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PubMed2006

[Traumatic luxation of the testis due to self-mutilation: a case report].

A 16-year-old male patient was admitted to our hospital with traumatic luxation of right testis due to self-mutilation with a retractable knife on Apr. 20, 2004. He had been followed as temporal lobe epilepsy and suspicions of gender identify disorder by a pediatrician. He was fully oriented with a clear sensory and normal perception, but had no memory of what he had done. His parents were free of psychiatric disease, and he was the youngest in siblings of two older brothers. The laboratory examination showed no abnormal findings. Under general anesthesia, right testis was replaced in the scrotum and the scrotal wound was closed at the emergency operation. He had an attack of epilepsy and recovered by itself on the next day. He was discharged on the eighth postoperative day. After the operation, no recurrence has been seen until now. To our knowledge, this is the 37th case of male genital self-mutilation reported in the Japanese literature.

Adolescent↗
PubMed1977

The pathology of self-mutilation and destructive acts: a forensic study and review.

Self-destructive behavior of man and its consequences may be presented in various forms, including self-mutilation, injury, and malingering, and with various manifestations, including the Munchausen syndrome, polysurgery, purposeful accidents, impotence, and frigidity. The general subject of focal suicide has been a relatively unknown and unrecognized entity for different reasons, including the fact that most physicians are trained to approach a case in a manner which treats the patient-physician relationship as one of honor and faith regarding the authenticity of the complaints of the patient. The maturity of years and experience may be required before the physician becomes aware of the motivation of patients' behavior. It is hoped that this article will provide new insight into areas which may be unfamiliar to the forensic practitioner and clinician but which might enable them to learn about the background of an unexpected death or the possibilities of motivation in civil suits alleging professional negligence or malpractice.

Forensic Medicine↗
PubMed1980

Some interpersonal aspects of self-mutilation in a borderline patient.

Some interpersonal aspects of self-mutilation and vampiristic blood rituals in borderline states are discussed, as these were clarified in the therapeutic relationship established with a hospitalized young woman. The therapeutic stance during the period of inpatient treatment discussed emphasized consistent reinforcement of boundaries and limits in order to facilitate a mutual exploration of the interpersonal context in which her symptoms emerged. Blood rituals repeatedly expressed primitive identifications with intrusive, controlling, and sadistic aspects of a psychotic mothering figure. These were reflected in the treatment in her crazed, angry demands--through her symptoms--for a "caring" response from the therapist, whom she deliberately and vengefully assaulted through the medium of her own blood. Her manipulative and controlling efforts to maintain a human attachment highlighted her anxieties about separation and abandonment. In subsequent phases of the psychotherapeutic work, her relation to her own blood reflected struggles with womanhood and sexuality.

Adult↗
PubMed1994

Lesch-Nyhan syndrome: successful prevention of lower lip ulceration caused by self-mutilation by use of mouth guard.

Lesch-Nyhan syndrome (LNS) is a disorder caused by congenital absence of a purine metabolic enzyme, hypoxanthine guanine phosphoribosyl-transferase (HGPRT). This syndrome is characterized clinically by hyperuricemia and neurologic features including choreoathetoid spasticity, self-mutilation, and mental retardation. We report on a patient in whom self-mutilation of the lower lip was suppressed with the help of a mouth guard made from soft resin.

Humans↗
PubMed1985

Increase of self-mutilation behavior in forelimb deafferented rats, following stimulation of the dorsal raphe nucleus.

The role of dorsal raphe nucleus (DRN) was studied in rats which develop scratching or/and self-mutilation after deafferentation of brachial plexus. The extent of the lesions was measured in four groups of deafferented rats. Two control groups: implanted and not implanted, a group of animals in which DRN was stimulated, and a group in which it was electrolytically destroyed. We observed an increase of scratching and self-mutilation in the implanted group but overall in the stimulated group, and no change in the abnormal behavior was provoked by DRN lesion.

