Autophagia

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Autophagia refers to the practice of biting/consuming one's body. It is a sub category of self-injurious behavior (SIB). [1] Commonly, it manifests in humans as nail biting and hair pulling. In rarer circumstances, it manifests as serious self mutilative behavior such as biting off one's fingers. [2] Autophagia affects both humans and non humans. [3] Human autophagia typically occurs in parts of the body that are sensitive to pain, such as fingers. Human autophagia is not motivated by suicidal intent, but may be related to the desire to seek pain. [2]

Contents

There has been medical research into the relationship of prevalence of autophagia as a symptom of mental disorders including obsessive compulsive disorder, borderline personality disorder, anxiety, and Lesch-Nyhan Syndrome.

Medical research has displayed the presence of autophagia in rats. In a study conducted by Gopal, Female rats affected by spinal cord injuries displayed autophagia, by chewing their tails. [3] Similarly, in a study conducted by Frost, patients affected by spinal cord injuries displayed extreme autophagia (i.e. finger and limb biting practices). [4]

There is limited scientific research on Autophagia as the most common symptom of nail biting is prevalent in large parts of society. Hence, research into autophagia tends to be a part of broader questions of 'self injurious behaviour' (SIB), rather than being specifically about autophagia.

People who experience command hallucinations (often associated with schizophrenia and bipolar disorder) are most prone to self-mutilation, including the biting or eating one's own flesh. More examples of people who are very susceptible to severe self-mutilation like autophagia are ones with religious preoccupations, history of substance abuse, and intense social isolation. [5]

Symptoms

Common symptoms in humans include:

Possible causes

This section will focus on the causes for autophagia in humans. There is no single primary cause for autophagia. Due to limited medical research which differentiates autophagia from typical nail biting practices, the causes of autophagia remain broad. [7] There is limited medical research into the ultimate explanation of Autophagia, however, the explanation of the tendency to engage in self-injurious behavior due to mental illnesses is strong. In a study conducted by Nock et al., those who engaged in self mutilative behavior, 52% reported they were attempting to stop bad thoughts and 34% said they did it to prevent doing something they did not want to do. [2] While such motivations exist in the general population, those with mental disorders are a greater at-risk category. [2]

Autophagia is related to impulse control behavior. Impulse-control disorders involve failing to resist an impulse, drive, or temptation to perform an act that is harmful to the person or to others. The majority of individuals affected by this disorder will often feel a sense of tension or arousal before committing the act, and then experience pleasure, gratification or relief at the time of committing the act. Once the act has been completed, the individual may or may not feel regret, self-reproach, or guilt. [8]

Psychological model

The psychological model suggests that autophagia occurs as an attempt to reduce tension as an outlet for emotional regulation. [6]

  1. Feelings of self isolation
  2. Psychological disorders: Schizophrenia, OCD. Autophagia can occur as a symptom alongside one of these mental illnesses/disorders.

Diagnosis

Autophagia is not classified as a mental disorder or a symptom of a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the diagnostic manual used in the United States. Since autophagia is not a mental disorder there is not a universally recognized method of diagnosis.

Diagnosis can be obtained through a clinical judgment of a doctor by assessing:

  1. The occurrence of behavior: the severity of the behavior can be analyse by the amount of physical damage done to the body.
  2. The frequency of the occurrence [1]
  3. The level of control that the patient is able to exercise in managing these behaviors: The Yale Brown Obsessive Compulsive Scale can be used to measure this quantitatively. [4]

Treatments

In a study conducted in 2008, the treatment options across five patients were studied. [4] These included prescribing medicines for pain, psychotherapy for impulse control, wearing gloves and doing nothing. [4] Each of these treatments worked with varying effectiveness. Hence, no single treatment option will have guaranteed effectiveness. Treatment options for autophagia include:

Gloves can be worn as treatment for autophagia, working as a physical barrier between mouth and skin GlovesAutophagiaTreatment.jpg
Gloves can be worn as treatment for autophagia, working as a physical barrier between mouth and skin

Environmental modification

  1. Using gloves: creating a physical barrier between human fingers and mouth prevents the individual from biting their skin. However, this may cause skin to heat up which provide discomfort. [4]
  2. Sensitization: Sensitize yourself to when autophagia occurs. Attempt engaging in a reverse behavior, such as flexing your toes or clenching your fist. [4]

