Self-Amputation in Patient with Body Integrity Dysphoria in Comorbidity with Gender Dysphoria: A Case Report.

We present a rare, atypical case of a 24-year-old transgender male (assigned as a female at birth) admitted to the hospital after the planned self-amputation of his left hand. The patient described his motivation for this self-amputation as coming from deep-rooted and persistent feelings that this hand was not a part of his body. He identified himself as having, according to internet peer group definition, body integrity identity disorder. This condition is now referred to as body integrity dysphoria (BID). This patient was later diagnosed as having gender dysphoria and other conditions, including bipolar disorder and gaming disorder. The follow-up 2 years after self-amputation is presented, during which, despite antipsychotic and antidepressant treatment, the symptoms of BID remained unchanged and the high variability of other psychopathology was observed. This is an unusual case of BID simply because several other comorbidities are presented. Like many other rare clinical situations, this case also presents a particular challenge to our understanding of the dynamics and interrelationships between comorbidities, raising concerns and questions.

Delusion assessment scales.

Since the beginning of the 19th century, delusions have been classified mainly by their content or theme. Clinical psychopathological investigation requires additional variables that will allow investigators to describe the structure of delusional experience more accurately. Delusions are multidimensional constructs that may change across the various mental disorders. Several authors have developed rating scales with the aim to measure individual dimensions of delusional structure. In this paper, common rating scales are mentioned and the main characteristics of the Simple Delusional Syndrome Scale (SDSS) are summarized. The SDSS scale consists of 7 items (logical organization, systemization, stability, conviction, influence on the action, extension, and insertion), scored from 1 to 5. Results of the statistical analysis confirm good psychometric characteristics of the scale, Cronbach coefficient alpha=0.8327. The SDSS may contribute to a better understanding and diagnostics of delusional disorders and, using statistical methods, can help quantify the relationship between the delusional syndrome and the primary disease process. The SDSS scale may also be utilized in the assessment of changes occurring in delusional syndromes depending on the therapeutic effect of psychopharmacological drugs.