'Van Gogh' syndrome: a term to approach with caution.

Abstract

Mudgal et al provided us with an interesting and comprehensive case report.1 The subject of their report presents with typical features of schizophrenia, evidenced by his score on the BPRS (Brief Psychosis Rating Scale). The only atypical features are an age of onset which is slightly younger than average, but this could be explained by his use of cannabis (an estimate of usage would be helpful). Importantly, given the patient’s history of self-harm, Mudgal et al consider and rule out premorbid impulsive and borderline personality traits. Although the self-harm seems linked to command hallucinations, it would have been interesting to see more detail on the patient’s insight into this extreme behaviour. The degree of self-harm has led the authors to use the term ‘Van Gogh syndrome’. ‘Van Gogh syndrome’ is not in the ICD-10 (International Classification of Disease) nor DSM-V (Diagnostic and Statistical Manual). It is defined not in the medical literature but on Wikipedia, where it is considered a synonym for NSSI (Non-suicidal Self-Injury). NSSI requires five or more days of mild to moderate self-harm in a year. Self-harm as a result of psychosis is excluded. Mudgal et al , however, follow the psychiatric literature in reserving ‘Van Gogh syndrome’ for severe self-harm (usually mutilation) associated with psychosis: a review of the literature found five papers (including Mudgal et al ’s), describing six patients with self-mutilation. All were diagnosed with psychosis: one with psychosis unspecified,2 three with schizophrenia1 3 4 and two with bipolar disorder.5 In …