CLINICAL PREDICTORS OF SELF-MUTILATION IN HOSPITALIZED FORENSIC PATIENTS

This study evaluated the clinical correlates and inpatient course of s elf-mutilation in a diagnostically diverse sample of hospitalized fore nsic patients. Fifty-three male forensic inpatients, treated in a maxi mum-security hospital, who engaged in at least one instance of self-mu tilation during a 2-year period, were studied and compared with 50 mal e forensic patients at the same hospital who had not engaged in self-m utilation. Self-mutilating patients were younger, more likely to carry a diagnosis of personality disorder or mental retardation, engaged in more outwardly directed aggressive behavior as assessed by the Overt Aggression Scale, were treated with substantially higher doses of neur oleptics, and were more likely to be civil or correctional patients th an insanity acquittees. The two groups did not differ on variables suc h as history of suicide, history of violence, neurological characteris tics, and other demographic variables. After an incident of self-mutil ation, the probability of recurrence was high. The substantially highe r level of outwardly directed aggression of self-mutilating patients, along with their higher apparent need for neuroleptization and the hig h risk of recurrence of the self-mutilation, suggest that they are a s ubset of violent individuals who are relatively unresponsive to treatm ent and who are dangerous to self and others.