amu@gmail.com 1 Healing of self-inflicted thermal injury of palatal mucosa by low-level laser therapy Low-level laser therapy (LLLT) results in direct biostimulation of various cells in the body. It can enhance the process of wound healing by stimulating effects on cells and hastening the repair process. ...
Self-inflicted injury to oral mucosa is a rare entity. These injuries can be premeditated, accidental or can result from an abnormal habit. These uncommon gingival injuries can sometimes test the clinician’s diagnostic abilities as well as treatment planning skills. In conventional treatment, removal of etiology and application of topical drugs is usually sufficient for healing. However, some cases require alternative or adjunctive wound healing methods. Low level laser therapy (LLLT) has been reported to be effective in pain management and improvement in wound healing through promotion, fortification, and commissioning of cellular cycle to generate productive and substitute cells. This report presents a case of 25- year- old female with complaints of a painful, non-healing wound on the palate for last six months. She had an unusual habit of keeping burning matchsticks in her mouth. Although she had quit the habit 2 months ago after psychiatric counselling, the wound on her palate did not show any improvement in symptoms. Based on the history and clinical findings, diagnosis of chronic wound by self-inflicted thermal injury was made. LLLT was administered on the wound every 48 hours for next 10 days. The burn wound healed completely after five applications of LLLT.
... But these injuries could also be seen on any other part of the body. [28] The wounds should be examined very carefully so that a distinction can be made between self-inflicted injuries and accidental self-injuries. In this study, we found self-inflicted injuries in 124 (13.27%) cases. ...
Background:
Sharp and penetrating object injuries (SPOIs) are seen frequently in forensic medicine practice. In this study, we aimed to retrospectively investigate cases with SPOIs.
Materials and methods:
This study investigated the charts of patients treated at Adiyaman University Education and Research Hospital between January 1, 2013, and December 31, 2017. A total of 934 inpatients with sharp object injuries were included in the study. Data were assessed using a suitable computer-aided package program. Cases were examined in terms of age, gender, injury body site, suicide or homicide, radiologic findings, presence of vital danger, and severity of injury.
Results:
In this study, we examined the charts for 934 inpatients with stab wounds. It was stated that 124 (13.27%) of those injured were female and 810 (86.63%) male; the average age of the injured persons was 29.8 ± 18.2 years. It was found that 214 (22.91%) people were exposed to vital danger and that 720 (77.09%) suffered from soft tissue injuries (penetrating skin and muscle injuries). Also, 69.27% of the cases (n = 647) involved people less than 35 years of age.
Conclusion:
Considering that stab injuries are more frequent in the lower age groups, we believe that such injuries could be reduced by increasing training programs for young people.
... Self-harming behavior refers to a wide spectrum of behaviors inflicted on oneself [3] and is a common finding in psychiatric and forensic practice. Such behaviors are often manifestations of mental disorders; they may also provide a judicial advantage in attempting to simulate crimes, or they might be performed for material gain (e.g. to avoid military service or commit insurance fraud) [4]. Because these behaviors are criminally relevant to the justice system, the forensic medicine expert is often required to distinguish whether an injury has been inflicted by the patient themselves or by a another party involved in the incident. ...
The distinction between self-inflicted injuries and other types of injuries is crucial in forensic medicine, and relevant features of wounds should be identified by pathologists, even when they are observed at atypical sites. Herein we report two cases of self-inflicted injuries of the neck involving two young women who had reported being attacked by men.
... Failure on the part of physician to do this will not only bring a charge of negligence but also misguide the law enforcing agencies in wrong direction and miscarriage of justice. The physicians should keep in mind that even if the injuries are fabricated, they remain calm and provide adequate medical care to the patient [10]. The case also highlights the degrading moral standards of the society where a person injures himself/herself to frame a false charge against someone. ...
Human infighting has been a part of our civilization since times immemorial. These incidences may go unnoticed or may attract attention of law enforcing agencies depending upon the severity of the offence. Though weapons are generally employed to inflict injuries, rare cases have been reported in literature where human teeth have been used to serve this purpose. Human bites may be self inflicted or self suffered in connivance with others to level an allegation against an adversary. We are presenting here such a case where such injuries were produced to bring a false charge against a neighbor.
