| ObjectiveTo summarize the morbidity characteristics,psychosomatic symptoms,sleep quality,behavioral characteristics and psychological influencing factors of adolescents with non-suicidal self-injury,and to improve the clinical recognition of adolescents with non-suicidal self-injury.To summarize the four diagnostic manifestations of TCM,TCM evidence types,and the rules of prescriptions and medications for non-suicidal self-injury in adolescents,and to discuss the TCM evidence-based treatment of non-suicidal self-injury in adolescents.The aim is to provide new ideas and methods for the treatment of non-suicidal self-injury in adolescents.MethodBased on the two purposes of the study,this study was divided into two parts:study 1 focused on the onset characteristics,psychosomatic symptoms,sleep quality,behavioral characteristics,personality traits,and family environment of the adolescent non-suicidal self-injury population;study 2 focused on the four diagnoses of TCM,TCM evidence patterns,and herbal treatments for non-suicidal self-injury.Study 1:Using a combination of questionnaire and interview method,information was collected from adolescent patients with non-suicidal self-injury who visited the Department of Psychological Sleep of Guangdong Provincial Hospital of Traditional Chinese Medicine from July 2020 to November 2021,including morbidity characteristics,psychosomatic symptoms,sleep quality,behavioral characteristics and psychological influencing factors:frequency distribution was used to summarize the morbidity characteristics of adolescent non-suicidal self-injury,psychosomatic symptoms,The frequency distribution was used to summarize the onset characteristics,psychosomatic symptoms,sleep quality,behavioral characteristics and psychological influencing factors of non-suicidal self-injury in adolescents.The patients were divided into mild self-injury group and moderate-severe self-injury group according to the degree and frequency of self-injury,and the differences in onset characteristics,psychosomatic symptoms,sleep quality,behavioral characteristics and psychological influencing factors between the two groups were investigated.Study 2:Based on the exploration of the evidence characteristics,TCM physical and psychosomatic symptoms of non-suicidal self-injury in adolescents in Study 1,the medical records of adolescent patients with non-suicidal self-injury who visited the psychological sleep specialist of Guangdong Provincial Hospital in the past 3 years were further reviewed to explore their morbidity elements,TCM evidence characteristics and medication patterns;data mining techniques such as frequency distribution,association principle and systematic cluster analysis were used to analyze the morbidity characteristics,TCM evidence characteristics and TCM grouping patterns of adolescent patients with non-suicidal self-injury.ResultStudy 1:Clinical recognition characteristics of non-suicidal self-injury in adolescents 1.Characteristics of the onset of non-suicidal self-injury in adolescents(1)General:A total of 29 adolescents with non-suicidal self-injury were included,including 9 males and 20 females,with a mean age of(14.97±1.66)years,and 52%were high school students;the mean BMI was 19.35±3.11,of which 11 cases(39%)had a normal BMI(18.5-23.9)and 17 cases(59%)had a low BMI(<18.5).The BMI index was high(>24)in 1 case,accounting for 3%.(2)Psychiatric diagnosis and medication:common psychiatric diagnoses were depressive episode(28%),depressive state(24%),and bipolar disorder(10%);common medications were antidepressants(52%)and antipsychotics(17%).(3)Characteristics of TCM symptoms:common TCM symptoms included weakness(9.47%),poor appetite(9.47%),poor sleep(8.42%),depressed mood(8.42%),irritability(6.84%),and worrying and thinking(5.79%);high-frequency tongue signs were light red tongue(21.92%),white coating(19.18%),greasy coating(16.44%),and thin white coating(13.7%);high-frequency pulse signs were light red tongue(21.92%).white coating(19.18%),greasy coating(16.44%),and thin white coating(13.7%);high-frequency pulse signs were fine pulse(27.12%),stringent pulse(27.12%),sunken pulse(13.56%),and slippery pulse(11.86%);high-frequency TCM evidence types were liver depression and spleen deficiency(44.83%),spleen and stomach qi deficiency(31.03%),and spleen and stomach volatile heat(10.34%).(4)TCM constitution distribution:the common constitution types were Qi deficiency(22%),Qi-depression(18%),Phlegm-dampness(14%),and Yin deficiency(12%).2.Psychosomatic symptoms of non-suicidal self-injury in adolescents(1)Cornell Health QuestionnaireThe most obvious physical symptoms(score weight ≥30%,score weight=score of this item/total score of this item,same below)were fatigue(47%),eyes and ears(44%),respiratory system(32%),digestive system(30%);the most obvious emotional symptoms(score weight ≥ 50%)were depression(66%),stress(54%),anger(30%);the most obvious emotional symptoms(score weight ≥50%)were depression(66%),stress(54%),anger(30%).The most obvious emotional expressions(score weight ≥50%)were depression(66%),tension(54%),and anger(51%).