I am posting the following because it is just interesting reading.
It has some information in it regarding different types and reasons
for self-mutilation, which is not that common, though has been seen
in various Tourette Syndrome cases.

The self-abusive behaviors could include, head banging especially as
young children, hitting one's self, licking lips sometimes until
they
are bleeding and infected, washing hands until they are raw, constant
picking at sores, grinding and pulling teeth, biting hands, lips,
cheeks, nails or tongue until they bleed, Carving or serious
scratching of the skin, scraping or dragging toes.

Tourette-Updates
Paul Marshall
editor@...
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Equine Self Mutilation
by: Sue McDonnell, PhD, Certified AAB
March 2000 Article # 3039


It's a beautiful winter weekend, and finally you have a full morning
to spend at the barn. You're happily grooming your horse when you
notice a cluster of patches of wet hair on his side. Peculiar pattern
to the wet hairs -- all are lying forward as if combed with a wet
brush. Oh well, odd but probably nothing, you think. But wait, some
of the wet spots have hairs missing or chopped off bluntly. You check
the other side, and there you find some more patches, like the wet
ones, but as if they have now dried. What's going on? There are more
of these patches on the left side than on the right side, but they
all are in the same area of the abdomen, from the ribs to the stifle.
Just then the barn manager comes in all excited. She's glad you're
there early today, because when she was feeding this morning, she
found your horse spinning in his stall, tearing at his blanket and
biting at his sides. Her first reaction was to scream at him to stop--
and he did. She figured the blanket was the problem, maybe it was
rubbing or pinching him under the leg. She got some help to
investigate. They couldn't find anything out of order with the straps
or the blanket, but took it off anyway. Then, just as they closed the
stall door, he really went nuts, spinning in a very tight circle,
biting his left flank. With each bite, he squealed and kicked out. As
he was turning and nipping, he sometimes was bucking and squealing.
They were too scared to open the door. He went on for what seemed
like forever, as if he wouldn't stop until he tore up the stall or
killed himself. Then he gradually came out of it.

"When we screamed his name, he turned toward the stall door, looking
at us with a sort of a worried, glassy eye, like he didn't know what
was happening. We threw him his hay, and he's been pretty quiet
since."

You run your fingers over the wet areas on his flanks and feel some
crusty bumps on the underlying skin. Separating the hairs, you can
feel little marks in the skin -- anywhere from one-quarter to one
inch in diameter. Some are fresh nicks, some are scabbed over, some
look healed. The rest of his coat is unblemished. No marks, no wet
spots, no chopped or missing clumps of hair other than on his flanks
and over his ribs.

So what is going on here?

This behavior commonly is called flank biting or flank sucking. The
biting is one aspect of a cluster of behaviors called self-
mutilation, because the horse likely will incur serious self-injury
during these explosive episodes.

In addition to biting the flanks, self-mutilation sequences can
include seemingly uncontrollable violent behavior. From horse to
horse, the sequence and form can vary, but most typically includes
spinning in circles, bucking, and kicking out with one or both back
legs while nipping at the flank, shoulders, or chest. In the photos
at the bottom of page 76, there is an example of a horse biting more
violently at his chest, and a resulting chest avulsion.
In extreme cases, the horse can violently lunge its body or head into
a wall or other solid object. More rarely, a horse might "throw
itself" to the ground (from standing to lateral recumbency). A single
episode can last from a few seconds to several minutes,
uninterrupted. The horse can work up a lather and steam in cool
weather. Episodes usually occur in a series separated by a few
seconds to a few minutes over a period of minutes, to hours. The
total daily time spent self-mutilating can vary from a few seconds to
an hour or more. In addition to bite wounds, the most common injuries
are to the legs and feet from the spinning and kicking.

Self-mutilation behavior of one form or another has been described in
many different species, including humans. Dog and cats lick and chew
on their paws or tails. People do all sorts of things--pull out their
hair, bite their fingernails or lips, scratch themselves, or
deliberately inflict burns, cuts, or other wounds.

People who have seen a horse in the midst of attacking itself often
describe the episodes as the most bizarre animal behavior they ever
have seen. Mental health professionals or others with first-hand
experience with human psychopathology often ask whether this might be
the horse equivalent of severe neurotic or even truly psychotic
behavior seen in people. For example, Dr. Nicholas Dodman, a
veterinary animal behavior specialist at Tufts New England Veterinary
College, said he has wondered whether certain forms of self-
mutilation in horses might be similar to Tourette's Syndrome in
humans. There are some interesting similarities, and some clear
differences.

Since self-mutilation occurs in other animal species and a variety of
human psychopathologic syndromes, it's probably too early to conclude
that any of the self-mutilation seen in horses represents the same
pathology as Tourette's in people. In other species, the trend in
clinical veterinary behavior has been to label self-mutilative
behavior "obsessive-compulsive disorder," or OCD.

