Top

Forensic Science, Medicine and Pathology

13-04-2024 | Review

Self-mutilation: a systematic review

Authors: Matheus Medeiros Nunes, Caio Rodrigues Maia, Paulo Roberto de Andrade Santos, Antônio de Lisboa Lopes Costa, Sérgio Adriane Bezerra de Moura, Pedro Paulo de Andrade Santos

Published in: Forensic Science, Medicine and Pathology

Abstract

Self-mutilation lesions can represent a clinical diagnosis challenge for healthcare professionals, as patients do not admit to self-mutilation. This leads to failed diagnoses due to the similarity of this condition to other diseases. Searches on the subject were carried out at the PubMed, Periódicos Capes, Scopus, Science Direct and WoS databases, according to the following inclusion criteria: articles in English, Portuguese or Spanish, published from 2018 to June 2023, encompassing case reports, case series and literature reviews. Men are slight more affected by self-mutilation injuries, also presenting the most serious lesions. Self-mutilation injuries are reported globally, mostly in the Asian and American continents. Clinical presentations are varied, but morphology is, in most cases, associated to the form/instrument used for self-mutilation. Greater evidence of diagnosed mental disorders in women and underreporting of these cases in men due to low demands for specialized treatment are noted. A higher prevalence of self-mutilation lesions was verified for men, affecting a wide age range, with the highest number of cases in the USA. The most affected body areas are arms and external genitalia, mostly due to knife use. An association between self-mutilation injuries and mental disorders is clear, with most cases being previously undiagnosed.

Laughter MR, Florek AG, Wisell J, Newman S. Dermatitis Artefacta, a form of Factitial Disorder imposed on self, misdiagnosed as Pyoderma Gangrenosum for eight years. Cureus. 2020;12(7):e9054. https://doi.org/10.7759/cureus.9054.CrossRefPubMedPubMedCentral

Khanna A, Agustines D. A rare and complex case of non-suicidal self-mutilation in a patient with Schizophrenia. Cureus. 2023;15(1):e33269. https://doi.org/10.7759/cureus.33269.CrossRefPubMedPubMedCentral

Ferri JVV, de Araujo DB. Dermatitis artefacta mimicking cutaneous vasculitis: case report and literature overview. Reumatologia. 2019;57(2):106–8. https://doi.org/10.5114/reum.2019.84816.CrossRefPubMedPubMedCentral

Binfadil W, Sinha RP, Saleh H, Ali F, Alshryda S. Self-mutilation of Fingers following median nerve Injury: Case Reports and Literature Review. Cureus. 2020;12(4):e7872. https://doi.org/10.7759/cureus.7872.CrossRefPubMedPubMedCentral

Del Brío Ibáñez P, Vázquez Fernández ME, Imaz Roncero C. Adolescente con autolesiones no suicidas en un entorno de adversidad psicosocial [Adolescent with non-suicidal self-harm in a psychosocial adversity environment]. Arch Argent Pediatr. 2019;117(5):e485-488. https://doi.org/10.5546/aap.2019.e485.CrossRefPubMed

Boualaoui I, El Bote H, Bellouki O, Ibrahimi A, El Sayegh H, Nouini Y. Rudy and Borden technique for penile self-mutilation in Klingsor syndrome: a case report. Pan Afr Med J. 2021;38:334. https://doi.org/10.11604/pamj.2021.38.334.28897.CrossRefPubMedPubMedCentral

Ukpong AE, Akaiso OE, Udo EA, Essiet IU, Peter OO, Etim IP. Scrotal self-inflicted gunshot injuries: report of two consecutive cases and literature review. Afr J Urol. 2021;27:130. https://doi.org/10.1186/s12301-021-00234-x.CrossRef

Tammaro A, Magri F, Chello C, Zollo V, Daniele A, Signati FM, et al. Occupational dermatitis artefacta: a clinical case in a flight attendant. Clin Ter. 2020;171(4):e288-290. https://doi.org/10.7417/CT.2020.2229.CrossRefPubMed

Mounir A, Elghobaier MG, Sadek AA, Othman AA. Pediatric self-inflicted eye trauma due to a major depressive disorder. Electron Physician. 2018;10(5):6771–4. https://doi.org/10.19082/6771.CrossRefPubMedPubMedCentral

10.

