Abstract
A 56-year old patient was admitted initially to the Department of Orthopaedic Surgery and Traumatology after self-mutilation of upper-left limb in the form of exarticulation of left wrist and broad injuries of left forearm. Patient was afterwards transferred to the Department of Psychiatry and Psychotherapy. She was diagnosed with recurrent depressive disorder, severe episode with psychotic symptoms. Therefore, the electroconvulsive therapy was carried out. Twelve procedures were performed with good result. Psychopharmacology was continued. Patient's past medical history revealed information about a significant reduction of neuroleptics. Limited contact with the patient and unfamiliarity with individual characteristics of psychosis relapse was the reason why psychotic symptoms were not recognised.
Highlights
Self-harming, defined as an intentional, direct injury to the body tissue without suicidal intentions, is a phenomenon that evokes extreme emotions
Deliberate acts against one’s own body seem to be in fundamental conflict with general social standards
According to Girard’s concept [1], the meaning of sacrifice through self-harm is based on a belief that controlled and planned aggression is needed to prevent acts of aggression on a large scale
Summary
Self-harming, defined as an intentional, direct injury to the body tissue (skin surface) without suicidal intentions, is a phenomenon that evokes extreme emotions. Self-harm was a part of religious, healing, burial or sexual rituals in various cultures. Specific types of self-harm were sanctioned by society and controlled by ritualization and symbolization. Modifications such as piercings or tattooing, undeniably forms of self-harm, have become more acceptable in modern society. In this context, the boundary between “normal”, culturally acceptable self-harm, and a pathological, deviant act seems to be blurred [2]. Not every person who performs self-injury is diagnosed with a psychiatric illness, the presence of certain types of psychiatric disorders increases the risk of self-harm [3]. Other risk factors include schizophrenia [6], overdosing on psychoactive substances and some personality traits, such as impulsiveness or poorly developed problem-solving skills [4]
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