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      Genital Self Mutilation in Alcohol Withdrawal State Complicated with Delirium

      case-report

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          Abstract

          Genital self mutilation is a rare and a severe form of self-injurious behavior usually described in psychotic disorders, with delusions and hallucinations. It has been ascribed to sexual conflicts, Body image distortions, Internalized aggression, and suicidal intent. This phenomenon has been described in schizophrenia, affective psychosis, alcohol intoxication, and personality disorders. The present case genital self mutilation in a case of alcohol withdrawal state complicated by delirium is reported.

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          Relationship between 5-HT function and impulsivity and aggression in male offenders with personality disorders.

          J B Deakin, M. Dolan, Wayne F. Anderson (2001)
          Reduced serotonergic (5-HT) function and elevated testosterone have been reported in aggressive populations. To investigate relationships between impulsivity, aggression, 5-HT function and testosterone in male offenders with personality disorders. Sixty male offenders with DSM-III-R personality disorders and 27 healthy staff controls were assessed using the Special Hospital Assessment of Personality and Socialisation (SHAPS), impulsivity and aggression ratings, d-fenfluramine challenge and plasma hormone concentrations. The SHAPS non-psychopaths and those with schizoid personality disorders had enhanced 5-HT function (prolactin response to d-fenfluramine). Reduced 5-HT function was found in offenders with DSM-III-R borderline personality disorders and those with a history of repeated self-harm or alcohol misuse. The 5-HT function was inversely correlated more strongly with impulsivity than with aggression. Plasma testosterone correlated positively with aggressive acts. The SHAPS primary psychopaths had lower initial cortisol and higher testosterone concentrations than controls. Future studies are needed to investigate regional brain 5-HT function.
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            Genital self-amputation and the Klingsor syndrome.

            B I Schweitzer (1990)
            Two psychotic individuals, who performed acts of genital self-amputation, are presented. One of the patients had self-mutilated with the intention of suicide and had also in the past amputated his hand. Psychotic patients with delusions (often religious), sexual conflict associated with guilt, past suicide attempts or other self-destructive behaviour and depression, severe childhood deprivation, and major premorbid personality disorder, are the group at risk for genital self-amputation. It has been proposed that the eponym, the "Klingsor" syndrome, be applied only to acts of genital self-mutation, involving religious delusions. The author suggests that this syndrome should be expanded to include all cases of genital self-mutation resulting from a psychotic illness.
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              Genital self-mutilation.

              S Aboseif, Ralph Gomez, J McAninch (1993)
              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.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Psychol Med
                Journal ID (publisher-id): IJPsyM
                Title: Indian Journal of Psychological Medicine
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0253-7176
                ISSN (Electronic): 0975-1564
                Publication date (Print): Jul-Dec 2011
                Volume: 33
                Issue: 2
                Pages: 188-190
                Affiliations
                [1]Department of Psychiatry, Mamata Medical College and General Hospital, Khammam, Andhra Pradesh, India
                Author notes
                Address for correspondence: Dr. Sri Hari Charan, Department of Psychiatry, Mamata Medical College and General Hospital, Khammam, Andhra Pradesh - 507 002, India. E-mail: drsriharicharan@ 123456gmail.com
                Article
                Publisher ID: IJPsyM-33-188
                DOI: 10.4103/0253-7176.92045
                PMC ID: 3271498
                PubMed ID: 22345848
                SO-VID: 61992fc0-8e0f-4dd7-aee4-71aedcdb3dcf
                Copyright © Copyright: © Indian Journal of Psychological Medicine
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Categories
                Subject: Case Report

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: alcohol,genital,self mutilation,delirium
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: alcohol, genital, self mutilation, delirium

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