Behavioral modification

  1. Behavioral management/psychotherapy: talking to a trained professional may help impulse control behavior. This will be more effective for patients with other underlying mental disorders such as schizophrenia, obsessive compulsive disorder, etc. [4]
  2. Pharmacotherapy: prescribing medicines as well as psychotherapy [9]
  3. Prescribed medicines: Fluoxetine, fluvoxamine. Antibiotics are commonly prescribed for pain management. [4]
  4. Reducing hallucinations: In patients with schizophrenia, reducing hallucinations may prevent autophagia. [9]

Living with autophagia

If displaying cases of extreme autophagia, it is likely that individuals have other underlying mental disorders. [4] Hence, to live with extreme autophagia psychotherapy is encouraged to control obsessive thoughts and self harm. [9] However, in benign cases, living with autophagia should not make a material impact to one's lifestyle.

Autophagia in rats

Similar behavior has been observed in laboratory rats in experiments looking at spinal cord and peripheral nerve injuries. The resulting behavior consists of the rats licking and then chewing their nails, and the tips of their toes. In extreme cases, the rats will chew off whole toes or even the foot. [10]

In animals, autophagia tends to be restricted to the hind limbs and the lower parts of the abdomen. [3]

Symptoms include chewing of limbs, paws and tails. In extreme cases the entire tail is consumed. [11] Unlike humans, the causes for autophagia in rats has not yet been determined. However, rats with spinal cord injuries have displayed autophagia as seen in Gopal et al. [3] Rats with fewer lesions on their spinal cords, are more likely to display autopgahia compared with rats who have 100% of their spinal cord affected by lesions.

Potential treatment for rats with autophagia is providing metronizadol, which helps prevent autophagia behaviors as well as it prevent from occurring again. [7] An environmental treatment, is placing a physical barrier of New Skin or a mouth guard to prevent rats from chewing their own skin. [7] After testing this mixture on 24 rats with spinal cord injuries, only one rat had chewed its toes after a two- to three-week period. [7]

Once rats engage in autoaphagia, they continue with self-injurious behavior until the body deteriorates. [3]

Contrary to rats, in humans, there need not be a sensation of physical pain which leads to autophagia. Emotional pain and feelings of self isolation have been reported by human patients of autophagia. [4]

See also

Related Research Articles

<span class="mw-page-title-main">Cognitive behavioral therapy</span> Therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. Cognitive behavioral therapy is one of the most effective means of treatment for substance abuse and co-occurring mental health disorders. CBT focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.

<span class="mw-page-title-main">Borderline personality disorder</span> Personality disorder of emotional instability

Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a personality disorder characterized by a long-term pattern of intense and unstable interpersonal relationships, distorted sense of self, and strong emotional reactions. Those affected often engage in self-harm and other dangerous behaviors, often due to their difficulty with returning their emotional level to a healthy or normal baseline. They may also struggle with dissociation, a feeling of emptiness, and a fear of abandonment.

<span class="mw-page-title-main">Self-harm</span> Intentional injury to ones body

Self-harm is intentional behavior that is considered harmful to oneself. This is most commonly regarded as direct injury of one's own skin tissues usually without a suicidal intention. Other terms such as cutting, self-injury, and self-mutilation have been used for any self-harming behavior regardless of suicidal intent. Common forms of self-harm include damaging the skin with a sharp object or by scratching, hitting, or burning. The exact bounds of self-harm are imprecise, but generally exclude tissue damage that occurs as an unintended side-effect of eating disorders or substance abuse, as well as societally acceptable body modification such as tattoos and piercings.

<span class="mw-page-title-main">Delusional disorder</span> Mental illness featuring beliefs with inadequate grounding

Delusional disorder, traditionally synonymous with paranoia, is a mental illness in which a person has delusions, but with no accompanying prominent hallucinations, thought disorder, mood disorder, or significant flattening of affect. Delusions are a specific symptom of psychosis. Delusions can be bizarre or non-bizarre in content; non-bizarre delusions are fixed false beliefs that involve situations that could occur in real life, such as being harmed or poisoned. Apart from their delusion or delusions, people with delusional disorder may continue to socialize and function in a normal manner and their behavior does not necessarily generally seem odd. However, the preoccupation with delusional ideas can be disruptive to their overall lives.