Sangha S, Shah K, Gajaram G, Prasad V. Oedipism and Self-Amputation in a Schizoaffective, depressed type patient: to heal or feel Pain? Cureus. 2021;13(8):e17515. https://doi.org/10.7759/cureus.17515.CrossRefPubMedPubMedCentral

11.

Al-Fahdi A, Al-Mahrouqi T, AlZain I, Al-Aamri H, Al-Huseini S. Self-inflicted total amputation of the External Genitalia as a psychological repercussion of the COVID-19 pandemic: a Case Report. Cureus. 2022;14(12):e32725. https://doi.org/10.7759/cureus.32725.CrossRefPubMedPubMedCentral

12.

Sahoo S, Rani S, Parveen S, Pal Singh A, Mehra A, Chakrabarti S, et al. Self-harm and COVID-19 pandemic: an emerging concern - A report of 2 cases from India. Asian J Psychiatr. 2020;51: 102104. https://doi.org/10.1016/j.ajp.2020.102104.CrossRefPubMedPubMedCentral

13.

Baig MR, Levin TT, Lichtenthal WG, Boland PJ, Breitbart WS. Factitious disorder (Munchausen’s syndrome) in oncology: case report and literature review. Psychooncology. 2016;25(6):707–11. https://doi.org/10.1002/pon.3906.CrossRefPubMed

14.

Hausteiner-Wiehle C, Hungerer S. Factitious disorders in Everyday Clinical Practice. Dtsch Arztebl Int. 2020;117(26):452–9. https://doi.org/10.3238/arztebl.2020.0452.CrossRefPubMedPubMedCentral

15.

Schrader H, Bøhmer T, Aasly J. The incidence of diagnosis of Munchausen Syndrome, other Factitious disorders, and Malingering. Behav Neurol. 2019;2019:3891809. https://doi.org/10.1155/2019/3891809.CrossRefPubMedPubMedCentral

16.

Basu A, Boland A, Witt K, Robinson J. Suicidal Behaviour, including ideation and Self-Harm, in Young migrants: a systematic review. Int J Environ Res Public Health. 2022;19(14):8329. https://doi.org/10.3390/ijerph19148329.CrossRefPubMedPubMedCentral

17.

Blanchard A, Chihuri S, DiGuiseppi CG, Li G. Risk of self-harm in children and adults with Autism Spectrum disorder: a systematic review and Meta-analysis. JAMA Netw Open. 2021;4(10):e2130272. https://doi.org/10.1001/jamanetworkopen.2021.30272.CrossRefPubMedPubMedCentral

18.

Fredrick SS, Demaray MK. Peer victimization and suicidal ideation: the role of gender and depression in a school-based sample. J Sch Psychol. 2018;67:1–15. https://doi.org/10.1016/j.jsp.2018.02.001.CrossRefPubMed

19.

Lucas-Molina B, Perez-Albeniz A, Fonseca-Pedrero E. The potential role of subjective wellbeing and gender in the relationship between bullying or cyberbullying and suicidal ideation. Psychiatry Res. 2018;270:595–601. https://doi.org/10.1016/j.psychres.2018.10.043.CrossRefPubMed

20.

Favril L, Yu R, Hawton K, Fazel S. Risk factors for self-harm in prison: a systematic review and meta-analysis. Lancet Psychiatry. 2020;7(8):682–91. https://doi.org/10.1016/S2215-0366(20)30190-5.CrossRefPubMedPubMedCentral

21.

Yates GP, Feldman MD. Factitious disorder: a systematic review of 455 cases in the professional literature. Gen Hosp Psychiatry. 2016;41:20–8. https://doi.org/10.1016/j.genhosppsych.2016.05.002.CrossRefPubMed

22.

Dalsgaard S, Thorsteinsson E, Trabjerg BB, Schullehner J, Plana-Ripoll O, Brikell I, et al. Incidence rates and cumulative incidences of the full spectrum of diagnosed Mental disorders in Childhood and Adolescence. JAMA Psychiat. 2020;77(2):155–64. https://doi.org/10.1001/jamapsychiatry.2019.3523.CrossRef

23.

Lupariello F, Curti SM, Coppo E, Racalbuto SS, Di Vella G. Self-harm risk among adolescents and the Phenomenon of the Blue Whale Challenge: Case Series and Review of the literature. J Forensic Sci. 2019;64(2):638–42. https://doi.org/10.1111/1556-4029.13880.CrossRefPubMed

24.

