What does a confused enemy do if it has no "item in hand" for the damaging self result?

Question

A PC uses Gift of Madness and confuses an enemy. The enemy rolls a d100 on the confusion table and gets between 51-75. The table indicates the following:

• 01–25 Act normally.
• 26–50 Do nothing but babble incoherently.
• 51–75 Deal 1d8 points of damage + Str modifier to self with item in hand.
• 76–100 Attack nearest creature (for this purpose, a familiar counts as part of the subject’s self).

If read as written, the result for 51-75 strictly says with item in hand. What happens if the enemy is unarmed, and its only attacks listed are Slam attacks? Does it still punch itself in the face, or, unable to meet the conditions, does it just babble incoherently?

Answer 1

I would not treat it as a conditional (as in you need an item in hand to do it) but as a descriptive means:

If they hold an item in their hand, they strike at themselves. If they don't hold an item in their hand, they still strike at themselves, but with an unarmed strike.

The damage is fixed 1d8+STR, so even if a Giant would wield a large Bastard sword of Giantbane for 2d8+2d6+STR vs Giants, he still just gets 1d8+STR. On the other side, an Iron Golem¹ without a weapon would still inflict 1d8+STR (in his case, the Strength modifier is 11) onto himself instead of his 2d10+16 Slam attack.

Also remember, that some creatures have Damage Reduction. Aforementioned Iron Golem still has DR 15/adamantine, so he still is allowed to cut 15 points of damage off the inflicted 1d8+11, resulting in any 1-4 on the roll doing no damage, and 5 to 8 taking away 1 to 4 hitpoints. In case the maker choosing to equip the Iron Golem with an Adamantine claw on the hands, the Damage Reduction would not apply and the golem would take full 1d8+11.

^{1 - ignoring their construct traits and immunnity to magic for a moment}

Answer 2

They punch themselves.

The added "with item in hand" is there to specify the type of damage in regards to Damage Reduction.