Psychiatry and Clinical Psychopharmacology

An atypical self-mutilation: skin-burn with a lighter

Psychiatry and Clinical Psychopharmacology 2014; 24: Supplement S90-S90
Read: 28613 Published: 18 February 2021

Non-suicidal self injury (NSSI) or self mutilation is deliberate self harming behavior to body tissue for the purpose of emotional relieving, punishment, getting attention or escaping a compelling situation. Estimated NSSI prevalence is %4 of general population whereas the rate is higher in adolescents and among individuals with psychiatric history as well as alcohol/substance abuse. Psychiatric comorbidities are common among individuals who are prone to self-harm. Bipolarity, personality disorders, particularly borderline and antisocial personality disorder are the risk factors for NSSI. There are different methods of NSSI including cutting, biting, hitting and skin picking or burning. Cutting is considered to be the most encountered form of self-mutilation in clinical practice. In this case report, we present a 21-year-old male with the diagnosis of bipolar II disorder, who burnt some parts of his body by using a lighter for self mutilation. Our patient was referred to outpatient clinic with restlessness, sleeplessness, racing and reference thoughts, and increased psychomotor activity. In his history, he had the diagnosis of Cluster B Personality Disorder before his last referral and had no current medication. In clinical evaluation, in addition to his mood disorder symptoms, conduct problems and substance use have been investigated due to his self-mutilation and substance abuse history. He reported no recent and current substance use while in his examination some red areas were seen on his forearms, neck and pectoral region. He reported that he had burnt his skin via a lighter to relieve his anxiety but he couldn’t have remembered how and when he had made these lesions. His prior form of self-mutilations was cutting his skin whereas he had no burning type of self-harm before. He had no current suicidal thought and no suicidal attempt before. After clinical assessment, risperidone 2 mg/day and valproate sodium 1000 mg/day were administered as medication. Self-mutilation is increasingly becoming a more remarkable clinical condition in psychiatric practice. Whereas it was described as criteria of borderline personality disorder in DSM-IV TR, there is a tendency to consider it as distinct clinical entity. Several forms of self- harm have been reported in literature such as genital self-injury. Self-mutilation is not only a clinical symptom of personality disorders but also associated with mood disorders such as depression or bipolar disorder, anxiety disorders such as PTSD, OCD and a range of psychotic spectrum disorders. As self mutilation may be seen as in uncommon form like burning, clinicians should be aware of its probability in assessing individuals, particularly those with the diagnosis of mood disorders and personality disorders and evaluation should include all forms of self injury, rather than common forms such as cutting and hitting, only.

EISSN 2475-0581