This syndrome in humans has two distinct components. One component is
the compulsive, repetitive behavior, such as repeatedly checking to
see if the stove has been left on. The other component is the
accompanying obsessive thoughts or worries, such as concerns about
being caught in a burning building. Often the thoughts or worries are
related to the compulsive behavior and logically appear to drive it.
In the case of animals, we don't know whether they think or worry, so
this label of obsessive-compulsive behavior might be too elaborate.
Some behaviorists now are calling these behaviors in animals simply
compulsive behavior.

There are at least three distinct types of self-mutilative behavior
in horses. One type is simply an "extreme" behavioral response to
physical discomfort. We know that physical pain alone, particularly
in the abdominal area, can evoke behavior similar to that of the
horse in the situation described above. We know it is physical pain
because coincident with finding and correcting an apparently or
potentially painful condition, the self-mutilative behavior stops
without any other treatment. For example, the classic behavior we
associate with colic or early labor in broodmares involves turning
the head back toward the flank, either looking or nipping at the
flank, and sometimes kicking out. Although it is not as common, some
horses' behavioral response to physical pain has more violent
episodes, including spinning, kicking, bucking, and serious self-
biting. Some of the less-common physical root causes for violently
colic-like behavior have been a twisted testicular cord, an abdominal
abscess, urethral tears, or gastric ulcers. These sometimes can be
intermittent and difficult to find. This is in contrast to the other
types of self-mutilation. When there is a physical cause, there often
is an increase in the behavior in association with work. The most
explosive episodes might be during or soon after work. As time goes
on, the horse might anticipate the exacerbation of pain with work, so
can become agitated when being prepared for work.

A second type of self-mutilation is what could be called self-
directed intermale aggression. This type occurs in stallions and
geldings. The sequence follows what two stallions at liberty would do
when meeting, except that the stallion himself is the target of his
own behavior. When stallions meet, they typically stand parallel to
one another, head-to-tail. They investigate each other's flank area,
usually sniffing and nipping at the flank and genitals. The encounter
can be pretty noisy. The stallions usually squeal and kick out with
each nip or bite. They also might spin, buck, stomp, and romp, going
around one another in circles. The sniffing of each other's flank and
genitals, and of each other's feces, is an important trigger for the
nipping and biting.

Sometimes the self-mutilation process begins over a stud pile. In the
stallion which is sniffing and biting himself, each episode begins
with the sniffing of his own feces or feces of other stallions in
shared turn-out facilities. Oily body residues on stall walls,
fences, or doorways can trigger episodes. We have seen several cases
of self-mutilation that appeared to have started when a stallion was
exposed to the smelly residues of another stallion in a trailer.
Unlike the pain-related self-mutilation, this type usually develops
over a period of months. It can start as early as the first year of
life or as late as the teens. It typically continues for the life of
the stallion.

A third type of self-mutilation is a more quiet, rhythmic, repetitive
nipping at various areas of the body. It looks similar to stereotypic
weaving or stall walking in that it appears that the horse has
nothing better to do. By formal definition, stereotypic behavior is
characterized by repetitive, highly stylized, and seemingly
functionless movements and sequences of movements.

Spanning the top of pages 76 and 77 is a series of photos of a
stallion which had a very fixed pattern of biting himself from flank
to shoulder to chest to opposite shoulder to opposite flank and on
and on. He did it at the same place in the pasture at the same time
of day for the same length of time, just as some horses walk their
stall in very complex and fixed patterns day after day.
Stereotypies occur in one form or another in all captive wild and
domestic animal species, and are a common feature of human
psychopathology, as well as developmental and neurologic disorders.
Subadequate environment and nutrition seem to be the major factors
predisposing animals to stereotypies.

In horses, the classic stereotypies are cribbing, weaving, pacing,
stall-circling, and head-shaking. Certainly, in cases in which a
physical root cause is not apparent, self-mutilation fits this
definition of a stereotypy. Of course, the performance of a
stereotypy, no matter what the initial precipitating cause, is self-
rewarding. Endorphins are released, and they can be positive
reinforcement sufficient to sustain the behavior as a habit. We often
wonder if self-mutilation, for which we can find no contemporary
physical cause and that doesn't quite fit the self-directed intermale
aggression type, might have started during a period of physical
discomfort, but now is a lingering habit.

How Common Is Self-Mutilation?

It's very difficult to estimate how many horses suffer from self-
mutilation. My guess would be that the problem occurs in less than
0.005% of all horses. Most equine veterinarians might see only a few
cases in their entire careers. Self-mutilation can occur in
stallions, mares, and geldings. Of course, the self-directed
intermale aggression type is almost always in stallions and geldings.
We don't know whether or not the predisposition for self-mutilation
is highly heritable. We know that the behavior probably is the result
of domestic environmental and nutritional factors, in that it
apparently does not occur in wild or feral horses.

