behavior pattern

F. Frank LeFever flefever at ix.netcom.com
Thu Mar 18 22:22:49 EST 1999


Once again I must apologize to the newsgroup for my poor spelling/poor
memory for technical terms.  There is a disorder, "Lesch Neihans" (just
looking at it I think looks farther from correct spelling than I
thought it would be!) which involves self-biting, especially when uric
acid blood levels are high (it is a--perhaps genetic?--metabolic
disorder).

This case sounds less extreme than examples of that condition I have
read of, but conceivably one could have milder expressions at one end
of a "spectrum" of this basic disorder.

Irt may, of course, be something entirely different.  I believe L.N.
patients bite themselves more for self-stimulation than for expression
of anger.  Early in my career (as an intern), I worked with patients
with various self-injurious behaviors, in a Behavior Therapy unit.

We were not so successful with a patient who was equally ready to hurt
others as to hurt herself, but very successful with one who just hurt
herself.  She came to us  with self-inflicted cigarette burns all over
her arms, almost no hair on her head, and many  scars on her face (most
from putting it through a glass door, deliberately), and we interrupted
this behavior long enough for wounds to heal and hair to grow back.

In those days, one could control patients' behavior by giving or
witholding cigarettes...  With these (or tokens which could be
exchanged for them) we first rewarded prompt compliance to a command to
sit--wherever she was, on the floor if no chair was right there.  When
this became reliable, almost automatic, it could be used to interrupt
self-injurious behavior the moment we saw it.  Eventually, she could
work towards accumulating tokens (yes, they could be exchanged for
other things besides cigarettes) earned by number of hours without
self-injurious acts.

On the other hand, might the case described be an expression of OCD? 
Are their other aspects of behavior which would fit this diagnosis? OCD
these days is treatable with SSRIs, although (as a speaker at one of my
own conferences reported a few years ago) there is evidence that
cognitive/behavioral therapy for OCD can produce changes in regional
brain metabolism similar to that achieved by SSRI treatment.

F. Frank LeFever, Ph.D.
New York Neurppsychology Group



In <7cquot$lpl$1 at news-2.news.gte.net> "SGH" <newsun at gte.net> writes: 
>
>Recently one subject was entered into a research study with one
unusual
>behavior exhibited.  The subject was a 9y/o white male who, when
seemingly
>aggravated , bit the back of his right hand over the knuckles. 
>Unfortunately for us, this particular exhibit seems to be unknown to
our
>reference data.  I am trying to locate a reasonable "explanation" with
>possible preliminary diagnosis in order to clarify this behavior
pattern.
>
>This child's history, according to his parents:  This child has bit
the
>back of his hand while stomping his feet since he was able to put his
fist
>in his mouth.  The mother reports noticing it at the age of 11 months.
 He
>has one sibling, female 2 years his senior.  Father reports child had
bit
>his hand more frequently when he was younger, however, seems to bite
it
>less now.  Father had put "nail biting deterrent " on child's hand to
keep
>him from biting it.  Father reported that this did not work.  Both
parents
>report verbal reprimands to this behavior and Father reports biting
his
>hand in an effort to "show him how stupid he looks".
>
>OK, how do I catalog this?  Is this similar to nail biting?  I can't
find
>anything other than some material on children / adults that self
>maim....This doesn't seem to fit this category.
>
>If there is anyone who can point me in the right direction....please
reply
>to : <newsun at gte.net>
>Many thanks in advance, S. Goddard, RN




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