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Category: Volume 08 Issue 02 February 2020
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Title: Autosarcophagy: A Systematic Review of Psychological Correlates, with Genetic Propositions

Authors: Arumugam Subramanian Senthilkumar, Pichaachari Rathika, Kaliyan Veeramuthu, Srinivasan Lakshmanan, Eswaran Sobana

 DOI: https://dx.doi.org/10.18535/jmscr/v8i2.138

Abstract

   

Autosarcophagy (self-cannibalism) is rarely reported in the literature. Prognosis depends on the nature and severity of the primary cause or medical condition, more so in genetic disorders. Aggressive management can modify the outcomes preventing permanent disfigurement and disability. We did a qualitative systematic review on autosarcophagy, with prevalence of psychological correlates as the research question, and explored for specific patterns in gene loci of common syndromes of self-mutilation. Presence of psychosis, modes and parts ingested were the comparators studied. Analysis of clinical and psychosocial profile from all reports of "autosarcophagy/self-cannibalism" (eligibility) from PubMed database till December 2019 was done, along with documentation of two new cases. Out of 550 studies screened, eighteen (on 24 patients) were identified, wherein individual participant data was available for 85%. Documentations of autosarcophagy have increased to about six times since 2006 (P<0.05). More than three fourths of multiple attempts were by non-psychotic patients (P<0.05). Most non-psychotics preferred eating fingers, while more than one in five patients with psychosis preferred other organs. Paraesthesia and pain insensitivity were predominant in groups with and without psychosis respectively. Differences in all these other comparators were not significant. Impulsivity, obsessive compulsiveness, and aggressiveness were the commonest of all factors, in both groups. Targeting cumulative psychological factors from the onset may reduce frequency, relapse, insight and prognosis. Linkage and genetic recombinations were hypothesized from the adjacency of terminal gene loci of different chromosomes. The genomic analysis of the proposed linkage would help earlier diagnosis and intervention. Limitations include not evaluating other genes (of self-mutilation) of lesser scores.

Keywords: autosarcophagy, self-cannibalism, Lesch-Nyhan syndrome, autism spectrum disorder, pain insensitivity, self-mutilation, terminal alleles, evolutionary genomics.

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Corresponding Author

Pichaachari Rathika

Assistant Professor, Department of Psychiatry, GVMCH, Vellore, India