Bilateral self-enucleation in acute transient psychotic disorder: the influence of sociocultural factors on psychopathology Thippeswamy Harish ⁎ , Namdev Chawan, Ravi Philip Rajkumar, Santosh Kumar Chaturvedi National Institute of Mental Health and Neurosciences, Bangalore, India-560029 Abstract Self-inflicted eye injuries are rare but a devastating consequence of a serious mental disorder. Bilateral self-enucleation also known as oedipism has been documented in ancient texts and myths. Various biologic, psychologic, and social theories have been put forward to explain this rare phenomenon. In this report, we describe a case of oedipism, which highlights the influence of sociocultural factors on the psychopathology in acute transient psychotic disorder. © 2012 Elsevier Inc. All rights reserved. 1. Bilateral self-enucleation and oedipism in acute transient psychotic disorder: the influence of socio- cultural factors on phenomenology Self-inflicted eye injuries are rare and generally first present in an ophthalmological setting [1]. The spectrum of such injuries ranges from mild abrasions to complete self- blinding and autoenucleation. The latter phenomenon has been referred to in the literature as oedipism, a term first introduced by Blonel in 1906 [2]. Oedipism has been documented in ancient texts and myths, although reports in psychiatric literature are few [1]. The act is frequently bilateral [1,3,4] and can be achieved either manually or through the use of various instruments [1]. Various biologic and psychologic theories have been put forward to explain this phenomenon (Table 1), which has been associated with a wide range of psychiatric diagnoses, including dementia, substance-induced states, psychosis, and obsessive-compul- sive disorder [1,3-5]. Self-enucleation has been reported in patients with continuous drug abuse of cannabis and amphetamines [6]. Shiwach [7] has suggested that oedipism is, to some extent, a culture-bound phenomenon restricted to Christian cultures. It has been noted that, when not associated with dementia, oedipism is usually associated with delusions or hallucinations having religious and sexual themes [1,3-5]. Self-inflicted eye injuries are rare but dangerous consequence of severe psychotic illness. Literature on enucleation phenomena in India is sparse, and we could trace only 2 case reports. In 1 report, enucleation occurred in a patient with severe depression, and in the other instance, the patient had paranoid schizophrenia with active psychotic symptoms [8,9]. We herein present the unusual case of a middle-aged male patient from a rural Hindu background who developed an acute and transient psychotic episode associated with bilateral oedipism. 2. Case summary Mr A was a married farmer aged 40 years, educated up to middle school, from a lower socioeconomic background, with no family or personal history of mental or neurologic illness or substance abuse. About a week before presentation at our institute, his relatives noticed a sudden change in his behavior. He was found to speak excessively about God and religion and was agitated and unable to sleep that night. Because of his restlessness, he was physically restrained by his family. However, he escaped from his home and, at this time, reported hearing the voices of grahagalu (planets), alternately saying that he was a bad or a good person. He suddenly felt and developed the idea that he should offer his eye to God. He went to the local temple and removed his right eye manually and reports that he felt “at peace” after Available online at www.sciencedirect.com Comprehensive Psychiatry 53 (2012) 576 – 578 www.elsevier.com/locate/comppsych ⁎ Corresponding author. Tel.: +91 80 26995279, fax: +91 80 26564822. E-mail address: docharisht@gmail.com (T. Harish). 0010-440X/$ – see front matter © 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.comppsych.2011.07.001