<span class="mw-page-title-main">Lesch–Nyhan syndrome</span> Rare genetic disorder

Lesch–Nyhan syndrome (LNS) is a rare inherited disorder caused by a deficiency of the enzyme hypoxanthine-guanine phosphoribosyltransferase (HGPRT). This deficiency occurs due to mutations in the HPRT1 gene located on the X chromosome. LNS affects about 1 in 380,000 live births. The disorder was first recognized and clinically characterized by American medical student Michael Lesch and his mentor, pediatrician William Nyhan, at Johns Hopkins.

<span class="mw-page-title-main">Nail biting</span> Medical condition

Nail biting, also known as onychophagy or onychophagia, is an oral compulsive habit of biting one's fingernails. It is sometimes described as a parafunctional activity, the common use of the mouth for an activity other than speaking, eating, or drinking.

Psychomotor agitation is a symptom in various disorders and health conditions. It is characterized by unintentional and purposeless motions and restlessness, often but not always accompanied by emotional distress. Typical manifestations include pacing around, wringing of the hands, uncontrolled tongue movement, pulling off clothing and putting it back on, and other similar actions. In more severe cases, the motions may become harmful to the individual, and may involve things such as ripping, tearing, or chewing at the skin around one's fingernails, lips, or other body parts to the point of bleeding. Psychomotor agitation is typically found in various mental disorders, especially in psychotic and mood disorders. It can be a result of drug intoxication or withdrawal. It can also be caused by severe hyponatremia. The middle-aged and the elderly are more at risk to express it.

Thought broadcasting is a type of delusional condition in which the affected person believes that others can hear their inner thoughts, despite a clear lack of evidence. The person may believe that either those nearby can perceive their thoughts or that they are being transmitted via mediums such as television, radio or the internet. Different people can experience thought broadcasting in different ways. Thought broadcasting is most commonly found among people that have a psychotic disorder, specifically schizophrenia.

Schizophreniform disorder is a mental disorder diagnosed when symptoms of schizophrenia are present for a significant portion of time, but signs of disturbance are not present for the full six months required for the diagnosis of schizophrenia.

Olfactory reference syndrome (ORS) is a psychiatric condition in which there is a persistent false belief and preoccupation with the idea of emitting abnormal body odors which the patient thinks are foul and offensive to other individuals. People with this condition often misinterpret others' behaviors, e.g. sniffing, touching their nose or opening a window, as being referential to an unpleasant body odor which in reality is non-existent and cannot be detected by other people.

<span class="mw-page-title-main">Dermatophagia</span> Medical condition

Dermatophagia or dermatodaxia is a compulsion disorder of gnawing or biting one's own skin, most commonly at the fingers. This action can either be conscious or unconscious. Those affected with dermatophagia typically bite the skin around the nails, leading to bleeding and discoloration over time. Some people also bite on their skin on their finger knuckles which can lead to pain and bleeding just by moving their fingers. In herpetology, dermatophagia is used to correctly describe the act in which amphibians and reptiles eat the skin they shed, but this is not what occurs in humans. Those diagnosed with this disorder do not develop wounds on the bitten areas of their hands or lose any skin. Instead, they experience a thickening of the skin being repeatedly bitten. Contemporary research suggests a link between impulse-control disorders and obsessive–compulsive disorders, and this was addressed in the DSM-5 when dermatophagia and other related disorders were classified as 'other specified obsessive-compulsive related disorders' and are given the specification of body focused repetitive behavior. Further information on OCD, other anxiety disorders, dermatophagia and other related body focused repetitive behaviors can be found in the DSM-5.

