A Rare and Complex Case of Non-suicidal Self-Mutilation in a Patient With Schizophrenia

Abstract

The literature describing acts of non-suicidal self-mutilation (NSSM) in the adult population is limited. Of the cases that document NSSM, a disproportionate number of these individuals have a history of psychiatric illnesses. Although the motivation to perform NSSM varies across patients, the literature suggests that past self-injurious behaviors, extreme religious delusions, and command hallucinations are the most significant risk factors. The primary forms of NSSM include ocular, genital, and limb mutilation. Limb mutilation is the least common of the three and typically occurs proximal to the wrist or hand. Here, we present a rare case involving a 42-year-old man with schizophrenia who was hospitalized due to osteomyelitis of his autoamputated digits. This case is unique in involving multiple digits of the hand and using a rare amputation method. We aim to compare this case with the existing body of work on NSSM and identify factors that may predispose patients to act on these extreme impulses. We also highlight a novel interventional program that reduces psychiatric and medical comorbidities.

Suicide by sharp force associated with major self-mutilation and self-cannibalism

“…Previous self-mutilation actions, suicidal attempts, command hallucinations, and active symptoms associated with untreated schizophrenia Fig. 1 The photographs taken at the place where the body was found: the body of the deceased lying face down on the ground (a), the anterior aspects of the body showing multiple sharp force injuries and the presence of fly eggs and maggots (b), the right aspects of the head showing part of the right ear being cut off (c), and the kitchen knife found in the forest (d) are among the predictors of self-injurious behavior [18,19]. Self-cannibalism is an extremely rare form of major self-mutilation [20,21].…”

Bilateral Self-Enucleation in the First Psychosis Episode in a Person With Deprived of Liberty: Case Report

“…Non-suicidal major self-mutilation (NSMSM) is an uncommon manifestation of severe mental disorders, but with enormous complications, it drastically limits the quality of life for patients considering the physical disability and the underlying mental problem. 1,2 Frequently, schizophrenia spectrum psychosis is related to NSMSM, 1 and some of the risk factors associated are extreme religious hallucinations, command hallucinations, and a previous history of self-injury. 2 Although the medical literature about the NSMSM is limited, the ocular, genital, and limb regions are the main areas affected.…”

“…1,2 Frequently, schizophrenia spectrum psychosis is related to NSMSM, 1 and some of the risk factors associated are extreme religious hallucinations, command hallucinations, and a previous history of self-injury. 2 Although the medical literature about the NSMSM is limited, the ocular, genital, and limb regions are the main areas affected. 1 Additionally, self-injury seems to be more likely to occur in the first psychotic episode, 3 especially in ocular injuries, where it has been described more frequently in the first episode of psychosis in comparison with previously treated psychosis.…”