One such condition is Autophagia, a little seen and even less understood condition that may cause those afflicted with it to have a desire to eat their own flesh or even a compulsive need to bite themselves without considering the consequences. This “self-eating” is so rare and so contrary to nearly universal instincts of self-preservation that it is difficult to define or categorize. This is not to be confused with a meaning of the term that refers to the natural processes of the body used to consume and/or dispose of its own tissues when they are no longer needed.
In this article, we will take a closer look at this nightmarish condition and do our best to understand it.
Autophagia is a difficult disorder to pin down, and it’s often co-defined with Autophagy. In some ways, almost every individual experiences a mild form of Autophagia that could be realized in the form of harmlessly biting dead skin from the lips or fingernails on occasion. This is not a cause for concern for most individuals or their medical care providers. The more serious form of the disorder is characterized by the desire or action of consuming – or attempting to consume – one’s own flesh.
The most extreme versions of this condition can see severe mutilation or even deliberate cannibalism of the patient’s own body tissues. It is surprising to discover that it is not classified as a mental disorder or a symptom of a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The authority on mental disorders in the United States, it just may be that there has not been enough recorded cases of it to do a sufficient amount of research to define the disorder in anything other than a speculative manner.
The most consistent symptom of Autophagia is a compulsion to commit self-harm by biting one’s own flesh, although some so inflicted cut out portions of their bodies with knives and even cook the flesh before consuming it. There is an indifference to the harm this causes to the patient, although pain and suffering are still experienced. In certain cases, this may not necessarily be true, and the symptoms may stem from a desire to experience sensation rather than to consume and come as a result of a loss of sensory input from other sources. This seeking of stimuli is most often observed in elderly patients who experience sensory loss (numbness, blindness, etc.) and seek stronger stimuli even if it may be painful or harmful.
Less severe symptoms include gradual nibbling away of the flesh of the fingers, much in the same manner as a compulsive nail biter, but taken to an extreme. Thus, the symptoms of Autophagia are for the most part clearly visible and fairly difficult to conceal from a medical practitioner even during a cursory examination.
Cases of Autophagia are often horrifying and unthinkable even for seasoned medical personnel. However, it is more commonly observed in seniors who are struggling with other disorders and represent the less extreme portion of the treatment continuum. One case of Autophagia documented by the NCBI was nonetheless a quite severe example of this type of Autophagia. The 66-year-old man admitted for the disorder had been mutilating his fingers with biting for over 6 years.
This behavior resulted in the loss of not only his fingertips but the phalange bones of all fingers on both hands. The odd thing about the case was that the only initial complaint that the patient had was insomnia. The waters were muddied, as is often the case with this baffling disorder, with the presence of severe diabetic neuropathy in both the hands and feet. Although there was no evidence of cognitive decline, there was serious brain atrophy detected by a computed tomographic scan.
The conclusions of the medical practitioners were that the self-mutilation was associated with other factors such as neuropathy, impulsivity disorder and social isolation. The patient may have been seeking the stimulation of sensation, escalating the amount of trauma inflicted just to experience the sensory input. The consequence was nonetheless potentially life-threatening
Another case studied and added to the US National Library of Medicine National Institutes of Health chronicled a more disturbing example of Autophagia. This baffling case of self-mutilation followed by self-cannibalism began when the 34-year-old male patient was brought to the emergency room from a prison with a grisly laceration on his right leg. The prisoner had sliced a rectangle of soft tissue off of his thigh and had eaten the flesh. This was characterized as intentional self-harm but without a wish to die from the injury. The prisoner was calm when questioned by medical professionals but was unresponsive.
Prison authorities reported that this was the second such incident, and the same prisoner had eaten a portion of his arm the year before. The patient was treated for his physical injuries and diagnosed with a psychotic disorder and transferred to a secure psychiatric ward. The case was very challenging to the physicians involved because of a lack of cooperation from the prisoner, who severely impeded psychiatric evaluation. The diagnosis had to be reached based on incomplete information, including apparent auditory and sensory delusions and inappropriate affect.