<span class="mw-page-title-main">Grandiose delusions</span> Subtype of delusion

Grandiose delusions (GD), also known as delusions of grandeur or expansive delusions, are a subtype of delusion that occur in patients with a wide range of psychiatric disorders, including two-thirds of patients in a manic state of bipolar disorder, half of those with schizophrenia, patients with the grandiose subtype of delusional disorder, frequently as a comorbid condition in narcissistic personality disorder, and a substantial portion of those with substance abuse disorders. GDs are characterized by fantastical beliefs that one is famous, omnipotent, wealthy, or otherwise very powerful. The delusions are generally fantastic and typically have a religious, science fictional, or supernatural theme. There is a relative lack of research into GD, in contrast to persecutory delusions and auditory hallucinations. Around 10% of healthy people experience grandiose thoughts at some point in their lives but do not meet full criteria for a diagnosis of GD.

<span class="mw-page-title-main">Neurological disorder</span> Any disorder of the nervous system

A neurological disorder is any disorder of the nervous system. Structural, biochemical or electrical abnormalities in the brain, spinal cord or other nerves can result in a range of symptoms. Examples of symptoms include paralysis, muscle weakness, poor coordination, loss of sensation, seizures, confusion, pain, tauopathies, and altered levels of consciousness. There are many recognized neurological disorders, some relatively common, but many rare. They may be assessed by neurological examination, and studied and treated within the specialties of neurology and clinical neuropsychology.

Self-embedding is the insertion of foreign objects either into soft tissues under the skin or into muscle. Self-embedding is typically considered deliberate self-harm, also known as nonsuicidal self-injury, which is defined as "deliberate, direct destruction of tissues without suicidal intent."

Childhood schizophrenia is similar in characteristics of schizophrenia that develops at a later age, but has an onset before the age of 13 years, and is more difficult to diagnose. Schizophrenia is characterized by positive symptoms that can include hallucinations, delusions, and disorganized speech; negative symptoms, such as blunted affect and avolition and apathy, and a number of cognitive impairments. Differential diagnosis is problematic since several other neurodevelopmental disorders, including autism spectrum disorder, language disorder, and attention deficit hyperactivity disorder, also have signs and symptoms similar to childhood-onset schizophrenia.

Schizophrenia is a primary psychotic disorder, whereas, bipolar disorder is a primary mood disorder which can also involve psychosis. Both schizophrenia and bipolar disorder are characterized as critical psychiatric disorders in the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5). However, because of some similar symptoms, differentiating between the two can sometimes be difficult; indeed, there is an intermediate diagnosis termed schizoaffective disorder.

<span class="mw-page-title-main">Tactile hallucination</span>

Tactile hallucination is the false perception of tactile sensory input that creates a hallucinatory sensation of physical contact with an imaginary object. It is caused by the faulty integration of the tactile sensory neural signals generated in the spinal cord and the thalamus and sent to the primary somatosensory cortex (SI) and secondary somatosensory cortex (SII). Tactile hallucinations are recurrent symptoms of neurological diseases such as schizophrenia, Parkinson's disease, Ekbom's syndrome and delirium tremens. Patients who experience phantom limb pains also experience a type of tactile hallucination. Tactile hallucinations are also caused by drugs such as cocaine and alcohol.

Organic personality disorder (OPD) or secondary personality change, is a condition described in the ICD-10 and ICD-11 respectively. It is characterized by a significant personality change featuring abnormal behavior due to an underlying traumatic brain injury or another pathophysiological medical condition affecting the brain. Abnormal behavior can include but is not limited to apathy, paranoia and disinhibition.

Amygdalotomy is a form of psychosurgery which involves the surgical removal or destruction of the amygdala, or parts of the amygdala. It is usually a last-resort treatment for severe aggressive behavioral disorders and similar behaviors including hyperexcitability, violent outbursts, and self-mutilation. The practice of medical amygdalotomy typically involves the administration of general anesthesia and is achieved through the application of cranial stereotactic surgery to target regions of the amygdala for surgical destruction. While some studies have found stereotactic amygdalotomy in humans to be an effective treatment for severe cases of intractable aggressive behavior that has not responded to standard treatment methods, other studies remain inconclusive. In most cases of amygdalotomy in humans, there is no substantial evidence of impairment in overall cognitive function, including intelligence and working memory, however, deficits in specific areas of memory have been noted pertaining to the recognition and emotional interpretation of facial stimuli. This is because there are specialized cells in the amygdala which attend to facial stimuli.

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