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Facial self-mutilation: an analysis of published cases
  1. Irina Ciorba1,
  2. Oana Farcus2,
  3. Roland Giger3,
  4. Lluís Nisa4
  1. 1Private Practice, Bern, Switzerland
  2. 2Private Practice, Oxford, UK
  3. 3Department of Otorhinolaryngology—Head & Neck Surgery, Bern University Hospital/Inselspital, Bern, Switzerland
  4. 4Department of Otorhinolaryngology—Head & Neck Surgery, Hôpital de Sion—CHCVs/RSV, Sion, Switzerland
  1. Correspondence to Dr Lluís Nisa, Department of Otorhinolaryngology—Head & Neck Surgery, Hôpital de Sion—CHCVs/RSV, Avenue du Grand Champsec 80, Sion 1950, Switzerland; llnisa{at}yahoo.ca

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<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.

  • Psychiatry

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