The Psychiatric Aetiologies of Epistaxis

Abstract

exploring epistaxis with a psychiatric aetiology. This paper aims to summarise the existing literature documenting the various causes and management of psychiatric epistaxis-an uncommon cause for a common condition. TraumaPsychiatric conditions presenting as traumatically induced epistaxis appear in two distinct groups; chronic trauma due to compulsive behaviours, and acute injuries.Epistaxis secondary to trauma, especially digital trauma, is well established as a common presenting complaint [5]. Compulsive nose picking, termed rhinotillexomania, is a common habit with reported rates of up to 97.5% [6] in adolescents and 91% of adults [7]. Rates of epistaxis secondary to rhinotillexomania in these studies were 25% for adolescents [7] and 18% for adults [6]. Jefferson, et al. also reported a coexistence of nail biting, cuticle picking, hair pulling, and scratching of a specific spot in individuals with frequent rhinotillexomania.Chronic rhinotillexomania is associated with self-mutilation, typically resulting in erosion and/ or perforation of the nasal spectrum, turbinates, ethmoidal sinus, medial orbital wall [8][9][10][11]. The self-reported rate of injuries more serious than a simple bleed ranges from 0.8% to 2% of those with rhinotillexomania [6,7].Self-mutilation is defined as a deliberate act of destruction and/or body alteration without suicidal intent and is noted to occur in a wide variety of psychiatric conditions [12,13]. Major self-mutilation that results in permanent organ loss or dysfunction is