Introduction: The complexity of self-inflicted injury behaviour hinders understanding of this phenomenon and the person's motive. Impulsivity is the most described risk factor (Ferraz., et al. 2009). Other socio-psychological factors are also described: anxio
Introduction: The complexity of self-inflicted injury behaviour hinders understanding of this phenomenon and the person’s motive.Impulsivity is the most described risk factor (Ferraz., et al . 2009). Other socio-psychological factors are also described: anxio-depressive disorders, history of physical or sexual abuse, parental relationship disorders, unemployment... etc. For some authors, thisphenomenon represents a suicidal risk factor. In this perspective, ask whether these people practicing this act of self-harm present anassociated psychopathological terrain. On the other hand, to ask whether this act constitutes a pathological element whose suicidalact is disguised. The question is then to assess the intentionality of these people with stigmata of self-harm in the forensic service andto look for possible social or psychological factors that can be contributed.We will try to show that this act of self-harm is practiced to simulate aggression (a thoughtful act used as physical evidence toprosecute an alleged aggressor), or uncontrolled occurring against any thoughtful will.Material and Method: We conducted a retrospective study analyzing the questionnaires of people with self-inflicted injuries at themedico-judicial consultation of the University Hospital of Sidi Bel Abbés (Algeria). This study ran from 01.03.2017 to 28.02.2019.Persons under the age of 18 and those with an inability to cooperate with the questionnaire were eliminated.Impulsivity was measured by La Barratt Impulsiveness Scale version 11 (BIS-11; Patton., et al. 1995). We translated and validatedit in a version adapted to the cultural context and lifestyle of the target population. The suicidal potential was assessed by the Risk-Emergency-Dangerousness (RUD) tool.Obtaining the participant’s informed consent, following his or her information; Its collaboration is integrated within the frameworkof an anonymous, voluntary research work and that there is no benefit, in particular, on legal proceedings.Data analysis was performed using IBM SPSS 23 (Statistical Package for the Social Sciences) software.
(PDF) Self-inflicted Injuries in The Forensic Pathology Department. Is there an Underlying Socio-psychopathological Terrain? (A Retrospective Study of 100 Cases). Available from: https://www.researchgate.net/publication/371360259_Self-inflicted_Injuries_in_The_Forensic_Pathology_Department_Is_there_an_Underlying_Socio-psychopathological_Terrain_A_Retrospective_Study_of_100_Cases [accessed Aug 13 2024].
L’automutilation demeure mal comprise malgré son intérêt médico-judiciaire et social. Même si ce phénomène chez les malades mentaux est reconnu depuis plusieurs années, la documentation sur cette question est loin d’être suffisante. Au niveau des consultations médico-judiciaires (CMJ), les personnes présentant des blessures ayant des caractéristiques auto-infligées affirment avoir été conséquences d’agressions. Ces blessures sont utilisées comme preuve matérielle afin d’engager des poursuites judiciaires au tribunal pénal ou constituent une menace contre une personne innocente. Les blessures auto-infligées (BAI) sont évocatrices par leurs caractères. Cependant, aux allégations on note souvent une discordance lors de la reconstitution des faits. A l’examen clinique, ces blessures sont superficielles avec une profondeur égale aux extrémités. Souvent, uniformes (linéaires ou légèrement curvilignes), groupées, parallèles et se croisent entre elles, orientées dans la même direction, symétriques au niveau des zones accessibles par la personne (évitant les zones mortelles ou sensibles à la douleur et le côté dominant). La présence de blessures d’hésitation et l’existence d’ancienne cicatrice d’automutilation sont un signe évocateur. Elles peuvent être surajoutées à des blessures légères causées par un agresseur, dont le but est de majorer une incapacité totale de travail (ITT). Parfois, ces blessures se trouvent en postérieur du corps sur une zone accessible par la personne ou causées à l’aide d’une tierce personne (complice). L’examen des vêtements a une grande importance dans le diagnostic médico-légal des BAI (absence d’entaille vestimentaire en regard de la blessure ou l’entaille ne correspond pas). En médecine légale, la problématique majeure de ces BAI demeure essentiellement sur le diagnostic médico-légal pour les cas particuliers et la rédaction d’un certificat médical initial de constatation de blessures, notamment en matière de fixation d’ITT. Le diagnostic médico-légal de BAI a une importance judiciaire notamment en matière de différenciation entre une agression, une simulation et autres types de comportement autodestructeur. Il permet aussi une rédaction d’un certificat médical adapté évitant une enquête inutile par le service de police ou de gendarmerie, d’innocenter un présumé agresseur et de soulager son inquiétude ou son anxiété injustifiée. C’est une étude incluant des personnes portant des BAI récentes pour avantage judiciaire. En fonctions des données situationnelles de cette étude, nous allons tenter de cerner le caractère médico-légal de ces blessures notamment leurs formes.