(2)Self-assessment scale of anxiety and depressionThe score of depression in adolescents with non-suicidal self-injury was 67.67±11.10,which was moderate depression;the score of anxiety was 55.54±10.49,which was mild anxiety.3.Sleep quality of adolescents with non-suicidal self-injuryThe total score of Pittsburgh Sleep Quality Index for adolescents with non-suicidal self-injury was 10.52±4.49,which is a mild-moderate sleep disorder.4.Characteristics of non-suicidal self-injury behavior in adolescents(1)Frequency of self-injurious thoughtsThe average frequency of self-injurious thoughts within 1 month was 1.41 ±0.87,within 6 months was 2.21 ± 1.11,and within 12 months was 2.07±1.03.That is,the frequency of self-injurious thoughts within 1 month was greater than 1 time,that is,the frequency of self-injurious thoughts within 6 months and 12 months was greater than 1 time per month.The difference in the frequency of self-injurious thoughts in the three time periods was statistically significant(P<0.001).(2)Frequency of self-injurious behaviorsThe mean frequency of self-injurious behavior within 1 month was 0.9±0.94,within 6 months was 1.66±1.32,and within 12 months was 1.55±1.06.That is,the frequency of self-injurious thoughts within 1 month was less than 1 time,and the frequency of self-injurious behavior within 6 and 12 months was greater than 5 times.The difference in the frequency of self-injurious behavior in the three time periods was statistically significant(P=0.002).(3)Mode,location and severity of self-injurious behaviorsAmong the non-suicidal self-injurious behaviors,cutting(13.04%),scratching(13.04%),hitting(13.04%),and stabbing with sharp objects(10.87%)were the most common methods used by non-suicidal self-injurious adolescents;and among the self-injurious sites,the common sites were the hand(28.38%),lower arm or wrist(13.51%),and upper arm or arm and elbow(10.81%).The self-injury modes were classified as mild,moderate,and severe based on the lethality and harmfulness of the self-injury mode.The three levels of self-injury among the adolescents in this study were counted.The results showed that the distribution of non-suicidal self-injury adolescents in this study was not statistically different among mild,moderate,and severe self-injury modalities(H=0.829,P=0.662).(4)Causes of self-injurious behaviorsThe analysis of the causes of self-injurious behavior included internal and external emotion regulation,social influence,and stimulus seeking.The results showed that internal emotion regulation score was 15.03±8.68;external emotion regulation score was 7.55±4.43;social influence score was 2.03±3.17;and stimulus seeking score was 2.34±2.16.A nonparametric test of the above four reason scores showed that the difference between the four self-injury reasons was statistically significant(H=59.286,P<0.001).(5)Source and invisibility of self-injurious thoughts58.6%(17/29)of the non-suicidal self-injured adolescents first committed self-injury from "their own thoughts",and 34.5%(10/29)of them chose to let few or no one know about it.(6)Pain level of self-injurious behavior62.07%(18/29)of the non-suicidal self-injured adolescents felt pain only occasionally or sometimes,and 20.69%(6/29)of the adolescents never felt pain.(7)Effectiveness of self-injury in relieving emotions65.52%(19/29)of the adolescents thought that self-injury relieved their emotions for no more than 5 minutes.5.Psychological influences of adolescents’ non-suicidal self(1)Childhood physical abuse situation62%(18/29)of non-suicidal self-injured adolescents experienced childhood physical abuse during their growth.(2)Personality characteristicsThe results of the Cattell 16-item personality factor questionnaire showed that compared with the Chinese norm,adolescents with non-suicidal self-injury scored lower on each subscale of the 16PF than the Chinese norm.(3)Defensive stylesThe results of the defense style questionnaire showed that the most common defense mechanism among non-suicidal self-injured adolescents was intermediate defense mechanism(40.3%),among which isolation(12.5%)and avoidance(8.8%)were more common;followed by immature defense mechanism(36.7%),fantasy(11.3%)and splitting(6.3%)were more common.(4)Family environment① Family environment scale:Compared with the Chinese norm,the family environment scale of non-suicidal self-injury adolescents showed lower intimacy and lower emotional expression than the norm,and higher ambivalence than the norm.