Self-Amputation in Two Non-Psychotic Patients (original) (raw)
Related papers
Upper-Extremity Self-Amputation in a Case of Dissociative Identity Disorder
The Journal of Clinical Psychiatry, 1999
Sir: Dr. Schlozman's recent article 1 reviewing 13 documented cases of self-amputation is an important contribution, which hopefully will encourage more clinicians, like myself, to add to the reports in the literature. He notes that all the patients were psychotic (schizophrenic or psychotic depression), with a preponderance of guilt and religious preoccupation related to sin and punishment. Eleven of the patients were men and few were acutely suicidal; indeed, the self-amputation may have helped to contain and localize the self-destructive impulse to the hand, which is then severed to get rid of the defective or offending body part. I am essentially in agreement with his conclusions, but wish to add another diagnostic category to the series-the profoundly traumatized individual with a dissociative disorder, especially dissociative identity disorder, formerly known as multiple personality disorder. Such patients may be chronically suicidal with periods of greater impulsivity and higher risk. 2-4 Case report. Ms. A, a 37-year-old married mother of 2, was readmitted to the psychiatric unit for an upsurge of suicidal feelings and urges to amputate her left hand by placing it under an approaching train. She could not see how this plan would have jeopardized her whole body, i.e., her life, insisting that she would feel much better to have the hand removed. The patient had been sexually abused in childhood by an uncle and brutally gang raped in college. She never forgave herself for not being able to defend herself and wished they had killed her instead. Her left hand did "bad things" and came to symbolize all of her sexual "sins," a finding described by Dr. Schlozman in many of the other cases. She had cut her left wrist several times in the past, sustaining nerve damage that left it numb but not paralyzed; a paralyzed hand was a second choice to frank amputation. At the time of admission, she also had a self-induced osteomyelitis of a finger that she hoped would spread and require amputation by the surgeons, another option in case she could not get to the train. All of these self-inflicted injuries occurred while Ms. A was in an autohypnotic, amnestic, fugue-like state that she experienced as a malevolent "alter personality" named "the unknown one." When she learned that the osteomyelitis was responding to antibiotics and her finger would be spared, she went into a silent rage. One evening, while Ms. A was still hospitalized, "the unknown one" reemerged and severed the finger with the sharp edge of a soda can, flushing the digit down the toilet so it could not be reattached. When Ms. A "returned," she was blasé and somewhat relieved by the amputation, much to the horror and shock of the staff. The "curative" effects of this selfamputation lasted several months when an upsurge of impulses to "complete the job" necessitated readmission to the hospital.
major self-mutilation in the first episode of psychosis
Major self-mutilation (MSM) is a rare but catastrophic complication of severe mental illness. Most people who inflict MSM have a psychotic disorder, usually a schizophrenia spectrum psychosis. It is not known when in the course of psychotic illness, MSM is most likely to occur. In this study, the proportion of patients in first episode of psychosis (FEP) was assessed using the results of a systematic review of published case reports. Histories of patients who had removed an eye or a testicle, severed their penis, or amputated a portion of a limb and were diagnosed with a schizophrenia spectrum psychosis were included. A psychotic illness was documented in 143 of 189 cases (75.6%) of MSM, of whom 119 of 143 (83.2%) were diagnosed with a schizophrenia spectrum psychosis. The treatment status of a schizophrenia spectrum psychosis could be ascertained in 101 of the case reports, of which 54 were in the FEP (53.5%, 95% confidence interval 43.7%-63.2%). Patients who inflict MSM in FEP exhibited similar symptoms to those who inflict MSM later in their illness. Acute psychosis, in particular first-episode schizophrenia, appears to be the major cause of MSM. Although MSM is extremely uncommon, earlier treatment of psychotic illness may reduce the incidence of MSM.
Journal of Forensic and Legal Medicine, 2013
Self-inflicted abdominal stab wounds are generally uncommon and there is no published report of survivors after extensive self inflicted disembowelment with mutilation. Here we present a case of 28 year old male who was brought to hospital 2 1/2 h after disembowelment through self inflicted abdominal stab injuries. The patient had hypovolemic shock due to bleeding from the mesentery and a 450 cm segment of small bowel which had been pulled out from 2 abdominal stab wounds and slashed multiple times by him. He had alcohol intoxication and hallucinations and did not seem to be in pain or emotionally affected by the severe injury. After resuscitation, and emergency resection with anastomosis he had an uneventful post-operative recovery. On psychiatric evaluation during follow-up, he was found to have schizophrenia aggravated by alcohol abuse and was treated accordingly. As self mutilation can be the first presentation of a psychotic episode, a psychiatric evaluation is necessary for all patients with self inflicted injuries.
