Anatol J Clin Investig 2009:3(1):94-96

A CASE OF DEPRESSION WITH NAIL EXTRACTION AND AN OVERVIEW OF
SELF-MUTILATION
TIRNAK ÇEKME DAVRANIŞI İLE BİRLİKTELİK GÖSTEREN BİR DEPRESYON OLGUSU
VE KENDİNE ZARAR VERME DAVRANIŞI ÜZERİNE GENEL BİR BAKIŞ
Recep TÜTÜNCÜ1, Betül ONAT1
1

Etimesgut Army Hospital, Psychiatry Service, Ankara, Turkey

Abstract
Self-mutilation is defined as the deliberate harming or alteration of one’s body tissue without consciously intending
tocommit suicide.Numerous psychological mechanisms contribute to the etiology and persistence of selfmutilation . In this paper a case of very unusual self mutilating behavior “nail extraction”with depression is
reported and a short overview of self mutilation is made. (Anatol J Clin Investig 2009:3(1):94-96).
Özet
Self mutilasyon kişinin beden bütünlüğüne bilinçli özkıyım niyeti olmaksızın verdiği zarar olarak tanımlanır. Self
mutilasyonun etyolojisine ve devam etmesine birçok psikolojik mekanizma katkıda bulunmaktadır. Bu yazıda
oldukça nadir görülebilecek “tırnak çekme”şeklinde kendine zarar verme davranışı ile giden depresyon vakası
bildirilmekte ve self mutilasyon kısaca gözden geçirilmektedir. (Anatol J Clin Investig 2009:3(1):94-96).

Introduction
Pathological self mutilation is direct and socially
unacceptable, even within general social
subcultures; it is differentiated from direct selfharm such as drinking and driving, and from
more socially acceptable bodily harm such as
ear piercing and tattooing.
It is important to note that numerous
psychological mechanisms contribute to the
etiology and persistence of self-mutilation. These
include religious and sexual delusions, response
to command hallucination, resolution of
unconscious conflicts (implicated primarily in
major
self-mutilation),
attention
seeking,
autoerotic self-mutilation, frustration, turning
inward of anger, tension release, termination of
depersonalization,
euphoria,
depression,
loneliness or distressing sexual feelings, anger
release, self-punishment, attempt to gain feelings
of security or uniqueness, and manipulation of
others [1-6].
Self-mutilation have many features similar to
impulse control disorders. All of the disorders in
this grouping are characterized by the failure to
resist an impulse, drive, or temptation to perform
some act that is harmful to the patient or others.
In most cases the person senses increasing
tension or arousal prior to the act and
experiences pleasure, gratification, or relief
during or following the act. For this reason some
researchers discuss self-mutilation as a separate
disorder under the title of impulse control
disorders [5,7].
Recep TÜTÜNCÜ
Etimesgut Army Hospital, Psychiatry Service, Ankara, Turkey
E-mail: drtutuncu@yahoo.com

Here we report a case of very unusual self
mutilating behavior with a major psychiatric
disorder. To the best of our knowledge this is the
first case, reporting self mutilation by nail
extraction.
36 year-old, married woman was admitted to our
psychiatry clinic voluntarily with the complaints of
anhedonia, loss of interest, social withdawal,
irritability and anger bursts. She was self
mutilating by nail extraction. She was extracting
her nails with no pain. She was totally amnestic
about the act. After the mutilation she was
feeling herself very relieved. As her children told
at that time she was wandering in the house like
searching something, and then she was
destructing her needles into small pieces and
extacting them. This self-mutilation was occuring
usually everyday especially in the evenings. Her
complaints had been started for six months and
increased significantly since last month.
Also she had been never sewing for two years
because whenever she had intended to do, she
felt so tensive and tore all the clothes. In addition
she had been eating 100 mg/day dry tea for 20
years.
According to psychiatric examination her mood
was depressive. She was thinking about death
but no suicidal ideation detected. There were
dissociative amnestic periods. There were
lesions due to self mutilation. In psychological
assessment MMPI and Beier tests were given

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