②Parenting style scale:compared with the Chinese norm,father-factor Ⅰ and mother-factor Ⅰ(warmth,understanding),father-factor Ⅳ and mother-factor Ⅴ(favoring subjects),and father-factor Ⅵ(overprotectiveness)were lower than the Chinese norm;father-factor Ⅱ and mother-factor Ⅳ(harshness,punishment),father-factor Ⅲ and mother-factor Ⅱ(overinterference),and father-factor Ⅴ and mother-factor Ⅲ(rejection,denial)were higher than the Chinese norm.6.Interrelationship between psychosomatic symptoms,sleep quality and psychological influences(1)The relationship between psychosomatic symptoms and sleep qualityThe total score of Cornell Health Questionnaire,A-L score(somatic symptoms),M-R score(emotional symptoms)and the total score of PSQI were positively correlated(correlation coefficients were(r=0.502,P=0.006);(r=0.467,P=0.011);(r=0.463,P=0.011)),respectively,and the above correlation coefficients r were statistically significant.(2)Interrelationship between psychological influences①Interrelationship between defense styles and personalityImmature defense factor scores were positively correlated with bullying and skepticism in the Cattell 16 personality factors questionnaire(correlation coefficients were(r=0.479,P=0.009);(r=0.517,P=0.004),respectively).Intermediate defense factor scores were negatively correlated with intelligence(r=-0.438,P=0.017)and positively correlated with skepticism(r=-0.443,P=0.016)on the Cattell 16 Personality Factor Questionnaire.② Interrelationship between defense styles and family environmentThe maturity defense factor score was positively correlated with the father factor VI(overprotectiveness)in parenting style(r=0.369,P=0.049).(3)Correlations between Cornell Health Questionnaire and defensive stylesThe immature defense factor score was positively correlated with the total,A-L(somatic symptoms),and M-R(emotional symptoms)scores of the Cornell Health Questionnaire(correlation coefficients were(r=0.580,P=0.001);(r=0.508,P=0.005);(r=0.600,P=0.001),respectively),and the above correlation coefficient r was statistically significant.Intermediate defense factor scores were positively correlated with Cornell Health Questionnaire M-R scores(emotional symptoms)(r=0.440,P=0.017).7.correlation between the severity of non-suicidal self-injury in adolescents and morbidity characteristics,psychosomatic symptoms,sleep quality,and psychological influencesAdolescents with non-suicidal self-injury were divided into mild self-injury group(n=15)and moderate-severe self-injury group(n=14)according to the frequency and severity of self-injury.(1)Comparison of morbidity characteristics between the two groups①BMI:BMI in the moderate-severe self-injury group(19.23±3.62)kg/m2 was lower than that in the mild self-injury group(19.46±2.68)kg/m2,and the difference was not statistically significant(Z=-0.830,P=0.407).②TCM constitution:In terms of TCM constitution,the scores of Qi deficiency,Qi yu,Yin deficiency,blood stasis,phlegm dampness,and damp heat in the moderate-severe self-injury group were higher than those in the mild self-injury group,while the scores of Yang deficiency and special endowment were lower than those in the mild self-injury group.The difference between the two groups was not statistically significant(P>0.05).(2)Comparison of psychosomatic symptoms between the two groups①Cornell Health Questionnaire In the moderate-severe self-injury group,17 of the 20 items of the Cornell Health Questionnaire,such as total score,MR score,eyes and ears,respiratory system,cardiovascular system,and digestive system,were higher than those of the mild self-injury group;only 3 items,such as skin,genital and urinary system,and anger,were lower than those of the mild self-injury group.There was no statistically significant difference between the two groups in each score group(P>0.05).②Anxiety self-rating scale:The anxiety self-rating scale score was 57.86±9.71 in the moderate-severe self-injury group,which was higher than the anxiety self-rating scale score of 53.25±10.68 in the mild self-injury group,with no statistically significant difference between the groups(t=-1.213,P=0.236).③Depression self-rating scale:the depression self-rating scale score in the moderate-severe self-injury group was 71.61±8.25,which was higher than the depression self-rating scale score in the mild self-injury group 64±12.39,and the difference between the groups was not statistically significant(t=-1.931,P=0.064).(3)Comparison of sleep quality between the two groupsThe total rating of Pittsburgh Sleep Quality Index was higher in the moderate-severe self-injury group(12.00±4.82)than in the mild self-injury group(9.13±3.80),and the remaining subscales were higher than in the mild self-injury group,with no statistically significant difference(P>0.05).