Self-harm, Personified Inner States and Identity-related Distress in a Young Patient with Autistic Features: An Analytic Case Report

Abstract

Background: Self-injury and suicidal thinking can co-occur with autistic characteristics, affective symptoms and difficulties identifying emotional states, but these phenomena require individual assessment rather than a unitary causal explanation. Case Presentation: A young female patient receiving inpatient psychiatric care in Goiânia, Brazil, during September 2026 described recurrent distress following ambiguous interpersonal exchanges, rumination, impaired self-care, suicidal ideation and self-injury associated with tension relief, self-punishment and identity-related expression. She developed 11 illustrated inner characters, categorised as traumatic, protective or destructive, and described their intentions as protective despite their potentially harmful consequences. A history suggesting autistic characteristics, relational adversity and psychotropic medication exposure was reported; formal diagnostic substantiation, event-level documentation and treatment outcomes were not available for independent assessment. Discussion: A provisional functional formulation links perceived interpersonal threat, poorly differentiated affect, rumination, disturbances of identity continuity and behavioural relief. The characters could facilitate symbolic communication and emotional differentiation, but this interpretation cannot be distinguished definitively from artistic expression, intrusive cognitions, dissociation or psychosis without fuller phenomenological evidence. Conclusion: The descriptive value of this case lies in the coexistence of multiple attributed functions of self-injury and a structured system of personified internal experiences. Proposed mechanisms remain untested, and no conclusion about a confirmed autism diagnosis or the causal role of the characters is warranted.