Non-suicidal self-injury (NSSI) is common among patients with borderline personality disorder(BPD) and is predominatly performed by cutting, scratching, burning and head banging. Here we present a case of an unusual form of NSSI.
The patient, a 23-year old woman with BPD, presented in our clinic with a four month history of intravenous application of a liquid dosage form of nicotine that is generally used for nasal application. Based on the obsessive idea to die from nicotine the current intravenous nicotine abuse had originally developed within a suicide plan, where the patient had failed in inducing a lethal intoxication through ingestion of tobacco saturated water. Within first probatory intravenous applications of nicotine the patient observed the possibility to easily induce euphoria, immediate stress relaxation and reduction of inner tensions. Subsequently she abandoned other NSSI forms in favour of nicotine injections. Within four weeks she developed nicotine dependence according to ICD-10 F17.25. On time of admission she reported to inject herself up to thirty doses per day resulting in an approximate daily intravenous nicotine application of about 33 mg. We performed an in-patient detoxification whereat the patient did not develop a markedly withdrawal syndrome.
To our knowledge, this is the first report on NSSI by intravenous application of nicotine in BPD resulting in nicotine dependence. Besides the singularity of the described NSSI method another major issue of the present case is the large amount of rapidly injected nicotine that has been tolerated without life threatening consequences.