(4)Comparison of psychological influencing factors between the two groupsFrom the four aspects of childhood physical abuse incidence,personality characteristics,defense mechanism,and family environment,there was no significant difference between the two groups(P>0.05).Study 2:Exploratory study on the identification and treatment of non-suicidal self-injury in adolescents in Chinese medicineA total of 206 cases of non-suicidal self-injury in adolescents were collected in this study.1.Onset characteristics of non-suicidal self-injury in adolescents in the retrospective case data(1)General:the mean age was(15.17±1.74)years,among which 35 cases(16.99%)were male and 171 cases(83.01%)were female,and the mean duration of illness was(25.35±22.72)months.(2)Psychiatric diagnosis:In the data of adolescent non-suicidal self-injury cases,common psychiatric disorders included depressive states(20.87%),depressive episodes(16.5%),moderate depressive episodes(14.56%),and bipolar disorder(10.19%).(3)Stress history:no clear history of stress in 48 cases(23.30%),the presence of chronic stress in 135 cases(65.53%);the presence of acute stress in 24 cases(11.65%).2.Characteristics of TCM evidence of non-suicidal self-injury in adolescents(1)TCM symptoms of adolescent non-suicidal self-injury① Symptoms:The TCM symptoms of non-suicidal self-injury in adolescents were,in order,depressed mood(9.73%),poor sleep(7.95%),poor sleep(7.7%),irritability(6.6%),and negative perception(5.16%).②Category of symptoms:The TCM symptoms were further categorized according to the Internal Medicine of Traditional Chinese Medicine(TCM)as symptoms of emotion and will(26.23%).spleen and stomach(24.53%),heart(15.57%),qi,blood and fluid(11.25%),and liver and gallbladder(5.07%).③Physical characteristics:The physical characteristics of adolescents with non-suicidal self-injury were dark sores(2.88%)and thin body shape(0.51%).The symptoms of TCM were mainly emotional and mental disorders,spleen deficiency,mental disorder,and deficiency fire symptoms.(2)Tongue and pulse of non-suicidal self-injury in adolescents①Tongue signs:The common tongue and pulse signs of non-suicidal self-injury in adolescents include greasy coating(20.14%),light red tongue(14.54%),white coating(14.36%),red tongue(14.19%),and light tongue(34.6%).②Pulse:common pulse signs included smooth pulse(19.44%),stringent pulse(18.89%),thin pulse(17.5%),sunken pulse(13.61%).and inch floating(12.5%).③Cluster analysis of high frequency tongue and pulse signs(frequency of occurrence≥10)was performed,and four categories of tongue and pulse signs were summarized:Category 1:fat tongue,dentate tongue,sunken pulse,short pulse,light red tongue,thin white moss;Category 2:dry moss,slow pulse,red tongue,yellow moss,string pulse;Category 3:light tongue,cun-floating,guan-floating;Category 4:greasy moss,white moss,slippery pulse,thin pulse.Among them,categories 1,3 and 4 are all related to the evidence of spleen deficiency,and category 2 is related to the evidence of fire evil.(3)Distribution of TCM evidence types of non-suicidal self-injury in adolescentsThe TCM evidence of non-suicidal self-injury in adolescents was characterized by spleen deficiency(74.51%),and 45.10%also had liver depression,12.75%also had stomach qi deficiency,9.80%also had lung qi deficiency,and 6.86%also had heart blood deficiency.(4)Study on the medication pattern of non-suicidal self-injury in adolescents① Drug efficacy:According to the efficacy of traditional Chinese medicine,the top 3 drugs were:deficiency tonics(922 times,40.9%),antiphlogistic drugs(324 times,14.4%)and dampness-transforming drugs(135 times,6.0%).②The four gases,five tastes and meridians:the four gases are mainly warm(987 times,17.0%)and slightly cold(426 times,7.3%);the five tastes are mainly sweet(1359 times,23.4%),pungent(1055 times,18.1%)and bitter(984 times,16.9%);the meridians are the spleen(1159 times,18.6%),lung(1192 times,19.1%)and stomach(867 times,13.9%).867 times,13.9%),and liver meridian(837 times,13.4%).③ Commonly used single herbs:the top 5 in frequency of use were roasted licorice(8.07%),Radix Codonopsis pilosulae(5.96%),Atractylodes macrocephala(5.77%),Radix Bupleurum(5.5%)and Atractylodes cantonensis(5.19%).④The core drug pair and formula:the core drug pair was roasted licorice-Schi sandra-Astragalus-Atractylodes-Radix Codonopsis;the cluster analysis of high-frequency drugs yielded six drug combinations.category 1:Schisandra,Medlar,Shen Qu,Ginger,Sheng Ma,Astragalus,Radix Codonopsis,Chen Pi,Atractylodes,Yam,Smallpox Powder;Atractylodes,Angelicae,roasted licorice;category 2:Radix et Rhizoma,Radix Rehmanniae;category 3:Peppermint,Ginger,Poria,Mudanpi,Paeoniae(2)Class 4:Scutellaria baicalensis,Huang Lian,Chai Hu,Qiang Wu,Fang Feng,Sheng Gan Cao,Dan Shen;Class 5:Chuan Xiong,Xiang Shen,Fa Xian Xia.