Exhibitionism, substance use, and genital self-mutilation: A case report of Emotionally Unstable Personality Disorder
A. L. Volpatto, F. Borghi, M. V. Franco Geraldo, C. H. Morais ReisIntroduction
Emotionally Unstable Personality Disorder (borderline type) involves emotional instability, impulsivity, and unstable relationships. Impulsivity often leads to risky behaviors such as substance abuse, hypersexuality, self-mutilation, and suicide attempts. When associated with impulse control disorders and substance use, the condition worsens, affecting treatment and functioning. Some severe cases include genital self-mutilation.This report describes a clinical case of Emotionally Unstable Personality Disorder with severe impulsivity, hypersexuality, cocaine abuse, and genital self-mutilation, discussing the diagnostic, therapeutic, and functional challenges
Objectives
To report a complex clinical case of Emotionally Unstable Personality Disorder with severe impulsivity, substance use, hypersexuality, and genital self-mutilation, highlighting the clinical and functional challenges resulting from the association between personality disorders and impulse control disorders.
Methods
This is a clinical case report of a 48-year-old male patient, single, a teacher with a higher education degree. Psychiatric follow-up began in 2019, motivated by abusive cocaine use starting at the age of 37. The clinical history was obtained through interviews, psychiatric records, and patient self-reports. The diagnostic assessment was based on DSM-5 criteria for Borderline Personality Disorder and Impulse Control Disorders.
Results
The patient exhibited severe impulsivity, hypersexuality, substance use, and high-risk behaviors, including exhibitionism and the sharing of intimate images on digital media. Following these episodes, he reported intense regret, followed by severe self-mutilation, such as genital injuries resulting in penile amputation, urethral stenosis, and the need for catheterization. He also reported a history of childhood neglect and violence. He is currently on regular use of Sertraline 100 mg/day, Levomepromazine 15 mg/day, Diazepam 5 mg/day, Naltrexone 50 mg/day, and antiretroviral therapy (HIV-positive). At present, he is abstinent from substances and has had no recent episodes of self-mutilation. Despite partial symptom improvement and increased insight, he continues to experience significant functional impairment, being on medical leave from work, with a vocational rehabilitation plan in progress.
Conclusions
This case illustrates the severity and complexity of comorbid conditions involving personality disorders, impulsivity, substance use, and early trauma. Impulsivity contributes to high-risk behaviors and severe outcomes such as genital self-mutilation. Management requires a multidisciplinary approach involving pharmacological treatment, intensive psychotherapy, and psychosocial support, aiming at harm reduction, functional rehabilitation, and relapse prevention.
Disclosure of Interest
None Declared