任何蓄意破坏或改变身体的组织没有意识到自杀的目的是定义为自残,自虐,或自我伤害行为 1]。生殖器自残的光谱(GSM)发散从一个简单的皮肤裂伤总阉割的睾丸和阴茎见这个病人截肢。GSM是一种罕见的现象在发病率增加,原因不清楚。第一个生殖器情况于1846年出版。迄今为止大约123例,包括雄性和雌性,是识别和报告文学。相关的精神疾病不同性别。女性,GSM主要与人格障碍(主要是边缘类型)有关,而在男性,精神病是目前在80%的情况下( 2]。最常见的自我伤害行为是在女性皮肤切割更普遍。在男性生殖器自残的行为,会导致严重的损坏性和泌尿功能( 3]。自我残害行为一直在研究各种各样的种族,实足,种族、性别、人口和社会经济 4]。绝大多数的报道,事件发生在单身,白人男性在1920年代和1930年代的年龄范围 5),我们的病人满足这个标准除了结婚(独自生活)。

一位37岁的白人男性结婚与自我残害的历史行为带到急诊室阴茎截肢紧随其后。病人邀请一个随机的男性通过网络性和声称人打中了脑袋之后,他失去了意识。恢复意识时,他的阴茎被截肢,他被包围了血。在体检中,多个愈合造成的伤口在他的胸部,腹部和腹股沟区。伤口闭合和会阴urethrostomy后,病人被送往医疗楼,他把他的手指放在气孔被发现导致伤口感染,静脉注射和局部抗生素开始。几年前,病人被诊断患有双相情感障碍二世与多个招生精神病医院由于自杀意念。他试过各种心境稳定剂与次优福利门诊(OP)的基础上,在喹硫平300毫克睡前在此之前住院治疗。泌尿外科团队要求精神病学咨询评估病人。他承认,他一直被男性所吸引,但无法分享的感受与他的妻子和16岁的女儿。自从他搬出去工作他房子的发达对年轻男性“性幻想”,有这样的想法感到内疚和羞愧。 On different occasions, to “punish” him he castrated his left testicle, stabbed penis, and stabbed his abdomen that needed surgical attention. OP medical records showed that he was “plunging himself on knife” to get sexual gratification, and therapy was recommended which patient could not afford. During adolescence, patient was molested by his friend’s uncle multiple times. His father was not around and was raised by his mother. During admission and psychiatry evaluation, he reported depressed mood, low energy, poor concentration, guilt feelings, anhedonia, and poor self-esteem for the past several months; however, he denied any suicide ideations or intent or plan. A sitter had to be arranged to keep him from picking his wounds. Patient also stated that he “can get real high and spend a lot of money” when he is in really good mood but has not had these symptoms “in a long time.” He had been to drug rehabilitation programs due to prescription narcotic and benzodiazepine abuse, but he denied current illicit substance abuse. On mental status examination, he appeared to be fairly groomed with normal psychomotor activity and minimal eye contact. Speech was slow in rate and rhythm and normal in tone and volume. Mood was euthymic, and effect was indifferent to his injuries. Thought process was goal-directed. No sensory hallucinations were reported. Thought content is devoid of suicidal or homicidal ideations or intent or plan or any delusions. Insight and judgment were considered to be impaired. He had fair to poor impulse control and was oriented X 3. We diagnosed him with borderline personality disorder and bipolar II disorder, most recent episode depressed. Quetiapine 300 mg at bedtime was resumed for mood stabilization and recommended to follow-up with urologist, psychiatrist, and therapist in OP setting. After 1 week of stay in hospital, he got discharged under stable conditions.

GSM的最重要的精神动因主要包括妄想宗教和命令幻觉往往是偏执型精神分裂症和情感性精神病。GSM的其他诱发因素包括严重剥夺童年,病态的负罪感与异常性行为和冲突,异装癖者,自杀企图或其他历史上自毁行为,不合群,抑郁( 4, 5]。Mago表示,最重要的因素在精神病自残的行为内疚的感觉与性相关的冲突和宗教精神的体验。在nonpsychotics,性身份障碍是生殖器的最常见原因 4]。还与性self-mutilators罪恶感可能会毁坏自己更严重比那些没有( 6]。Ozan等人阐明截肢的严重性质的阴茎,它在中国文化中被认为是一个企图自杀( 7]。文学解释精神药品的作用是导致nonpsychotic GSM不能排除的人。有报道称使用非法药物像大麻、苯二氮卓类,胶嗅探,迷幻药,安非他命,酒精与故意自残[ 8]。然而,滥用药物不可能扮演了重要的角色在这个病人历史否定这些因素。行动在这种指数情况下的直接动机是内疚的感觉与他的性取向和性幻想。与以前发表的报告显示,80%自伤与精神病协会( 4),这个病人没有任何的精神病症状和抑郁症状一直出现在当前及后续访问。他否认autoamputation的阴茎是一个试图为过去的罪赎罪或试图改变自己的性别。他声称他不知道autoamputation和其他人的行为可能会这样做。然而,阴茎造成截肢的可能性远高于他之前反复GSM的历史行为,self-cutting行为明显的愈合是在腹股沟区,乳头(图 1)。也没有明显的头部创伤,正常的头部CT,缺乏悔恨强调截肢的阴茎都是自己造成的。他接受了他关于他的性取向和内疚的感觉异常的关于年轻男性性幻想。很明显,没有自杀意图病人。在这个病人,因此,我们发现这些特征,可以反映了作为他的GSM行为危险因素:(1)缺乏父亲的童年;(2)儿童性虐待;(3)以前自伤和self-castration;(4)性畸变和幻想伴随内疚的感觉;(5)药物滥用和双相情感障碍的历史。

本例中是独一无二的,当时autoamputation病人没有任何的精神特征。他的疾病控制和他没有妄想或宗教信仰“Klingsor综合症”,是表示齐名的人创造了GSM造成hyperreligious错觉[ 9]。这种情况下的一些方面精神病理学和GSM之间的关系;仍然需要进一步的研究在这一领域完全解释两者之间的关系。