Self-inflicted finger injury in individuals with spinal cord injury: an analysis of 5 cases.
OBJECTIVE
To describe the occurrence of finger autophagia in 5 persons with traumatic spinal cord injury and to present a discussion of putative causes and potential treatments.


BACKGROUND
Minor self-mutilating actions, such as nail biting and hair pulling, are common in humans and usually benign. In some circumstances, these behaviors are associated with obsessive-compulsive personality traits. In humans, self-injurious biting behaviors are well described in the setting of mental retardation and psychosis and in persons with Lesch-Nyhan syndrome. Rare cases of human autophagia in persons with intact cognition have been reported, most commonly in the setting of acquired nervous system lesions. After spinal cord injury, it has been suggested that this behavior constitutes a human variant of animal autotomy and a response to neuropathic pain.


METHODS
Case presentation narrative.


METHODS
Photographic and radiological study, administration of Yale-Brown Obsessive-Compulsive Scale (YBOCS).


RESULTS
In 5 patients with complete tetraplegia, pain in the hands was present in only one instance. The severity of autoamputation varied from minor to extreme. In all cases, damage was confined to analgesic body parts. In 3 cases, autophagia behavior was discovered in progress. Treatments included pharmacotherapy, counseling, and behavioral therapy, with mixed results. All patients were intelligent, willing to discuss their issues, and able to identify conditions of stress and isolation in their lives. Mild preinjury obsessive-compulsive behaviors, such as nail biting, were universal. On the YBOCS, only 1 patient scored in a range indicative of mild obsessive-compulsive symptomatology.


CONCLUSIONS
This group exhibited heterogeneous medical, social, and cultural characteristics. A link between pain and self-injurious behavior could not be demonstrated. This behavior may be viewed as an extreme variant of nail biting, with potential ominous complications. Treatment strategies have been employed with mixed results.
Department of Rehabilitation Medicine, Cleveland Clinic, Desk C15, 9500 Euclid Avenue, Cleveland, OH 44195 frostf@ccf.org
Frederick S
FS
Frost
Sridevi
S
Mukkamala
Edward
E
Covington
D000368:Aged; D005260:Female; D005383:Finger Injuries / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016728:Self-Injurious Behavior / Q000473:pathology*; D013119:Spinal Cord Injuries / Q000523:psychology*