# Managing Medically Severe Self-Injury in Borderline Personality Disorder and Autism: A Case Report of Self-Induced Toe Gangrene

## TL;DR

A woman with borderline personality disorder and autism caused severe self-injury requiring urgent medical and psychiatric care.

## Contribution

This case report highlights the unique challenges of managing medically severe self-injury in patients with co-occurring EUPD and ASD.

## Key findings

- Self-induced toe gangrene occurred due to prolonged ligature application in a 31-year-old woman.
- Conservative management was chosen due to preserved vascular integrity despite psychiatric detention.
- The case emphasizes the need for coordinated care across medical and psychiatric teams.

## 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.