Managing Medically Severe Self-Injury in Borderline Personality Disorder and Autism: A Case Report of Self-Induced Toe Gangrene
Abstract
Medically severe self-injury (MSSI) in individuals with emotionally unstable personality disorder (EUPD) and co-occurring autism spectrum disorder (ASD) can be life- or limb-threatening, requiring urgent multidisciplinary intervention. We report a 31-year-old woman who developed self-induced toe gangrene following prolonged ligature application. Despite systemic stability, conservative management was pursued due to preserved vascular integrity, while psychiatric risk necessitated detention under the Mental Health Act. This case underscores the complex clinical, ethical, and legal challenges in balancing patient autonomy with safety, highlighting the importance of individualized, coordinated care across psychiatric, medical, and surgical teams.
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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