Sherman Nathan
Medicine, University of Arizona School of Medicine, Tucson, USA.
Cureus. 2018 Sep 18;10(9):e3332. doi: 10.7759/cureus.3332.
The border between self-harm and suicidal behaviors is not always clear. Self-mutilation is a common finding in mood and personality disorders, and cutting of the extremities is more common than cutting of the neck. The case put forth regards a young adult male with a past history of depression and drug abuse who presented to the emergency department with superficial lacerations on his left arm and bilaterally on his neck with a large abscess in his right forearm. The patient reported the cuts on his arm to be from testing the sharpness of a kitchen knife and the cuts on his neck to be the result of sexual activity between him and his girlfriend. Collateral reports were inconsistent with the patient's version of events, and he voluntarily chose to receive psychiatric evaluation. After undergoing hospital rehabilitation, the patient was discharged with the diagnosis of bipolar disorder unspecified due to the findings of chronic mood instability without conclusive evidence of mania or hypomania. The etiology of his neck cutting behavior remained unexplained.
自残行为和自杀行为之间的界限并不总是清晰的。自残是情绪和人格障碍中的常见表现，肢体切割比颈部切割更为常见。本文所举案例是一名有抑郁症和药物滥用史的青年男性，他因左臂有浅表割伤、双侧颈部有割伤且右前臂有一个大脓肿而到急诊科就诊。患者称手臂上的伤口是为了测试菜刀的锋利程度，颈部的伤口是他与女友性行为的结果。旁证报告与患者对事件的描述不一致，他自愿选择接受精神科评估。经过住院康复治疗，由于发现患者存在慢性情绪不稳定但无确凿的躁狂或轻躁狂证据，患者出院时被诊断为未特定的双相情感障碍。他颈部切割行为的病因仍无法解释。
