External Genitalia Trauma Following the First Manic Episode in an Elderly Woman With Sexual Disinhibition

Authors

1 Department of Psychiatry, Research Center of Addiction and Behavioral Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran

2 Department of Urology, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran

10.5812/atr.30695

Abstract

Introduction
Late onset bipolar disorder is not common. In addition, bipolar disorder with a dominancy over sexual behaviors is very rare. Hence, traumatic and vigorous sexual behavior, such as masturbation and self-mutilation, are odd and rare occurrences.


Case Presentation
An elderly woman in a manic phase of bipolar disorder without a previous history of psychiatric disorders was concomitant with problematic sexual over stimulation in the context of hyper sexuality. She had traumatized her genitals and underwent surgery for their repair. Following her admission and psychopharmacologic therapy, she recovered.


Conclusions
The presentation of bipolar disorder in the elderly can be seen in sexual behaviors and self-mutilation that can lead to the need for reparative surgery. In each case with trauma to the external genitalia, psychiatric problems should be considered.

Keywords


1. Yassa R, Nair V, Nastase C, Camille Y, Belzile L. Prevalence of bipolar disorder
in a psychogeriatric population. J Affect Disord. 1988;14(3):197–
201. [PubMed: 2968383].
2. Depp CA, Jin H, Mohamed S, Kaskow J, Moore DJ, Jeste DV. Bipolar disorder
in middle-aged and elderly adults: is age of onset important?. J
Nerv Ment Dis. 2004;192(11):796–9. [PubMed: 15505527].
3. Yassa R, Nair NP, Iskandar H. Late-onset bipolar disorder. Psychiatr Clin
North Am. 1988;11(1):117–31. [PubMed: 3288976].
4. Carvalho J, Stulhofer A, Vieira AL, Jurin T. Hypersexuality and high sexual
desire: exploring the structure of problematic sexuality. J Sex Med.
2015;12(6):1356–67. doi: 10.1111/jsm.12865. [PubMed: 25808900].
5. Greilsheimer H, Groves JE. Male genital self-mutilation. Arch Gen Psychiatry.
1979;36(4):441–6. [PubMed: 426611].
6. Clark RA. Self-mutilationaccompanyingreligious delusions: a case report
and review. J Clin Psychiatry. 1981;42(6):243–5. [PubMed: 7240105].
7. Ames D. Autocastration and biblical delusions in schizophrenia. Br J
Psychiatry. 1987;150:407. [PubMed: 3664117].
8. Wan SP, Soderdahl DW, Blight EJ. Nonpsychotic genital selfmutilation.
Urology. 1985;26(3):286–7. [PubMed: 4035844].
9. Kaplan HI, Sadock BJ. Synopsis of psychiatry. 8th ed. New York: Courtney
Milet; 1998. pp. 869–70.
10. Krauthammer C, Klerman GL. Secondary mania: manic syndromes associated
with antecedent physical illness or drugs. ArchGenPsychiatry.
1978;35(11):1333–9. [PubMed: 757997].
11. Vafaei B. Two case reports of self-mutilation or van Gogh syndrome.
Acta Medica Iranica. 2003;41(3):199–201.
Arch