Nesi J, Burke TA, Bettis AH, Kudinova AY, Thompson EC, MacPherson HA, et al. Social media use and self-injurious thoughts and behaviors: a systematic review and meta-analysis. Clin Psychol Rev. 2021;87: 102038. https://doi.org/10.1016/j.cpr.2021.102038.CrossRefPubMedPubMedCentral

25.

Troya MI, Chew-Graham CA, Babatunde O, Bartlam B, Higginbottom A, Dikomitis L. Patient and public involvement and Engagement in a doctoral research project exploring self-harm in older adults. Health Expect. 2019;22(4):617–31. https://doi.org/10.1111/hex.12917.CrossRefPubMedPubMedCentral

26.

Evans RL, Tew JC, Yates GP, Feldman M. Factitious disorder (Munchausen Syndrome) in plastic surgery: a systematic review of 42 cases. Ann Plast Surg. 2021;86(4):e1-6. https://doi.org/10.1097/SAP.0000000000002526.CrossRefPubMed

27.

Fliege H, Scholler G, Rose M, Willenberg H, Klapp BF. Factitious disorders and pathological self-harm in a hospital population: an interdisciplinary challenge. Gen Hosp Psychiatry. 2002;24(3):164–71. https://doi.org/10.1016/s0163-8343(02)00171-8.CrossRefPubMed

28.

Rodríguez Pichardo A, García Bravo B. Dermatitis artefacta: a review. Actas Dermosifiliogr. 2013;104(10):854–66. https://doi.org/10.1016/j.ad.2012.10.004.CrossRefPubMed

29.

Tomas-Aragones L, Consoli SM, Consoli SG, Poot F, Taube KM, Linder MD, et al. Self-inflicted lesions in Dermatology: a management and TherapeuticApproach - A position paper from the European Society for Dermatology and Psychiatry. Acta Derm Venereol. 2017;97(2):159–72. https://doi.org/10.2340/00015555-2522.CrossRefPubMed

30.

Oliveira RK, Bayer LR, Lauxen D, Roth F, Serrano PD, Ruschel PH. Factitious lesions of the hand. Rev Bras Ortop. 2013;48(4):381–6. https://doi.org/10.1016/j.rboe.2012.09.008.CrossRefPubMedPubMedCentral

31.

Lavery MJ, Stull C, McCaw I, Anolik RB. Dermatitis artefacta. Clin Dermatol. 2018;36(6):719–22. https://doi.org/10.1016/j.clindermatol.2018.08.003.CrossRefPubMed

32.

Altınbaş Ö, Özer SF, Şeramet A, Tanyeli Ö, Görmüş N. Self-Inflicated Cardiac Injury by Multiple Sewing Needles. Balkan Med J. 2018;35(2):214–5. https://doi.org/10.4274/balkanmedj.2017.0585.CrossRefPubMedPubMedCentral

33.

Garofalo M, Colella A, Sadini P, Bianchi L, Saraceni G, Brunocilla E, et al. Management of self-inflicted orchiectomy in psychiatric patient. Case report and non-systematic review of the literature. Arch Ital Urol Androl. 2018;90(3):220–3. https://doi.org/10.4081/aiua.2018.3.220.CrossRefPubMed

34.

Gschwind M, Lascano AM, Kaya G, Assal F. Self-Injurious Behavior Revealing Advanced Primary Progressive Multiple Sclerosis with a Massive Right Temporal Lesion. J Clin Neurol. 2018;14(2):251–3. https://doi.org/10.3988/jcn.2018.14.2.251.CrossRefPubMedPubMedCentral

35.

Girijala RL, Falkner R, Dalton SR, Martin BD. Exfoliative Cheilitis as a Manifestation of Factitial Cheilitis. Cureus. 2018;10(5):e2565. https://doi.org/10.7759/cureus.2565.CrossRefPubMedPubMedCentral

36.

Parkhouse N, de Vere Hunt IJ. Self-harm scar revision. BMJ Case Rep. 2018;2018:bcr2017222490. https://doi.org/10.1136/bcr-2017-222490.CrossRefPubMedPubMedCentral

37.

