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Original article
Facial self-mutilation: an analysis of published cases Irina Ciorba,1 Oana Farcus,2 Roland Giger,3 Lluís Nisa4 ▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ postgradmedj-2013-132036) 1
Private Practice, Bern, Switzerland 2 Private Practice, Oxford, UK 3 Department of Otorhinolaryngology—Head & Neck Surgery, Bern University Hospital/Inselspital, Bern, Switzerland 4 Department of Otorhinolaryngology—Head & Neck Surgery, Hôpital de Sion —CHCVs/RSV, Sion, Switzerland Correspondence to Dr Lluís Nisa, Department of Otorhinolaryngology—Head & Neck Surgery, Hôpital de Sion —CHCVs/RSV, Avenue du Grand Champsec 80, Sion 1950, Switzerland; [email protected] Received 11 April 2013 Revised 9 January 2014 Accepted 13 January 2014 Published Online First 10 February 2014
ABSTRACT Objectives Facial self-mutilation is rare. It is usually discussed from the psychiatric or psychoanalytic perspectives but has little prominence in general medical literature. Our objective was to describe facial self-mutilation in terms of its comorbidities, and to outline the different types of facial mutilation, as well as the basic approach to the patients with facial self-mutilation. Methods We undertook a review of all published cases of facial self-mutilation (1960–2011). Results We identified 200 published cases in 123 relevant papers. Four major groups of comorbidities emerged: psychiatric, neurological and hereditary disorders, and a group of patients without identified comorbidities. There were three general patterns of facial self-mutilation: (1) major and definitive mutilation, with the ocular globe as primary target—seen in patients with psychotic disorders; (2) stereotypical mutilation involving the oral cavity and of variable degree of severity, most often seen in patients with hereditary neuropathy or encephalopathy; (3) mild chronic self-mutilation, seen in patients with non-psychotic psychiatric disorders, acquired neurological disorders, and patients without comorbidities. About 20% of patients that mutilated their face also mutilated extra-facial structures. Patients with psychiatric conditions, especially those with psychotic disorders, had significantly higher (p
Original article
Facial self-mutilation: an analysis of published cases Irina Ciorba,1 Oana Farcus,2 Roland Giger,3 Lluís Nisa4 ▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ postgradmedj-2013-132036) 1
Private Practice, Bern, Switzerland 2 Private Practice, Oxford, UK 3 Department of Otorhinolaryngology—Head & Neck Surgery, Bern University Hospital/Inselspital, Bern, Switzerland 4 Department of Otorhinolaryngology—Head & Neck Surgery, Hôpital de Sion —CHCVs/RSV, Sion, Switzerland Correspondence to Dr Lluís Nisa, Department of Otorhinolaryngology—Head & Neck Surgery, Hôpital de Sion —CHCVs/RSV, Avenue du Grand Champsec 80, Sion 1950, Switzerland; [email protected] Received 11 April 2013 Revised 9 January 2014 Accepted 13 January 2014 Published Online First 10 February 2014
ABSTRACT Objectives Facial self-mutilation is rare. It is usually discussed from the psychiatric or psychoanalytic perspectives but has little prominence in general medical literature. Our objective was to describe facial self-mutilation in terms of its comorbidities, and to outline the different types of facial mutilation, as well as the basic approach to the patients with facial self-mutilation. Methods We undertook a review of all published cases of facial self-mutilation (1960–2011). Results We identified 200 published cases in 123 relevant papers. Four major groups of comorbidities emerged: psychiatric, neurological and hereditary disorders, and a group of patients without identified comorbidities. There were three general patterns of facial self-mutilation: (1) major and definitive mutilation, with the ocular globe as primary target—seen in patients with psychotic disorders; (2) stereotypical mutilation involving the oral cavity and of variable degree of severity, most often seen in patients with hereditary neuropathy or encephalopathy; (3) mild chronic self-mutilation, seen in patients with non-psychotic psychiatric disorders, acquired neurological disorders, and patients without comorbidities. About 20% of patients that mutilated their face also mutilated extra-facial structures. Patients with psychiatric conditions, especially those with psychotic disorders, had significantly higher (p
