Facial self-mutilation: an analysis of published cases

Ciorba, Irina; Farcus, Oana; Giger, Roland; Nisa, Lluís (2014). Facial self-mutilation: an analysis of published cases. Postgraduate medical journal, 90(1062), pp. 191-200. BMJ Publishing Group 10.1136/postgradmedj-2013-132036

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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<0.05) rates of permanent facial self-mutilation than others. Most treatment plans were very individually based, but some principles, such as prevention of irreversible loss of function and structure, or development of infection are applicable to all patients with facial self-mutilation. CONCLUSIONS Facial self-mutilation is a potentially severe manifestation of diverse conditions. Several aspects of facial self-mutilation remain to be fully characterised from a clinical perspective.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Ear, Nose and Throat Disorders (ENT)

UniBE Contributor:

Giger, Roland

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0032-5473

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Lilian Tschan

Date Deposited:

19 Mar 2015 15:46

Last Modified:

16 Nov 2015 10:25

Publisher DOI:

10.1136/postgradmedj-2013-132036

PubMed ID:

24516174

Uncontrolled Keywords:

Psychiatry

BORIS DOI:

10.7892/boris.65610

URI:

https://boris.unibe.ch/id/eprint/65610

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