Sherman N. Neck Cutting Behavior: Paraphilia or Suicide Attempt? A Case Report of Self-harm in the Context of Drug Abuse and Depression. Cureus. 2018;10(9):e3332. https://doi.org/10.7759/cureus.3332.CrossRefPubMedPubMedCentral

38.

Bonomo R, Latorre A, Bhatia KP. Self-Injurious Behaviour in SCA17: A New Clinical Observation. Tremor Other Hyperkinet Mov (N Y). 2019;9. https://doi.org/10.7916/tohm.v0.672.

39.

Hagiwara T, Munakata S, Ishiyama S, Michitoshi G, Takahashi R, Kure K, et al. Repeated Enterocutaneous Fistula in a Munchausen Syndrome Patient. Case Rep Gastroenterol. 2019;13(1):173–7. https://doi.org/10.1159/000499443.CrossRefPubMedPubMedCentral

40.

Murthy VR, Matada R, Deshmukh AV, Samak L, Kulkarni VV. An interesting case of factitious pseudomembranous conjunctivitis. Indian J Ophthalmol. 2019;67(10):1693–4. https://doi.org/10.4103/ijo.IJO_223_19.CrossRefPubMedPubMedCentral

41.

Olisova OY, Snarskaya ES, Smirnova LM, Grabovskaya O, Anpilogova EM. Dermatitis artefacta: self-inflicted genital injury. Int Med Case Rep J. 2019;12:71–3. https://doi.org/10.2147/IMCRJ.S192522.

42.

Singer M, Schorr L. Self-mutilation of the Fifth Finger in an Infant due to Iatrogenic Ulnar Nerve Neurapraxia: A Clinical Case Report and Review of the Literature. J Am Acad Orthop Surg Glob Res Rev. 2019;3(8):e012. https://doi.org/10.5435/JAAOSGlobal-D-19-00012.CrossRefPubMedPubMedCentral

43.

Yanes AF, Owen JL, Colavincenzo ML. Factitial panniculitis as a manifestation of self-imposed factitious disorder. Dermatol Online J. 2019;25(5). https://doi.org/10.5070/D3255044071.

44.

Adebanjo GAR, Parisella FR, Cittadini A, Luzi F, Tammaro A. A case of dermatitis artefacta during a pandemic. Dermatol Ther. 2020;33(6):e14235. https://doi.org/10.1111/dth.14235.CrossRefPubMedPubMedCentral

45.

Comoglu S, Enver N, Sen C, Aydemir L. Migration of a foreign object to the parapharyngeal space: an unusual factitious disorder. Braz J Otorhinolaryngol. 2020;86(2):261–3. https://doi.org/10.1016/j.bjorl.2016.05.004.CrossRefPubMed

46.

Fukushima Y, Kitamura T, Ikami E, Yumoto M, Sano Y, Sato T, et al. A case of burning mouth syndrome leading to suicide 10 days after self-cutting of tongue. Psychogeriatrics. 2020;20(1):126–8. https://doi.org/10.1111/psyg.12449.CrossRefPubMed

47.

Khalil A, Abbas SA, Qureshi T, Ali S, Ayub B. A case report of Munchausen syndrome presenting with bleeding from ear: a rare factitious disorder. J Pak Med Assoc. 2020;70(1):168–70.PubMed

48.

Komagoe S, Azumi S, Hasegawa Y. Self-inflicted human bite followed by hand necrotizing fasciitis in an adult with Down syndrome. Clin Case Rep. 2020;8(4):699–701. https://doi.org/10.1002/ccr3.2701.CrossRefPubMedPubMedCentral

49.

Le Daré B, Gicquel T, Baert A, Morel I, Bouvet R. Self-inflicted neck wounds under influence of lysergic acid diethylamide: A case report and literature review. Medicine (Baltimore). 2020;99(27):e20868. https://doi.org/10.1097/MD.0000000000020868.CrossRefPubMed

50.

Martínez-Carpio PA, Álvarez M, Fortea R, Bedoya Del Campillo A. Self harm: suturing of lips. Rev Esp Sanid Penit. 2021;23(2):86–7. https://doi.org/10.18176/resp.00035.CrossRefPubMedPubMedCentral

51.

Obi AO, Ulebe AO, Nnadozie UU, Maduba CC, Okorie CO, Anikwe ON. Self-inflicted gunshot injury to the external genitalia: a case report and review of literature. Afr J Urol. 2021;27:18. https://doi.org/10.1186/s12301-021-00123-3.CrossRef

52.

