Veeder Thomas A, Leo Raphael J
Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA.
Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA.
Gen Hosp Psychiatry. 2017 Jan-Feb;44:43-50. doi: 10.1016/j.genhosppsych.2016.09.003. Epub 2016 Sep 14.
To identify psychiatric diagnoses and psychosocial factors associated with intentional male genital self-mutilation (GSM) of specific injury subtypes.
A search of MEDLINE, EMBASE, PsycINFO, PubMed, Web of Science and CINAHL for cases of GSM was conducted until December 2015, based on GSM and related terms. Cases were examined for injury subtype, psychiatric diagnosis and psychosocial factors. Chi-square analyses were employed to determine differences in frequency of such factors across injury subtypes.
Data were obtained from 173 cases: genital mutilation (n=21), penile amputation (n=62), castration (n=56) and combined amputation/castration (n=34). Common psychiatric disorders included schizophrenia spectrum (49%), substance use (18.5%), personality (15.9%) and gender dysphoric disorders (15.3%). Chi-square analyses revealed that schizophrenia spectrum disorders occurred significantly more often among auto-amputates as compared with self-castrators or mutilators. Gender dysphoria occurred significantly more often among self-castrators than auto-amputates. No significant differences emerged regarding psychosocial factors across GSM subtypes. However, associations were observed between psychosocial factors and psychiatric diagnoses. Although altogether not commonly reported, experiential factors were reported in 82% of psychotic individuals. Treatment inaccessibility was noted among 71% of gender dysphorics engaging in auto-castration.
Clinicians must consider the diverse range of psychiatric disorders and psychosocial factors underlying GSM.
确定与特定损伤亚型的男性故意性生殖器自残（GSM）相关的精神疾病诊断和社会心理因素。
基于GSM及相关术语，检索MEDLINE、EMBASE、PsycINFO、PubMed、Web of Science和CINAHL数据库，直至2015年12月，查找GSM病例。对病例进行损伤亚型、精神疾病诊断和社会心理因素检查。采用卡方分析确定这些因素在不同损伤亚型中的频率差异。
共获取173例数据：生殖器切割（n = 21）、阴茎切断（n = 62）、阉割（n = 56）以及切断/阉割联合（n = 34）。常见精神疾病包括精神分裂症谱系障碍（49%）、物质使用障碍（18.5%）、人格障碍（15.9%）和性别焦虑症（15.3%）。卡方分析显示，与自我阉割者或生殖器切割者相比，自动切断者中精神分裂症谱系障碍的发生率显著更高。自我阉割者中性别焦虑症的发生率显著高于自动切断者。不同GSM亚型在社会心理因素方面未发现显著差异。然而，观察到社会心理因素与精神疾病诊断之间存在关联。尽管总体上报告不常见，但82%的精神病患者报告了体验因素。71%进行自我阉割的性别焦虑症患者存在治疗不可及的情况。
临床医生必须考虑GSM背后多种精神疾病和社会心理因素。
