Van Gogh syndrome

Van Gogh syndrome is a mental condition in which an adult performs self-harm. It usually happens on the ground of a specific psychiatric condition. during one of his psychotic episodes. Sufferers may burn themselves, attempt to severely damage their genital organs (especially amputate their penis), castrate themselves, extract their own eyes, amputate their own hands, or commit suicide.
Another medical condition for which the term is used, but only rarely, is when the vision turns yellow for a period of time as, for example, in digoxin toxicity. Van Gogh syndrome is now a synonym for non-suicidal self injury (NSSI), where participants intentionally and repetitively inflict injuries on their bodies without suicidal intention and not socially sanctioned. These injuries are not intended to cause lethal harm and range from biting, scratching, cutting to mutilating reproductive parts. Self-injuring occurs commonly in children from 9-18 months, and is considered pathological in children beyond 3 years of age. NSSI is most prevalent in adolescents and patients with diagnosed psychological illnesses, however frequent incidents are also recorded among young adults. In the past, NSSI was thought of as symptoms that associated with many psychological conditions, not an entity by itself. With increasing reports of prevalence and causative origins, recently, NSSI has been classified as an independent syndrome that can co-occur with a variety of other mental conditions. NSSI patients usually use self-harm as a mean to relieve stress and negative feelings, often harbor thoughts of self-injure, repeat injuries, and experience satisfaction post-action. Although NSSI is often associated with suicidal attempts, there is a clear distinction between the two behaviors. People who practice NSSI do not set death as their final goal. Severity of wounds may vary and some may end up needing medical attention, however, the purpose is not to cause lethal harm. and in the DSM-5-TR released in 2022 the disorder remains only as a proposal.
Diagnosis
Because NSSI is associated with a wide range of psychological syndromes and biopsychosocial factors, like eating disorders, dissociative disorder, borderline personality, depressive disorders, and suicidality, it used to be regarded as manifesting symptoms of these conditions. The criteria also exist in a proposal for the disorder in the DSM-5-TR.
Risk factors
Adolescents are the most prevalent age group for NSSI, the average age of onset is around 13-14 years old. Studies showed that adolescents are vulnerable to NSSI due to the sensitive transitional period in life that happens during adolescent years. Non physically abusive parenting can also place high susceptibility on adolescents. Parental control refers to when parents want to influence their child either by physical or emotional manipulation, while parental support implies behaviors that are encouraging, accepting, and supportive. Households with heavy use of parental control, and lack thereof of parental support, usually lead to high tendency of NSSI. Internal issues stem from emotional dysregulation and psychological distress also push individuals towards NSSI tendency.
Functions
An overwhelming number of NSSI cases were reported in accordance to stress release intention. Most NSSI patients are associated with sadness, anxiety, depression, feeling of abandoned, and isolated, they often find themselves trapped in a high amount of uncontrollable stress and emotional burden that is hard to endure; living quality is also negatively impacted. Inflicting physical wounds is an outlet to relieve unbearable distress, the act of cutting through skin is a mean to physically lessen the pain, and many have reported that feelings of satisfaction and goodness were perceived post-injury.<ref name=":1" /> Among other individuals, NSSI behaviors are also considered as a way to self-punish and self-direct anger. Other uses of NSSI include wanting to fit in, gaining attention, and alleviating emotional numbness.<ref name":3" /> NSSI functions are classified into four sub-functions: automatic negative reinforcement, automatic positive reinforcement, social negative reinforcement, and social positive reinforcement. Automatic negative reinforcement aims to eliminate feeling of emotional numbness or negative feelings of emotional disturbances, automatic positive reinforcement seeks to gain any type of feelings, even pain, social negative reinforcement helps individuals get away from feeling peer pressure and being forced to do things against their wills, lastly, social positive reinforcement is done to attain attention, negative or positive.<ref name":42" />
Overall, automatic negative reinforcement and automatic positive reinforcement prevail the other two methods, while automatic negative reinforcement is more common than automatic positive reinforcement. These findings correspond to popular utilization of NSSI as tool to alleviate negative stress. Individuals that participate in automatic positive reinforcement have higher risk for suicidal attempts. The desire to obtain certain feelings from self-mutilation tends to push those individuals towards higher frequency of self-harm repetition, along with desensitization to pain and elimination of fear towards suicidal thoughts.<ref name=":3" />

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