Facial self-mutilation: an analysis of published cases

Area of Science:

• Medical literature
• Psychiatry
• Neurology

Background:

• Facial self-mutilation is rarely discussed in general medical literature, often overshadowed by psychiatric and psychoanalytic perspectives.
• This condition presents a complex clinical challenge with diverse underlying causes and manifestations.

Purpose of the Study:

• To describe facial self-mutilation by detailing its comorbidities.
• To outline the different types of facial mutilation.
• To establish a basic approach for managing patients with facial self-mutilation.

Main Methods:

• A comprehensive review of all published cases of facial self-mutilation from 1960 to 2011 was conducted.
• 200 cases were identified across 123 relevant publications.

Main Results:

• Four main comorbidity groups were identified: psychiatric, neurological, hereditary disorders, and cases with no identified comorbidities.
• Three patterns of facial self-mutilation were observed: major ocular mutilation in psychotic disorders, stereotypical oral mutilation in hereditary neuropathies/encephalopathies, and mild chronic mutilation in non-psychotic psychiatric or neurological disorders.
• Patients with psychiatric conditions, particularly psychotic disorders, showed significantly higher rates of permanent facial self-mutilation.

Conclusions:

• Facial self-mutilation is a severe manifestation of various underlying conditions.
• Further clinical characterization of facial self-mutilation is needed.
• Management principles include preventing irreversible functional and structural loss and infection.