Self-inflicted injury/self-directed violence is a vast topic that is complex and multi-factorial. Various classification systems exist, and several categories based on the underlying motive(s) are proposed. Self-directed violence is seen in diverse clinical fields. The medico-legal importance in the assessment of injuries is to assist in establishing the underlying manner in which they were sustained. To assist in the determination of self-inflicted injury, “typical” injury patterns have been described; however, “atypical” injuries does not preclude such a diagnosis. A comprehensive history, examination, and ancillary investigations are required in the assessment of self-inflicted injuries.
Asylum seekers and refugees are constantly increasing worldwide because of human rights’ violations and political-related abuses. As a result, some of them show scars due to torture and other forms of maltreatments. In addition, they may also present scars due to ethnical practices, namely ritual scarifications.
This case study presents a victim who did not give consent to perform such ethnical practices on her body. The authors aim to enlighten the difficulty to understand the origin and the purpose of these specific injuries and the importance to know how to distinguish them from other forms of abuse. Indeed, it appears that such lesions follow a cultural path, meaning that the lesions are performed methodically and may show macroscopic differences compared to others. The story narrated by the victim can be helpful for the experts’ assessment, regardless, they may present memory-loss issues. This represents the value of a correct injuries’ diagnosis and the importance of cultural anthropology-related analyses. The cultural and social background are relevant since the injuries have their own signification because of their symbolism. Therefore, a multidisciplinary approach with a cultural anthropologist may have the possibility to help the forensic experts in understanding and interpreting such stories fostering their ability to better assess asylum seekers stories and their reliability.
The means by which people self-harm are diverse and so are the motives that drive them. They are intended for personal gain which may be psychological, legal or material. Fabricated injuries may be self-inflicted or permitted by others. We present three cases of fabricated injuries over the shoulder and upper limbs both alleging assault with a firearm. In all the cases meticulous examination elicited suspicion on how these were caused. Meticulous examination is essential to differentiate true from false accusations so that no innocent person is punished.
Clinical forensic medicine is the application of medical knowledge for the assessment of injuries in living persons for the purposes of administering justice.
Deliberate self-harm is usually a response to extreme personal stress.
Self-inflicted injuries can have various motivations. The most common causes are mental or neurological diseases or disorders. Sometimes, however, they are also used to simulate a crime and attract attention. Such a case is reported here. A young male student of Asian origin pretended to have been assaulted to force him to convert to Islam. He claimed that he had been beaten and his tongue had been cut with a knife. The clinical and medicolegal examination did not show any signs of blunt force, but only sharp force injuries in the form of superficial scratches and cuts on the forehead and tongue. Self-inflicted injuries to the tongue are very rare and mainly occur in neurological diseases and accidents where the tongue is bitten off.
Mit der Lethality of Suicide Attempt Rating Scale (LSARS) wurde ein angloamerikanisches Instrument zur Gefährlichkeitseinschätzung
von Suizidversuchen ins Deutsche übersetzt, für den hiesigen Gebrauch adaptiert und teilweise überarbeitet. Neben den im Original
bereits berücksichtigten mechanischen Verletzungen wurde dabei besonderer Wert auf eine adäquate Auswahl von potenziell gefährlichen
chemischen Substanzen und Medikamenten gelegt sowie deren Gefährlichkeit bestimmt. Mit der deutschen Adaptation der LSARS-II
bietet sich dem Anwender zum einen die Möglichkeit, die Gefährlichkeit von Suizidversuchen objektiv einzuschätzen, zum anderen
ermöglicht sie eine standardisierte und für Dritte nachvollziehbare Kommunikation über die Gefährlichkeit.
The Lethality of Suicide Attempt Rating Scale (LSARS), an Anglo-American instrument for estimation of the dangerousness of
suicide attempts, was translated into German, adapted for local use and partially revised. Besides mechanical injuries, which
were already covered in the original version, special emphasis has been placed on an adequate selection of potentially dangerous
chemical substances and pharmaceuticals. The German adaptation of the LSARS-II provides a means for an objective estimation
of the dangerousness of suicide attempts and offers a standardized form for communication, which can be universally understood.