Raman P. Curcumin on Camphor-Induced Chemical Burn on the Palate: Report of a Peculiar Self-Inflicted Case. Cureus. 2021;13(12):e20589. https://doi.org/10.7759/cureus.20589.CrossRefPubMedPubMedCentral

53.

Shah R, et al. A 14-year-old with dermatitis artefacta secondary to aerosolized spray deodorant: A rare case with an important learning opportunity. JAAD Case Reports. 2021;19:71–3. https://doi.org/10.1016/j.jdcr.2021.11.014.CrossRefPubMedPubMedCentral

54.

Dávila Siliezar PA, Duarte-Celada WR, Montalvan V, Duarte-Celada C, Aguilar Ruiz BE. Self-inflicted transorbital pontine stab injury with a retained pen. Proc (Bayl Univ Med Cent). 2020;34(2):323–4. https://doi.org/10.1080/08998280.2020.1854038.CrossRefPubMed

55.

Tsanakalis F, Almadhyan A, Flondell-Sité D. A rare case of complete male genital self-amputation posing challenges in the psychiatric diagnosis and management. Heliyon. 2021;7(6):e07349. https://doi.org/10.1016/j.heliyon.2021.e07349.CrossRefPubMedPubMedCentral

56.

Dalma-Weiszhausz J, Alvarado JAO, Licona AMS, Azuara MTS, Kende AD. Multiple Penetrating Eye Wounds Due to Suspected Self-Injury. Turk J Ophthalmol. 2021;51(1):58–61. https://doi.org/10.4274/tjo.galenos.2020.69822.CrossRefPubMedPubMedCentral

57.

Zima LA, Srinivasan S, Budde B, Kitagawa R. Thirty-two nails injected into the head: An operative report and review of the literature. Surg Neurol Int. 2022;13:377. https://doi.org/10.25259/SNI_512_2022.CrossRefPubMedPubMedCentral

58.

Ferrão J, Rodrigues Barros C, Figueiredo L, Fernandes A. Oral Self-Mutilation in Lesch-Nyhan Syndrome: A Case Report. Cureus. 2022;14(8):e27874. https://doi.org/10.7759/cureus.27874.CrossRefPubMedPubMedCentral

59.

Jengsuebsant N, Benjachaya S, Vuthiwong J, Tangsuwanaruk T. Penile self-amputation due to cannabis-induced psychosis: a case report. J Med Case Rep. 2022;16(1):37. https://doi.org/10.1186/s13256-022-03267-0.CrossRefPubMedPubMedCentral

60.

Nagoshi A, Kijima T, Suzuki I, Sakamoto K, Nozaki F, Fujisawa D, et al. A case of penile self-mutilation during a suicidal attempt successfully treated using a multidisciplinary approach. IJU Case Rep. 2022;5(3):165–7. https://doi.org/10.1002/iju5.12424.CrossRefPubMedPubMedCentral

61.

Ravichandran S, Smith PM, Tang V. Genital self-amputation-its psychological urge. J Surg Case Rep. 2022;2022(12):rjac569. https://doi.org/10.1093/jscr/rjac569.CrossRefPubMedPubMedCentral

62.

Delgado Salazar JA, Naveda Pacheco NC, Palacios Jaramillo PA, Garzón Yépez SD, Medina Loza VR, Romero Alvarado CA, et al. Ingestion of razor blades, a rare event: a case report in a psychiatric patient. J Surg Case Rep. 2020;2020(5):rjaa094. https://doi.org/10.1093/jscr/rjaa094.CrossRefPubMedPubMedCentral

Title: Self-mutilation: a systematic review
Authors: Matheus Medeiros Nunes
Caio Rodrigues Maia
Paulo Roberto de Andrade Santos
Antônio de Lisboa Lopes Costa
Sérgio Adriane Bezerra de Moura
Pedro Paulo de Andrade Santos
Publication date: 13-04-2024
Publisher: Springer US
Published in: Forensic Science, Medicine and Pathology
Print ISSN: 1547-769X
Electronic ISSN: 1556-2891
DOI: https://doi.org/10.1007/s12024-024-00809-4

At a glance: The STEP trials

Springer Medicine

Self-mutilation: a systematic review

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content