Neck Cutting Behavior: Paraphilia or Suicide Attempt? A Case Report of Self-harm in the Context of Drug Abuse and Depression

The border between self-harm and suicidal behaviors is not always clear. Self-mutilation is a common finding in mood and personality disorders, and cutting of the extremities is more common than cutting of the neck. The case put forth regards a young adult male with a past history of depression and drug abuse who presented to the emergency department with superficial lacerations on his left arm and bilaterally on his neck with a large abscess in his right forearm. The patient reported the cuts on his arm to be from testing the sharpness of a kitchen knife and the cuts on his neck to be the result of sexual activity between him and his girlfriend. Collateral reports were inconsistent with the patient’s version of events, and he voluntarily chose to receive psychiatric evaluation. After undergoing hospital rehabilitation, the patient was discharged with the diagnosis of bipolar disorder unspecified due to the findings of chronic mood instability without conclusive evidence of mania or hypomania. The etiology of his neck cutting behavior remained unexplained.