title: Autodestructive syndromes.
abstract: BACKGROUND
  The phenomenon 'autodestructive behaviour' is becoming an increasingly serious disease and cost factor in a wide range of medical fields. The present paper presents a survey of the literature on autodestructive behaviour, excluding psychotic, substance-induced or organic brain disorders. Starting out with a conceptual overview, the paper goes on to look into the epidemiology of autodestructive behaviour and the forms in which it manifests itself.
  
  
  METHODS
  A literature search was conducted in Medline, Psycinfo and Psyndex using the search terms 'artifact', 'artificially induced', 'autodestructive', 'self-mutilation', 'factitious', 'self-harm', 'self-induced', 'self-inflicted', 'self-injuring' and 'self-mutilation' for the period from 1977 to 2003.
  
  
  RESULTS
  Five of a total of 18 empirical studies describe the simultaneous occurrence of direct and indirect forms of autodestructive behaviour. Reported prevalence rates range from 0.032% to 9.36%. The ratio of females to males was found to be 2:1 (average age: 31.5 years; SD: 9.3 years); in contrast, the gender ratio was reversed for Munchausen's syndrome. The case history data presented are patchy and differ in terms of their priorities. We found a large number of codiagnoses, which seems to indicate that personality and dependence disorders, or substance misuse, are characteristic of both direct and indirect forms of autodestructive behaviour.
  
  
  CONCLUSIONS
  The task at hand is to use a yet-to-be-developed nomenclature and adequately operational diagnostic criteria to work out standardised survey instruments that do justice to the heterogeneity of this disorder complex.
authors.affiliation: Medizinische Klinik mit Schwerpunkt Psychosomatik, Charité Universitatsmedizin Berlin, Berlin, Deutschland. rd.kocalevent@charite.de
authors.forename: Rüya-Daniela
authors.initials: RD
authors.lastname: Kocalevent
authors.forename: Herbert
authors.initials: H
authors.lastname: Fliege
authors.forename: Matthias
authors.initials: M
authors.lastname: Rose
authors.forename: Marc
authors.initials: M
authors.lastname: Walter
authors.forename: Gerhard
authors.initials: G
authors.lastname: Danzer
authors.forename: Burghard F
authors.initials: BF
authors.lastname: Klapp
mesh_terms: D015897:Comorbidity; D005162:Factitious Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D017410:Practice Guidelines as Topic; D015995:Prevalence; D016728:Self-Injurious Behavior / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D013577:Syndrome; D009626:Terminology as Topic