A case of self-mutilation: the man who eats himself

Self-mutilation is a general term for a variety of forms of intentional self-harm without the wish to die. Despite many patients have been reported to have self-mutilation injuries, literature search do not yield any data on self-eating after self-mutilation. Here, a patient with self-eating following self-mutilation is reported. A male patient in his 34 was brought in the emergency department from the prison due to a laceration on the right leg. Physical examination revealed stable vital signs and a well-demarcated rectangular 7x11 cm (7 mm thick) soft tissue defect on his right anterior femoral area although calm in appearance, he did not respond to physicians’ questions. The prison authorities told that the prisoner had cut his thigh with a knife and had eaten the şesh in around one hour. They also added that the prisoner had done the same thing in his left arm a year ago. Psychiatric evaluation was also done in the emergency department. Psychiatric presumptive diagnosis was psychosis based on indifferent attitude, limited collaboration, low-toned speech with short questions and answers, mystic delusions (thinking himself as a devil), auditory sensory delusions such as hearing commands and inappropriate affection. Diagnosed with psychotic disorder, the patient was transferred to a contained psychiatric ward. Self-mutilating injuries are encountered predominantly in male patients in the emergency department. This pattern of behavior is seen prevalently in patients with personality disorders, acute and chronic psychotic disorders, major affective disorder, and gender disorders. Self-harm behavior is mostly encountered in patients with personality disorders, especially in borderline personality disorder. Self-harm behavior represents a rescue attempt triggered under circumstances in which expression of aggression is inhibited due to physical constraints. The present case is a typical example of this behavior seen frequently among prisoners. A variety of major self-mutilation attempts have been cited in the literature such as finger mutilation, tongue and penis amputation, enucleation. The present case has unique difficulties hampering a thorough evaluation leading to psychiatric formulation: presenting in an emergency setting, imprisonment and thus retrieval of history and other relevant data from prison officers and poor collaboration of the patient. The psychiatric presumptive diagnosis was psychosis. Imprisonment status of the patient, secondary gain such as getting away from prison for admission to hospital due to “illness”, probable decrements in the penalty to be received from the court warrants further investigation in terms of simulation, personality disorders and substance abuse.