The "embedding" of objects as a form of self-mutilation/self-injury is noted to be in the rise. Individuals who engage in this form of injury often begin as "cutters" and progress to embedding objects in their self-inflicted wounds. With cutting behavior, individuals report initial pain and then emotional relief with the sight of blood or with the injury site itself. Embedding causes constant pain and discomfort, including pain which occurs each time the person moves or touches that part of their body. Of the individuals involved in embedding objects, 70% repeated the behavior and 71% increased the size of the objects and intensity of the behavior. Self-injurious behaviors have long been associated with histories of physical or sexual abuse as well as a variety of psychiatric diagnoses. The self-injurious behaviors have been noted to have an addictive quality. William Shiels, D.O., Chief of Radiology at Nationwide Children's Hospital in Columbus recently reported on his findings. Dr. Shiels is advocating for a national registry for individuals with self embedding and is campaigning for the inclusion of the behavior as a unique clinical entity in the next update of the Diagnostic and Statistical Manual of Mental Disorders (DSMV).
At Brookhaven, we have identified a group of young adults who swallow objects and share many of the characteristics observed by Dr. Shiels. We have experienced some success with Naltrexone, combined with intense levels of psychotherapy and a highly structured treatment milieu. The young people with these problems pose great difficulty in most treatment programs and challenge the professional staff. We have recognized that all of our patients with "swallowing" behaviors come to us with substantial abuse histories and long histories of institutional placement.
We encourage clinicians to identify variants of self-injurious behaviors and to work together, as Dr. Shiels suggests, to develop dialogue and share strategies. To read a summary of Dr. Shiels recent presentation "click here" http://www.medpagetoday.com/MeetingCoverage/RSNA/12007