Unzulässige Operationserweiterung, indikationslose Sectio caesarea und versuchter Totschlag an einem NeugeborenenStGB §§ 212 Abs. 1, 218 Abs. 1 S. 1, Abs. 4 S. 1, 22, 223 Abs. 11.Zur Unzulässigkeit einer Operationserweiterung gegen den ausdrücklichen Willen des Patienten bei benignem Schnellschnitt-Befund.2.Versuchter Schwangerschaftsabbruch durch indikationslose Sectio caesarea bei fetaler Skelettfehlbildung („Zwergenwuchs“; Hypochondrogenesis) in der 29. Schwangerschaftswoche.3.Versuchter Totschlag an einem Neugeborenen bei zuvor eingeleiteten Reanimationsmaßnahmen.BGH-Urt. v. 20.05.2003—5 StR 595/02—(LG Görlitz)Nach den Feststellungen des LG Görlitz war der Angeklagte z. Z. der Taten Chefarzt für Gynäkologie und Geburtshilfe. Die Tatvorwürfe, u. a. wegen versuchten Totschlags betreffen 2 Fälle.Fall 1—SachverhaltDie 40-jährige Patientin wurde mit der Einweisungsdiagnose eines persistierenden Tumors des linken Eierstockes stationär aufgenommen. Vor der geplanten diagnostischen Bauchsp ...
As part of her current lifestyle, a 28-year-old Caucasian woman routinely injures and allows subsequent healing of her skin and other tissues. Her body modifications include a "split tongue" (a tongue split to the base), which does not interfere with speaking and eating. Other modifications include large scarification patterns produced by branding and cutting. This woman has been known to eat parts of her skin that were previously cut out of her body. She also performs "needle play" by allowing medical syringe needles to be lodged temporarily under her skin. The patient had a normal childhood, is currently employed full-time as an office manager, and is psychologically stable. Although one other case of self-induced penoscrotal hypospadias is known, this is the only report of extensive, nonpsychotic, autodestructive behavior. However, this may not be the case in the future as an increasing number of young individuals have become interested in body modifications.
The case of a self-amputation of the left-sided forefinger is presented. It was an isolated smooth amputation near the basic ankle of the finger without any accompanying injury of other fingers. The victim (a physician) claimed financial compensation from his accident-insurance; his contract included special disability taxes for finger injuries. However, the insurance company did not pay but was able to demonstrate — by means of a medico-legal reconstructive expertise — that the amputation was voluntary and self-inflicted. The argumentation concerning self-mutilation is presented (including the so-called execution-position of the finger and ergonometric aspects). Concerning the surgical care, intervention and diagnostic procedures a detailed documentation of the case history and the morphology of the injury pattern are recommended (especially in isolated finger-amputations of the non-working hand).
The case history of a 51 year-old man with paranoid-hallucinatory schizophrenia is presented. Very intensive autoaggressive actions (cutting off the ears, partial amputation of the penis, eating of the amputated pieces, sawing off the left lower leg) led to very unusual autopsy findings (i.e. the glans of the penis was found in the colon). The cause of death was prolonged exsanguination.
During the past few years in the Federal Republic of Germany, there has been a continuous increase in deliberate self-inflicted damage with the aim of defrauding insurance companies. This paper concerns itself with amputations of the finger(s) caused by axes, electric saws, and blunt force. The difficulty of proving an intentional injury is shown, and suggestions for a procedure for making a report are given.
German law distinguishes between attempted suicide which is not punishable and self-mutilation which is prohibited. This article describes the historical development of self-injurious behaviour, reviews the social, juridical, and ethical assessments of the past, and examines the statistical and biological results of current research. It relates observations from forensic medicine and psychiatry to specific clinical symptoms, toxicological circumstances, and social influences (stress incurred by everyday life, war, or imprisonment). Drawing on pertinent cases, it clarifies criminal and civil jurisdiction and emphasizes the importance of self-mutilation for private insurers. Intended for insurers, forensic scientists, and psychiatrists, recommendations concern the procedures to be followed in the examination, jurisdiction, and therapy involving cases of self-inflicted injuries.