EXPELLING THE SPIRIT OF NITER: THE DIFFERENTIAL DIAGNOSIS AND TREATMENT OF A YOUNG MALE WITH NON-SUICIDAL SELF-INJURY BEHAVIOR AND PSYCHOSIS.

Background: Self-mutilation, or non-suicidal self-injury (NSSI), is defined as when a person consciously commits injury to their own body. NSSI is associated with depression, borderline personality disorder, and other psychiatric conditions. NSSI has been included in the revised DSM-5 as a unique condition in its own right, occurring often during the teenage and adolescent years, and sometimes in later life. Continuation of such a cycle of self-mutilation becomes dangerous with time and leads to an increased risk of suicidal feelings. The prevalence rate in males and females by the teenage years is 6:1, decreasing with age to reach 3:1 or 4:1 by the second decade of life. Case presentation: This case study is of a young man who presented with persecutory delusions and bizarre complaints, following long-standing low mood. He believed that he was possessed. He was fixed on harming himself by burning his body. He had attempted suicide more than once, and had homicidal ideas of killing his wife and son. In addition, he had visual and auditory hallucinations. Though depression was initially assumed, the progression of his symptoms resulted in a diagnosis of Bipolar disorder type II.