A Systematic Approach to Effectively Treat Chronic Wounds Caused by Self-Harm: Two Case Reports

Abstract

Non-suicidal self-injury (NSSI) refers to the intentional act of causing physical injury without a clear suicidal intent. Patients in a dissociative state attempt to fulfill an underlying psychological need by inflicting cutaneous wounds on themselves. The mechanisms of NSSI can vary from mild to severe depending on the degree of soft tissue destruction. Self-destructive behavior triggered by psychosis, a different classification of self-injury, may have a variety of drivers, such as hallucination and delusion. Repetitive self-harm often results in chronic wounds and associated infections. As a conventional approach is inadequate for managing self-harm wounds, treating patients who self-injure presents many challenges for physicians. In the presence of hard-to-treat primary disorders, a systematic approach with custom procedures that may deviate from traditional wound management principles should be carried out within an interdisciplinary framework that considers the psychiatric condition. The authors provide several recommendations for appropriate management of chronic wounds caused by self-mutilation. Here, we report the cases of a 47-year-old female patient who presented with NSSI and a 67-year-old male patient with self-injurious behavior of psychosis, respectively.