Animals↗
PubMed1993

Repeat male genital self-mutilation precipitated by urinary complications of prior repair.

Male genital self-mutilation is uncommon, with repeat mutilation even more rare. Our case is unique in that a urological complication of the first mutilating act (meatal stenosis) helped to precipitate the second incident. This case underscores the need not only for immediate urological and psychiatric care at the time of initial mutilation but also for close, combined followup care as well. In the majority of cases, when properly monitored, the men do not repeat the mutilating act.

Adult↗
PubMed1995

Male genital self-mutilation: a case report.

A review of the literature on self-mutilation of male genitalia and/or auto-castration reveals that they are infrequent and usually related to psychoses or toxic states. In this report the authors present a case of a 17-year-old non-psychotic Japanese male who mutilated his genitalia under clear consciousness because of a conflict over his frequent masturbation.

Adolescent↗
PubMedDate not supplied

Self-mutilation: three cases and a review of the literature.

The self-mutilating patient is an unusual psychiatric presentation in the emergency department (ED). Nonetheless, serious underlying psychiatric pathology and drug abuse are important background risk factors. A careful stepwise approach in the ED is essential, although the prognosis, follow-up, and eventual rehabilitation are poor.

Adult↗
PubMedDate not supplied

Oral self-mutilation in the Lesch-Nyhan syndrome.

Lesch-Nyhan Syndrome is a disorder caused by congenital absence of a purine metabolic enzyme, hypoxanthine-guanine phosphoribosyl transferase (HPRT). This syndrome is characterized clinically by mental retardation, chorea, athetosis, hyperuricemia, uricosuria and self-mutilation. This report is of two children, who are cousins, both of whom have Lesch-Nyhan syndrome and presented with severe self-mutilation wounds on their lip(s). Vital pulpotomy and coronal resection was done as a more conservative approach than extracting all offending teeth. By maintaining the root portion of the teeth in the bone, it is expected that preservation of the alveolar bone will be achieved.

Bicuspid↗
PubMed1993

Genital self-mutilation.

We report a series of 14 patients with 19 self-inflicted genital injuries during a period of 10 years. Of the patients 65% were psychotic and 35% were not psychotic. Repeated attempts at genital self-mutilation occurred in 31% of the cases, mainly in the psychotic group. A history of alcohol and/or drug abuse was present in 55% of the cases. Injuries varied from simple laceration of penile or scrotal skin to actual amputation of the penis or testis. The degree of injury did not differ between the psychotic and nonpsychotic patients. Surgical management and outcome varied according to the severity of the injury, the delay in presentation for treatment, and the degree of alteration in the mental status and behavior. Followup of 9 patients showed good cosmetic results with no immediate or delayed complications related to the injury. The functional results in patients with penile replantation were satisfactory. In 1 patient a urethral stricture developed that was successfully managed endoscopically. Erectile function was difficult to assess because of the marked diversity of sexual behavior in this group.

Adult↗
PubMed2003

Disappearance of self-mutilating behavior in a patient with lesch-nyhan syndrome after bilateral chronic stimulation of the globus pallidus internus. Case report.

Lesch-Nyhan syndrome (LNS) is an X-linked hereditary disorder caused by a deficiency of hypoxanthine-guanine phosphoribosyltransferase. Patients with this syndrome are characterized by hyperuricemia, self-mutilation, developmental retardation, and movement disorders such as spasticity and dystonia. The authors performed bilateral chronic stimulation of the globus pallidus internus for control of dystonic movements in a 19-year-old man with LNS. His self-mutilating behavior unexpectedly disappeared after chronic stimulation. This is the first case of LNS that has been successfully treated with deep brain stimulation. The findings indicate that neurobehavioral features of this syndrome are either mediated in the basal ganglia pathways or secondary to the dystonia.

Adult↗
PubMed1981

Circannual fluctuation of a stereotyped behaviour with possible self-mutilation in a mentally deficient adolescent.

