a Department of Psychiatry and Mental Health , Baixo-Vouga Hospital Centre , Aveiro , Portugal.
J Sex Marital Ther. 2017 Aug 18;43(6):560-566. doi: 10.1080/0092623X.2016.1208699. Epub 2016 Jul 11.
Self-mutilation is understood as any willful gesture or alteration of the body tissue without a suicidal intent. The most common self-mutilating gestures are, to a great extent, those that are superficial or moderate, such as cuts, burns, or bites. The most severe, as is the case of genital self-mutilation (GSM), are extremely rare and, in most cases, observed in patients suffering from psychosis. Furthermore, they are mostly reported from a surgical standpoint. Here, we report the case of a 20-year-old female patient who resorted to the emergency department after having amputated her clitoris with surgical scissors. This dramatic gesture, coupled with the patient's narrative, prompted for differential diagnosis between a psychotic syndrome and a severe personality disorder. We propose that, despite the magnitude of the self-harm, it is possible to conceptualize this GSM within a disturbed personality with significant sexuality issues and, therefore, this case report aims to broaden the limits that have been associated with the self-mutilating gestures in borderline personality disorder.
自伤被理解为任何无自杀意图的、故意对身体组织做出的动作或改变。最常见的自伤行为在很大程度上是那些表面或中等程度的行为，如切割、烧伤或咬伤。最严重的，如生殖器自伤（GSM），则极为罕见，而且大多数情况下发生在患有精神病的患者中。此外，这些案例大多是从手术角度报告的。在这里，我们报告了一个 20 岁女性患者的案例，她使用手术剪刀切除了自己的阴蒂后到急诊科就诊。这一戏剧性的举动，加上患者的叙述，促使我们对精神病综合征和严重人格障碍进行鉴别诊断。我们认为，尽管这种自残行为的程度很严重，但仍有可能将这种 GSM 概念化为一种具有明显性问题的紊乱人格，因此，本病例报告旨在扩大与边缘型人格障碍中自伤行为相关的限制。
