ABSTRACT
Background: Trichotillomania and skin picking are two forms of body focused repetitive behaviors [BFRBs] classified among Obsessive Compulsive Disorders. Socio-governmental changes which had accompanied COVID-19 overwhelmed patients with BFRBs whom already experienced anxiety and social isolation. Our study was designed to determine if there is an association between COVID-19 pandemic and worsening of symptoms of BFRB disorders ( in particular, trichotillomania and skin picking patients). Methods: Cross-sectional online survey-based study conducted from June to August 2021. The survey collected data about participants sociodemographic, knowledge, concerns, and psychological impacts by using Massachusetts General Hospital Hair Pulling Scale ( MGHHPS) and/or modified skin picking scale-revised (SPS-R). Results: A total of 171 participants joined the study including 34 (19.9%) male and 137 (80.1%) females. There was a significant difference of the total modified SPS-R (max 32), the mean score has increased by 7.62 during COVID-19 (t=6.42, p<0.001). Also, 7 parameters (subscales) are statistically significant. There was a significant difference of Frequency of urges, the mean score has increased during COVID-19 by 1.33 (t=3.16, p<0.05=0.025). Conclusion: Throughout COVID-19 pandemic in Saudi Arabia, results revealed clearly the significant negative psychological impact of it on the population, specifically on those with BFRBs. The study gives a clue that both diseases are under-diagnosed, hence, the authors suggest conducting community screening programs for early and proper management. We suggest providing more attention and further protective psychological strategies during such stressful situations that go parallel with the physical health care plans.
ABSTRACT
BACKGROUND: Self-mutilating behavior in the pediatric population is associated with psychiatric and psychosocial factors. Autosarcophagy, or self-cannibalism, is an extremely rare form of self-mutilation and is predominantly seen with psychosis or substance use.1 We report a case of oral autosarcophagy in a pediatric patient in the absence of substance use or psychosis. OBJECTIVE: To learn about autosarcophagy and its treatment in the pediatric population and to explore other neuropsychiatric disorders in which it is a predominant manifestation. METHODS: Review of a case using electronic medical records and relevant literature. Key terms: 'autosarcophagy,' 'body focused repetitive behavior,' 'oral self injury,' 'pediatric self-mutilation' using Medscape and Google Scholar. RESULTS: We present a 14-year-old female with history of seizure disorder in full remission, depression, self-cutting behavior, and suicidal ideation with 2 psychiatric hospitalizations, who presented to the pediatric emergency department with oral bleeding after eating one-third of her tongue over the course of a month. Evaluation was notable for poverty of speech and constricted affect. Patient stated she was 'trying to remove an infection' and alleviate discomfort. She denied that this behavior was an attempt to end her life but endorsed past suicidal ideations and cutting behavior. History revealed emergency room evaluation for aggressive behavior and episodes of volitional enuresis. We diagnosed major depressive disorder, recurrent episode in remission without psychosis. Drug screen, complete blood count, complete metabolic panel, COVID-19, urinalysis, thyroid-stimulating hormone, head computed tomography, and beta-human chorionic gonadotropin were negative. Patient continued home oral medications aripiprazole 10 mg daily, fluoxetine 30 mg daily, and levetiracetam 500 mg twice daily and was discharged the next day. CONCLUSIONS: Self-harm is observed in 17.2% of adolescents, 13.4% of young adults, and 5.5% of older adults.2 Cases of self-mutilation in pediatric patients typically present as cutting, burning, or head banging.3 Our differential diagnoses include borderline personality disorder due to repeated impulsivity and self-harm, and body focused repetitive behavior disorder (obsessive-compulsive disorder-related disorder), which presents with repetitive strain injuries and dental malocclusions. Treatment of self-mutilation involves treating the underlying psychiatric condition with psychotropic medications.4,5 In pediatric patients, dialectical behavioral therapy has been shown to reduce parasuicidal behaviors after 1 year of therapy.6 Our patient, under constant 24-hour observation, was cleared by medical, psychiatric, and dental teams. The patient followed up with outpatient psychotherapy and psychiatry. We are presenting this rare case for clinicians to identify and manage pediatric patients presenting with unique forms of self-harm tendencies.