Desire for amputation of a limb: paraphilia, psychosis, or a new type of identity disorder
Psychological Medicine, 2005
Background. The objective of this paper is to describe and conceptualize an unusual and probably rare condition: the intense longstanding desire to have an amputation.Method. Structured interviews were conducted by telephone of 52 subjects (mean age: 48·6, range 23–77 years; 47 male, 4 female, 1 intersexed) self-identified as having had a desire to have an amputation.Results. Seventeen per cent (n=9) had an arm or leg amputated with two-thirds using methods that put the subject at risk of death and one-third enlisting a surgeon to amputate their healthy limb. The most common reported reason for wanting an amputation was the subject's feeling that it would correct a mismatch between the person's anatomy and sense of his or her ‘true’ self (identity). None were delusional. For all but one subject age at onset was during childhood or early adolescence. For those who had psychotherapy or medication there was no change in the intensity of the desire for amputation. The six subjec...
Indian Journal of Plastic Surgery, 2023
Major self-mutilations include injury to limbs, eyes, or genitals due to various psychiatric illnesses. Limb amputations are grievous injuries that radically decrease the quality of life. Controversy exists as to the advisability of replantation of the selfamputated limb. We report a case of self-amputation of the hand in a 54-year-old gentleman in a fit of psychosis. He underwent replantation of the hand and was given timely psychiatric help. Interdisciplinary management helped in improving the mood of the patient and he cooperated well with the rehabilitation schedule. Recent literature encourages surgeons to replant the limb and treat the mental illness with close observation for warning signs. We conclude that replantation along with early initiation of psychiatry treatment can help the patient overcome psychosis, realize the implications of his actions, and provide the motivation to perform physiotherapy, to achieve the optimum outcome possible in the replanted hand.
Major self-mutilations: castration and enucleation
Pathological self-mutilation has been prevalent throughout history and in many cultures. Major self mutilations-autocastration, eye enucleation and limb amputation-are rarer than minor self-mutilations like wrist cutting, head banging etc. Because of their gruesome nature, major self-mutilations invoke significant negative emotions among therapists and caregivers. Unfortunately, till date, there is very little research in this field. In the absence of robust neurobiological understanding and speculative psychodynamic theories, the current understanding is far from satisfactory. At the same time, the role of culture and society cannot be completely ignored while understanding major self-mutilations. Literature from western culture describes this as an act of repentance towards past bad thoughts or acts in contrast to the traditional eastern culture that praises it as an act of sacrifice for achieving superiority and higher goals in the society. The authors present here two cases of major self-mutilation i.e. autocastration and autoenucleation both of which occurred in patients suffering from schizophrenia. They have also reviewed the existing literature and current understanding of this phenomenon (
A Case of Genital Self-Mutilation in a Patient With Psychosis
The following case report highlights an act of Genital Self Mutilation. This case had multiple interacting risk factors which were-being a single unemployed male suffering from schizophrenia with religious delusions. After a review of the clinical information available the case best fits the description for Klingsor Syndrome (German J Psychiatry 2007;10: 25-28).
Genital self-mutilation in a case of first episode psychosis
Indian Journal of Psychological Medicine, 2016
Genital self-mutilation (GSM) is a much rare finding and more commonly associated with psychosis when it comes to comparison with self-mutilation as a whole. There have been anecdotal case reports of GSM in psychotic disorders with most of them being in long standing psychoses. We describe herein a case of GSM during the first episode of psychosis where multiple phenomenological variables were seen responsible for the act.
Case Report Self-Mutilation of Tongue and Lip in a Patient with Simple Schizophrenia
2016
Munerato et al. doi: 10.3121/cmr.2010.930 Self-inflicted lesions that cause mutilation are observed in schizophrenic patients. This case report describes the diagnosis and treatment of simple schizophrenia in a 31-year-old male patient who bit his own tongue and lower lip. The dental treatment proposed included the construction of a splint to prevent new lesions and to allow healing of existing ones. The treatment afforded to avoid tooth extraction before the patient responded to psychiatric drug treatment. The importance of a transdisciplinary approach to self-mutilation due to psychiatric disorders is stressed. The interaction between the two teams — stomatology and psychiatry — was crucial for the improvement of the patient’s condition.