The entire case was further complicated by the status of the patient as a prisoner. The physicians in the case could not be certain that a desire to get away from the prison, seeking hospitalization, or seeking a shorter sentence was not among the possible motivations for the extreme behavior. The possibility of this incident being a rather horrendous example of malingering could not be discounted either.
Unfortunately, there are no hard and fast facts that isolate a singular cause for Autophagia.
There is some consensus that it may be a symptom of other disorders such as Pica or Lesch-Nyhan syndrome rather than a discrete disorder, but its recorded instances have been too outlandish and are often unrelated to these potential causes and no true causal relationship has been established by research.
In the case of Lesch-Nyhan syndrome, there have been documented cases of self-harm, including finger-biting, that can increase during an especially stressful event. However, it is often without the ideation that characterizes Autophagia and can begin with involuntary biting of the lips or tongue. What’s more, severe cognitive impairment is a symptom observed in Lesch-Nyhan which is not always consistent with the mental state of those suffering from Autophagia.
Another commonly linked condition is Obsessive Compulsive Disorder (OCD). There have also been examples that seem motivated by either excessive hunger or nutritional deficiencies, such as those associated with sufferers of Pica. This hypothesis is deeply complicated by the potential presence or absence of Autophagy, in which there is a strong sexual component to the desire to eat one’s own flesh that is quite independent of any other possible diseases or deprivations. The theory of deep-rooted sexual problems being the main culprit remains as yet unproven. The more likely causation at this juncture is probably a disorder triggered by a confluence of other issues, including actual malnutrition, acute psychological distress from any of a number of mental disorders, and perhaps abnormal signaling from parts of the brain that manage physiological functions such as appetite.
Although considered to be a self-harm disorder, correlation with the well-understood causes of those behaviors (borderline personality disorder and antisocial personality, major affective disorders and substance-related disorder) is sometimes complicated by the oddly specific motivation to eat rather than a general attempt to mortify one’s flesh. Instances of self-harm are often encountered in patients with personality disorders, especially in those with borderline personalities. Autophagia is more often found in conjunction with more physical ailments, such as alcoholism, substance abuse, and inhibited sensory input.
Physical and mental health treatments. Initial treatment upon admission will include a standard regimen of care for any wounds in order to ensure healing and prevent a possible life-threatening infection. The mental treatment for the patient will be a little more complicated and may require a diligent diagnosis of associated conditions. The course of treatment normally pursued in cases of Autophagia is to isolate and treat other more well-defined disorders that the patient may be suffering from.
In the first case outlined above, the staff administered a combination of an antipsychotic antidepressant medication and this treatment proved to be beneficial in that particular case. However, there are some cases when ancillary disorders either are unknown or undiagnosed, which often proves to make treatment much more difficult. One thing is for certain and that is that both psychological and physical injuries must be treated as a result of this disorder.
An aggressive combination of medication and intense therapy – including traditional psychotherapy or cognitive behavioral therapy – will probably need to be incorporated into any treatment plan. In the second case study, institutionalization and imprisonment were already a factor, but confinement needed to be maintained as there was a clear danger to the patient and they may have posed a threat to others as well, based on the diagnosis of psychosis.
Prevention of Autophagia can be quite problematic to determine and even more difficult to implement.
Since there is no real insight into the true cause of this disorder, identifying preventative measures can be nearly impossible. In severe cases, institutionalization and restraints may be needed for some time, including protective coverings such as gloves that will prevent the patient from biting or otherwise mutilating themselves further.
Prevention of injury will always be given the utmost position in the treatment plan, with the treatment of underlying issues – including mental ones – coming when this situation is stabilized. In the cases where it is associated with OCD, proactive treatment of that disorder may lend itself to the prevention of incidents of Autophagia. This can also be held to be true if there is an associated nutritional deficiency, diabetes neuropathy, or other physical disorder that can be treated independently and effectively.
With such a puzzling disorder, which may be simply a symptom of something else or even a behavior prompted by an unrelated condition, there are no easy answers for those who seek preventative measures to protect patients from suffering the awful consequences of Autophagia.