PDF(Pubmed)
Abstract：
Bullying has reached epidemic proportions, affecting one in three students worldwide. A pervasive issue that carries profound physical, mental, and social consequences, significantly increasing the risk of non-suicidal self-injury (NSSI) and suicidal behaviors among those who experience this type of harassment and hazing. While physicians and most caregivers are fully aware and competent in identifying signs of self-harming behavior such as scratching, cutting, or burning the skin, oral self-injury is often overlooked as a potential indicator and is associated with unintentional soft tissue biting or specific conditions. We present a rare case of a 14-year-old male who sought medical attention due to severe bilateral tongue ulcers, leading to his admittance to the emergency department (ED) with excruciating pain and feeding difficulties. In the reported case, although the traumatic biting of the tongue emerged as the most probable etiological factor, a specific underlying motive and contextual comprehension were initially absent. It was only after successfully establishing a foundation of trust with the patient, enabling an honest response, that it became evident that the observed lesions represented a manifestation of bullying-induced non-suicidal self-injury. However, patients rarely openly acknowledge intentional self-inflicted lesions and/or their experiences of bullying, underscoring the necessity to maintain vigilance for alternative indicators such as behavioral changes or a noticeable decline in academic productivity. The significance of this case also goes beyond its presentation, highlighting the largely unexplored issue of how a patient\'s dentofacial features can serve as substantial catalysts for bullying. Therefore, it is only through equally prioritizing awareness of uncommon signs, symptoms, and context that one can expedite early diagnosis and intervention, emphasizing the essential need for comprehensive and timely management of such cases.
摘要：
欺凌已经达到流行病的程度，影响全球三分之一的学生。一个普遍存在的问题，承载着深刻的物理，心理，和社会后果，在经历此类骚扰和骚扰的人中，显着增加了非自杀性自我伤害（NSSI）和自杀行为的风险。虽然医生和大多数护理人员充分意识到并有能力识别诸如抓挠之类的自我伤害行为的迹象，切割,或灼伤皮肤,口腔自伤作为一种潜在的指标常被忽略,且与意外的软组织咬伤或特定条件有关.我们介绍了一个罕见的病例，一名14岁的男性因严重的双侧舌溃疡而寻求医疗护理，导致他因极度疼痛和进食困难而进入急诊科（ED）。在报告的案例中，尽管舌头的创伤性咬伤是最可能的病因，最初缺乏特定的潜在动机和上下文理解。只有在成功建立了与病人的信任基础之后，能够做出诚实的回应，很明显，观察到的病变代表了欺凌引起的非自杀性自我伤害的表现。然而,患者很少公开承认故意自我造成的病变和/或他们的欺凌经历，强调必须对其他指标保持警惕，如行为变化或学术生产力明显下降。这个案例的意义也超出了它的表述范围,强调了一个基本上未被探索的问题，即病人的牙面特征如何能成为欺凌的重要催化剂。因此,只有通过同样优先考虑不常见迹象的意识，症状,以及人们可以加快早期诊断和干预的背景，强调全面和及时管理此类案件的基本必要性。