A stereotyped behaviour with possible self-mutilation was measured in a mentally deficient child (age 17) with autistic features; the subject was observed 5 minutes each hour, daily from 0800 to 2000, for fourteen months. We studied variations of his behaviour (number of acts per minute of observation and per day) and especially circannual fluctuations with maximum in summer and minimum in winter. The origins of this variation are discussed, particularly from the chronobiological point of view. Eventual therapeutic issues of this kind of study are also considered.

Adolescent↗
PubMed1990

Suicide by chloroform ingestion following self-mutilation.

A case of suicide is described that combined elements of psychotic self-mutilation, both chronic and terminal, and poisoning with ingested chloroform. This illustrates the need to consider unusual methods when investigating the deaths of people with patterns of bizarre behavior and access to unusual, fatal materials.

Chloroform↗
PubMed1983

Naloxone and self-mutilation.

A 15-year-old male with a long history of self-mutilation resembling the Lesch-Nyhan syndrome, but with normal uric acid levels, was treated with naloxone. Pain-inducing behavior decreased in the evenings following infusion of the drug, and was markedly reduced for 2 days following the treatment period. Though not recommended as therapy, the observations suggest that naloxone may play a role in the regulation of endorphin/enkephalin neural systems.

Adolescent↗
PubMed2003

An American hijra: a report of a case of genital self-mutilation to become India's "third sex".

We report a case of male genital self-mutilation related to the subject's desire to become a "hijra," the "third sex" described in East Indian mythology. The patient is the first American hijra of which we are aware. He emasculated himself, performed a penectomy, and created a perineal urethrostomy. This report adds another potential cause for genital mutilation of which the urologist should be aware, along with accidents, gender dysphoria, psychotic self-injurious behavior, and assault.

Adult↗
PubMed1994

Equine self-mutilation syndrome (57 cases)

Owners who believed they had a horse with self-mutilating behavior were asked to complete a questionnaire to obtain information on the signalment, clinical history, clinical signs, management, and treatment of the condition. Fifty-two owners of 59 horses responded; 2 cases were omitted because an organic cause was determined. Owners also were asked to complete information for unaffected horses on the same farm. Various breeds were affected, and of the 57 horses, 20 were stallions, 31 were geldings, and 6 were mares. Affected horses tended to develop the condition prior to sexual maturity. Clinical signs included glancing or biting at the flank or pectoral areas, bucking, kicking, vocalizing, rubbing, spinning, or rolling. Several management and environmental factors were examined, but none were found to be exclusively related to expression of the disorder. Castration was associated with improvement in 7 of 10 stallions. Medications and changes in management reduced or prevented the behavior in some horses. The syndrome appears to be similar to Tourette's syndrome of human beings.

Age Factors↗
PubMed2000

Oral self-mutilation in a patient with rhombencephalosynapsys.

Rhombencephalosynapsis (RS) is a rare cerebellar malformation. Its essential features are the absence of the incisura cerebelli posterior, fusion of the cerebellar hemispheres, the absence of the velum medullare anterius and nuclei fastigii, and fusion of the dentate nuclei, which are shifted towards the mid-line. Clinically, affected patients present with signs of cerebellar and motor disturbances. The present report describes a new patient affected by RS. The subject first presented at the age of 22 years because of a psychiatric symptomatology which was characterized by obsessive oral self-mutilation associated with an intellectual disability. Objective evaluation documented dysmorphic features, while neurological examination showed only a slight truncal ataxia. The subject's IQ was 74 on the Wechsler Scale (verbal IQ = 79, performance IQ = 74). Psychiatric evaluation with DSM-IV criteria documented an obsessive-compulsive personality disorder associated with emotional instability and oral self-mutilation. The typical picture of rhombencephalosynapsis was evident on magnetic resonance imaging. Both chromosomal analysis and routine biochemical investigations were normal. The relationship between oral self-injurious behaviour and cerebellar malformations is discussed with particular regard to the behavioural aspects of cerebellar congenital pathology in affective disorders and in autism.

Adult↗