Where Does It Hurt?

For those horses whose self-mutilation episodes looks like a violent
form of colic, it is critical to look for and immediately treat any
possible causes of discomfort. Except for classic colic, this often
is easier said than done. It sometimes can be tough to find (see the
boxed table of examples of possible physical causes of discomfort on
page 74). No matter what the slickest animal psychic would have us
believe, our animals, like human infants, have only their non-verbal
behavior as clues to tell us where they hurt. After years of losing
sleep trying to find causes of self-mutilation in horses, I think our
best hope for figuring out potential physical sources of discomfort
that might be provoking episodes of self-mutilation turns out to be
pretty inexpensive and very low tech. It is simply to critically
observe the horse for hours at a time. This can be done live, but
there are many advantages to video recording the behavior.
Long, continuous observation periods allow the horse to go back to
its ongoing behavior, as opposed to being distracted by human
presence. Long observation periods also will enable you to see how
the self-mutilation episodes start and stop, and what in the
environment might provoke them. When casually watching a self-
mutilating horse, your attention is drawn to the noisy, more violent
episodes. When watching the horse continually for hours, you likely
will see mild and violent episodes. The milder episodes often are
more useful than the explosive episodes in localizing potential sites
of discomfort.

Once you have a clue as to where the pain might be, you can be
aggressive with veterinary diagnostics. This might include classic
radiography, scintigraphy, endoscopy, and ultrasound imaging.
Even if it appears to be a classic stereotypy, or a psychological
behavior problem, we should never stop looking for a possible
physical cause. A great example illustrating this point in horses is
the case of head shaking behavior. For many years, veterinarians have
looked for possible sources of discomfort in cases of head shaking.
Many times a source could be found--things like ear mites, tooth
abcess, guttural pouch problems, or allergies. But many times,
nothing physical could be found and it was assumed that the problem
was psychological. Only a few years ago did scientists in the United
Kingdom and California find that some headshaking in horses appears
to be induced by bright light or loud sound. It is a real physical
problem involving hyperactivation of a nerve tract that is physically
irritating to the horse. (See The Horse of October 1996, page 70.)

What Else Can You Do?

The best outcome of immediate and aggressive veterinary evaluation is
to identify and quickly treat a physical cause. An equine behavior
specialist can be a valuable member of a veterinary team. By
evaluating the behavior, possible sites of discomfort can be
identified, and an opinion can be offered on primary or secondary
psychological components to the episodes. If physical discomfort is
eliminated, the self-mutilation typically stops almost immediately.
We have seen cases in which months or years passed before a root
physical cause was found, in which the self-mutilation stopped
immediately when the discomfort was alleviated.

Unfortunately, often a physical cause is not found and the conclusion
is drawn that this is the self-directed intermale aggression type, or
is simply a stereotypy. Over the years, mostly by trial-and-error, we
have found a number of different treatment approaches, each of which
typically is either helpful, or at least does not exacerbate the self-
mutilation. Most are simple management changes that seem to work by
distracting the animal to another activity; some involve
sophisticated pharmacology.

Physical restraint Traditionally, a large percentage of the effort,
thought, and expense of treatment of self-mutilation has involved
various methods of physically preventing or discouraging the
behavior. This often is the first thing you will want to consider
while further evaluation is organized. Special neck cradles and side
poles, grazing muzzles, bibs, and protective wraps and blankets can
be used to prevent injury. Physical restraint alone rarely "cures"
self-mutilation. All too often when the horse is effectively
restrained from performing one behavior, another problem behavior
develops. If biting is prevented, the horse might start kicking or
lunging into walls. In the short term, while looking for and treating
possible causes, it is wise to creatively work at keeping the animal
from further injury.

For any restraint, care must to taken in devising materials that
don't cause new rub sores or other irritations. My favorite of all
the restraints for self-biting is the grazing basket shown on page
78. The horse effectively can eat hay and grass through the openings.
The basket inhibits a substantial grab of flesh, although the
persistent horse still can work a small nip of hair or skin through
the basket openings.

Social, feeding, and work distractions Typically, the most effective
management changes are those that seem to provide motivation for a
substitute behavior or a strong distraction to focus on something
else. For a stallion, self-mutilation sometimes can be relieved
significantly if the stallion is turned out to live in a large
pasture with one or more mares. In that situation, the stallion
becomes a harem stallion with great responsibility to herd and defend
the mares. Those harem maintenance behaviors seem to occupy the
stallion's time and distract him from the problem behavior. If he is
not supplemented with concentrated feed, his grazing and resting
fully occupy the remainder of his time.

