Complicated alcohol withdrawal presenting as self mutilation.

Area of Science:

• Psychiatry
• Toxicology
• Emergency Medicine

Background:

• Self-mutilation is defined as intentional self-inflicted bodily harm without suicidal intent.
• A known association exists between substance abuse and self-mutilating behaviors.
• Alcoholic hallucinosis, typically auditory, is often considered benign.

Observation:

• This case highlights a patient who inflicted multiple stab wounds to the abdomen.
• The self-harm behavior was a direct response to commanding alcoholic hallucinosis.
• The hallucinosis instructed the patient to inflict harm upon themselves.

Findings:

• Commanding hallucinations in alcoholic hallucinosis can precipitate severe self-harm.
• Patients experiencing such hallucinations may act on dangerous commands.
• This underscores the potential severity of alcoholic hallucinosis.

Implications:

• Clinicians should proactively inquire about substance abuse in emergency settings.
• Assessing for substance abuse is crucial for patients presenting with psychiatric symptoms.
• Early identification of substance abuse can prevent severe self-harm events.