Non-suicidal Self-Injury in the Context of Psoriasis, Post-traumatic Stress Disorder, and Acute Polysubstance...

Non-suicidal self-injury (NSSI) during acute intoxication has been reported in association with stimulant and polysubstance use. Chronic somatic pain and trauma exposure may further increase vulnerability to impulsive self-injury. However, the intersection of inflammatory skin disease, addiction, and trauma-related pathology remains underdescribed in the clinical literature. We describe an unusual case of a hospitalized patient with psoriasis, post-traumatic stress disorder, and polysubstance use disorder who intentionally ignited psoriatic plaques during acute intoxication with cocaine, amphetamines, cannabis, benzodiazepines, and alcohol. The patient's behavior appeared to be motivated by overwhelming pruritus and pain, compounded by intoxication-related disinhibition and trauma-related emotional dysregulation. This case highlights pain-relief-motivated NSSI as a clinically important yet underrecognized phenomenon in addiction care. Chronic somatic illness, trauma history, and stimulant intoxication may converge to produce severe self-injury in the absence of suicidal intent. Addiction treatment models should incorporate assessment of dermatologic pain, trauma exposure, and psychosocial instability to reduce the risk of recurrent NSSI.