Serious bodily harm related to Obsessions from Sri Lanka.

An obsession is a thought that persists and dominates an individual’s thinking despite the individual’s awareness that the thought is either entirely without purpose or else has persisted and dominated their thinking beyond the point of relevance or usefulness (Fish & Hamilton 1985). Obsessions occur in many psychiatric disorders such as Obsessive Compulsive disorder (OCD), Major Depressive disorder and Schizophrenia (APA 2013, Bahceci et al. 2014, Doyle et al. 2014). In certain patients medication such as clozapine may induce obsessions (Doyle et al. 2014). In the 5th edition of the Diagnostic and Statistical Manual of mental disorders (DSM 5), OCD has been categorized together with few other related disorders (APA 2013). Among these disorders there are several disorders with direct physical self-harm. They include Trichotillomania and Excoriation disorder which are presumably related to OCD in terms of a range of diagnostic validators (APA 2013). There have been case reports on patients with OCD who presented with self-injurious behaviour. A description of an older male presenting with late onset OCD and genital self-mutilation has been published from India, the closest neighbour to Sri Lanka (Pandit & Vardhan 2013). There are cases of Tourette’s disorder with comorbid OCD presenting with severe self-injurious behaviour (Krüger & Müller-Vahl 2015). In a series of patients with self-injurious skin picking, 52% of them was found to be suffering from comorbid OCD (Wilhelm et al. 1999). We could not find any larger studies on OCD and bodily harm. Sri Lanka is an island in the Indian Ocean with a multi-ethnic population of about 21 million (World Bank 2015). The psychiatrist to patient ratio is low and in 2012 there was approximately one consultant psychiatrist per 500,000 persons (Jenkins et al. 2012). Only 1.6% of the total health budget is spent on mental health (Jenkins et al. 2012). We describe two Sri Lankan patients presenting with significant bodily harm related to their obsessions. There is very few published data regarding bodily harm in relation to obsessions. Therefore we hope this description of two patients would be valuable to other clinicians treating patients with similar presentations.