Of course, this often is not a plausible solution for the fancy
breeding or busy performing stallion. There might be some difficulty
and danger in taking such a stallion or his mares in and out of such
a situation. Most stallions will not want to leave their mares. But
to the extent that the stallion can be distracted socially, in some
cases it is worth trying.

Horses appear to find meaningful social companionship from animals of
other species. Donkeys, goats, rabbits, and even chickens are useful
as stall or pasture companions. In my experience with chickens as
stall companions for self-mutilators, it seems that the horse
sometimes is reluctant to move around the stall, lest it cause the
chicken to scurry and flutter. Some stallions also seem distracted by
their effort to avoid stepping on the chicken.

Another effective distraction for many self-mutilators is a vigorous
appetite. A change in diet from one heavy with grain to one of grass
and grass hay only (without any grain or richer forage) often can
lead to a remarkable change in behavior. The horse might spend almost
all of its time eating and resting, with seemingly no time for
anything else, including self-mutilation. A grazing muzzle like the
one described earlier can effectively prolong the eating time.
The all-grass, no-grain diet might have other benefits for behavior.
We know from work in horses and other grazing species that grain
diets predispose an animal to stereotypies and other behavior
problems. The grain diet might alter the brain neurochemistry,
setting the animal up for developing abnormal behavior. We long have
appreciated that grain increases the risk of behavior problems and
high-forage diets reduce the risk of behavior problems.

Work For the self-directed intermale aggression type of self-
mutilation, the behavior seldom is seen during work. Moderate work
also stimulates appetite. A horse which works one to two hours a day
and which is fed ad lib grass and grass hay almost always will spend
60% or more of his time eating and 20% of his time resting. This
approaches the natural time budget of a horse at liberty or in the
wild. Breeding work sometimes reduces and sometimes increases the
frequency and intensity of self-mutilation.

Gelding stallions? For the self-directed intermale aggression type
self-mutilating stallions, some veterinarians recommend castration,
and in some cases it works very well. Unfortunately, it also can get
worse or won't change. When advising clients on this option, I always
am reminded of the dozen or so geldings we have known which seemed
normal as colts, but were first seen to self-mutilate soon after
castration.

Medications Pharmacologic aids, which in some cases have appeared
helpful in relieving self-mutilation, include long-acting
tranquilizers, tricyclic anti-depressants such as imipramine and
clomipramine, progesterone, and the nutritional supplement l-
tryptophan. Some of these have been discovered by accident and some
are based on theories of brain neurochemistry. None of these
medications alone or in combination is likely to eliminate self-
mutilation completely. The particular choice depends on the severity
and nature of the self-mutilation. In combination with management
changes, medications often are judged to be valuable parts of the
plan to eliminate self-mutilation. The tendency is for people to over-
estimate their potential. An important concern for clinicians who
medicate the horse early in the evaluation is that the drugs might
help a horse to cope with physical discomfort, thus could effectively
mask the symptoms and delay diagnosis of a treatable physical
problem.

Other treatment tips For horses whose self-mutilation seems to be
triggered by male odors and feces, any number of creative steps can
be taken to reduce the stimulation. Odor-masking preparations can be
applied to the nostrils, the horse can be bathed frequently, and
feces and oily residues can be removed from stalls and pastures.
Sometimes, the sight or smell of another stallion seems to provoke
episodes. Housing changes can reduce the frequency and severity of
self-mutilation.

In our clinic we find that long-term video surveillance of the horse
can reveal events and situations that provoke the behavior. Often
these "provokers" can be simply and inexpensively eliminated. For
example, occasionally you find a horse which only bites himself when
the feed cart is coming down the aisle, or when other stallions are
on their way to the breeding shed.

Tie-stalls For reasons I'm not sure we ever will understand, simply
housing a horse in a tie-stall can effectively eliminate self-
mutilation. Recent work with tie-stalled horses in the pregnant mare
urine industry has indicated that abnormal behavior in general is
very low in tie-stalled horses compared to box-stalled horses.
No one treatment alone is likely to be effective. The cases for which
the greatest relief has been achieved have involved simultaneously
implementing as many of the treatment steps as possible. We recommend
spending time with your veterinarian to develop a custom plan based
on everything you know about the horse. Once everything is organized,
we recommend implementing all the changes and treatments at once.
This is not good science in that you might never know which of the
changes were most effective, but experience has taught us that major
change often is more effective than a systematic, step-wise approach.
In summary, we really know very little about the causes of self-
mutilation, other than physical discomfort. It is important to
realize that except for those cases for which a physical discomfort
can be identified and eliminated, the self-mutilation likely will
never be cured. The current treatments for the self-directed
intermale aggression and stereotypy types of self-mutilation rarely
effect a cure. At best, diligent attention and care will keep the
levels of injury low.
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Source: http://www.thehorse.com/viewarticle.aspx?ID=3039

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Tourette-Updates
Paul Marshall
editor@...