(5)Differences in Cornell Health Questionnaire scores by evidence typeThe differences in the scores of lung and spleen deficiency,liver depression and spleen deficiency,spleen and stomach qi deficiency,and heart and spleen deficiency in the Cornell Health Questionnaire for respiratory system(P=0.003)and cardiovascular system(P=0.044)were statistically significant,with the highest score of lung and spleen deficiency for respiratory system(8.00±1.89)and heart and spleen deficiency for cardiovascular system(6.77 ± 1.24).Conclusion1.characteristics of the onset of non-suicidal self-injury in adolescents:the age of onset is about 15 years(secondary school level),the duration of the disease is long,more females than males,and the physical appearance and signs show a low weight.It is often accompanied by significant mood disorders,such as depression,bipolar disorder,etc.Modern medical treatment mainly uses antidepressants and antipsychotics.The symptoms of TCM are mostly spleen deficiency,and the physical condition is mainly qi deficiency,showing the characteristics of psychosomatic co-morbidity.2.The onset of non-suicidal self-injury in adolescents is related to chronic stress.Most adolescents with non-suicidal self-injury have a history of chronic stress,and their onset characteristics,psychosomatic symptoms,and decreased sleep quality are highly consistent with the neuroendocrine changes triggered by chronic stress.The neurotic personality traits and avoidance defenses similar to depression in this group of adolescents interact with the emotional and somatic symptoms produced by stress to develop extreme forms of self-injury as one of the behavioral ways to cope with negative emotional experiences.3.The characteristics of the stressors and the manifestations of emotion dysregulation in adolescent non-suicidal self-injury are highly similar to and correlated with the"deficiency labor" in TCM.The four diagnostic signs and symptoms of TCM are mainly spleen deficiency,but also lung qi deficiency and deficiency fire symptoms.The pathogenesis of non-suicidal self-injury in adolescents lies in spleen deficiency,with lung and spleen deficiency common,and may be accompanied by liver qi failure and deficiency fire.4.Adolescent non-suicidal self-injury is a psychosomatic co-morbidity,physical symptoms are most prominent in fatigue,there is a general problem of decreased sleep quality,and emotional symptoms are depression,anxiety,anger are common.5.Self-directed behavioral characteristics of non-suicidal self-injury in adolescents have the following characteristics:due to the need for emotional regulation,self-injurious thoughts appear once a month on average,and self-injurious behaviors occur more than 5 times in a year.The most common method of self-injury is cutting,and the hand is the most common site of self-injury.The whole self-injury process is less painful,and the time to relieve emotion after self-injury is short.Non-suicidal self-injury among adolescents is insidious,mainly because their willingness to commit self-injury mainly comes from their own thoughts,and some adolescents do not inform others about their self-injurious behavior.6.From the perspective of the psychological impact of nonsuicidal self-injury,most nonsuicidal self-injured adolescents have a neurotic personality,have experienced childhood physical abuse,and have a poor family environment,and mostly use immature defense mechanisms such as isolation and avoidance.7.Compared with adolescents with mild self-injury,adolescents with moderate-to-severe self-injury have lower BMI(thin body type),more prominent body bias,more severe psychosomatic symptoms,and poorer sleep quality.However,there were no significant differences in the prevalence of childhood physical abuse,personality traits,defense mechanisms,and family environment among adolescents with different levels of non-suicidal self-injury.It is suggested that attention to BMI,TCM body composition,psychosomatic symptoms,and attention to sleep quality in adolescents with non-suicidal self-injury will help identify high-risk self-injury patients earlier.8.The treatment of non-suicidal self-injury in adolescents is based on the principle of tonifying the spleen and stomach,taking into account the lung qi,and promoting the clear yang and dipping the yin fire.In summary,most adolescent non-suicidal self-injury has a history of chronic stress.and the neuroendocrine disorder caused by chronic stress may be the biological mechanism of non-suicidal self-injury.Based on TCM theory,adolescent non-suicidal self-injury is associated with spleen deficiency,and Chinese herbal medicines for the spleen and stomach have been shown to regulate the neuroendocrine disorders caused by chronic stress,so it can be hypothesized that spleen therapy is a key target for the treatment of adolescent non-suicidal self-injury in order to provide new ideas and methods for the treatment of adolescent non-suicidal self-injury. |
PDF Full Text Request