Nasal self-invasive behavior as an unnoticed behavioral oddity in Schizophrenia: A rare case report
H. Zizi, R. Rania, Z. Ennaciri, I. Adali, F. ManoudiIntroduction
Behavioral oddities represent a frequently overlooked dimension of schizophrenia, particularly when they involve the patient’s own body. Silent self-invasive acts, underpinned by delusional rationalization, may remain unnoticed in the absence of functional complaints. We report an unusual case of incidental discovery of bony foreign bodies in the nasal cavities of a patient with schizophrenia, in the context of covert self-injurious behavior.
Objectives
The objective of this case report is to highlight an unusual form of silent self-injurious behavior in schizophrenia, consisting of nasal
self-invasion with osseous fragments. This observation aims to draw attention to the clinical relevance of systematic somatic assessment in chronic psychotic patients, even in the absence of functional complaints, and to emphasize the importance of integrating psychopathological interpretation with medical imaging findings.
Methods
This work is based on a single clinical case observed in a 29-year-old male patient with schizophrenia. Data were collected from direct clinical observation during psychiatric hospitalization, retrospective patient interviews, and systematic brain computed tomography (CT) performed during routine assessment. A follow-up CT scan was obtained to confirm the spontaneous extraction of the foreign bodies. Clinical data were complemented by a psychopathological analysis of the patient’s discourse and behavior.
Results
A 29-year-old man, followed for schizophrenia for three years, was admitted for acute psychotic relapse with auditory hallucinations. A routine brain CT scan unexpectedly revealed two foreign bodies occupying the nasal cavities, tubular in shape and osseous in nature, measuring 8 × 0.5 cm and 7.5 × 0.5 cm, respectively. On retrospective inquiry, the patient acknowledged self-insertion of these bone fragments with the aim of blocking voices. He manually extracted them during the clinical interview, while the remaining fragment was spontaneously expelled during a sneezing episode. No pain or functional impairment was reported. A control CT confirmed patent nasal cavities with mild, regular reactive thickening.
This case illustrates a self-inflicted bodily oddity rationalized by delusional ideation. Comparable reports are scarce in the literature and typically involve heterogeneous objects, in a context of altered body schema and disturbed ego boundaries. Beyond its clinical singularity, this observation underscores the need for systematic somatic assessment in chronic psychotic patients.
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