Self-Mutilation Is Not Novel, but Still Needs Early Intervention

CHICAGO – Reports by radiologists showing multiple cases of self-mutilation by adolescents involving the deliberate embedding of foreign objects must be kept in perspective, according to Dr. Louis Kraus, chief of child psychiatry at Rush Medical Center, Chicago.

“This is not novel,” he said in an interview. “In my practice, I've seen kids self-embedding for more than 20 years. The important thing is to understand the psychopathology behind it and how best to intervene.”

In one such report by radiologist William Shiels II, a pattern of self-injury was discovered during an ongoing longitudinal study of a novel percutaneous, image-guided, minimally invasive technique to remove soft tissue foreign bodies (STFBs) in pediatric patients.

Data on 505 patients over 13 years of age have demonstrated the technique's safety and effectiveness in removing STFBs with minimal scarring. In the vast majority of patients treated with the procedure, the injuries were accidental (stepping on a piece of glass, for example); however, in 10 patients, the injuries clearly were self-inflicted. One patient had inserted unfolded paper clips measuring 16 cm in length bilaterally into her biceps muscles.

Dr. Shiels, who is chief of radiology at Nationwide Children's Hospital, Columbus, Ohio, presented the results of a study of 10 patients at the annual meeting of the Radiological Society of North America.

Of these patients, 90% demonstrated suicidal ideation or behavior, and all had multiple psychiatric comorbidities, such as bipolar disorder, borderline personality disorder, depression, posttraumatic stress disorder, attention-deficit/hyperactivity disorder, and obsessive compulsive disorder.

All of the children had histories of psychological, physical and/or sexual abuse, had been removed from their families, and were living in foster homes or group homes. The children crossed all socioeconomic strata and racial groups; 90% of the patients were girls. Seventy percent of the patients embedded objects more than once, and of these, 71% demonstrated an escalating pattern of self-injury with increasingly large, painful objects.

The patients presented to the emergency department for treatment for one of three reasons: pain, shame, or guilt about their embedding behavior, and complications (usually an infection).

For the most part, adolescents who engage in these behaviors are not suicidal, Dr. Kraus said. “Typically, this behavior is seen in kids who have difficulty expressing some type of psychic pain. This is essentially a superficial form of self-mutilation.”

Dr. John Campo, chief of child and adolescent psychiatry at Nationwide Children's Hospital and Ohio State University, also in Columbus, said in an interview that the self-embedding behaviors “might represent one extreme of nonsuicidal self-injury or perhaps even a distinct problem.”

However, he added, “This is a clinical case series–no more and no less–so we do need to be careful about making excessive generalizations.”

CHICAGO – Reports by radiologists showing multiple cases of self-mutilation by adolescents involving the deliberate embedding of foreign objects must be kept in perspective, according to Dr. Louis Kraus, chief of child psychiatry at Rush Medical Center, Chicago.

“This is not novel,” he said in an interview. “In my practice, I've seen kids self-embedding for more than 20 years. The important thing is to understand the psychopathology behind it and how best to intervene.”

In one such report by radiologist William Shiels II, a pattern of self-injury was discovered during an ongoing longitudinal study of a novel percutaneous, image-guided, minimally invasive technique to remove soft tissue foreign bodies (STFBs) in pediatric patients.

Data on 505 patients over 13 years of age have demonstrated the technique's safety and effectiveness in removing STFBs with minimal scarring. In the vast majority of patients treated with the procedure, the injuries were accidental (stepping on a piece of glass, for example); however, in 10 patients, the injuries clearly were self-inflicted. One patient had inserted unfolded paper clips measuring 16 cm in length bilaterally into her biceps muscles.

Dr. Shiels, who is chief of radiology at Nationwide Children's Hospital, Columbus, Ohio, presented the results of a study of 10 patients at the annual meeting of the Radiological Society of North America.

Of these patients, 90% demonstrated suicidal ideation or behavior, and all had multiple psychiatric comorbidities, such as bipolar disorder, borderline personality disorder, depression, posttraumatic stress disorder, attention-deficit/hyperactivity disorder, and obsessive compulsive disorder.

All of the children had histories of psychological, physical and/or sexual abuse, had been removed from their families, and were living in foster homes or group homes. The children crossed all socioeconomic strata and racial groups; 90% of the patients were girls. Seventy percent of the patients embedded objects more than once, and of these, 71% demonstrated an escalating pattern of self-injury with increasingly large, painful objects.

The patients presented to the emergency department for treatment for one of three reasons: pain, shame, or guilt about their embedding behavior, and complications (usually an infection).

For the most part, adolescents who engage in these behaviors are not suicidal, Dr. Kraus said. “Typically, this behavior is seen in kids who have difficulty expressing some type of psychic pain. This is essentially a superficial form of self-mutilation.”

Dr. John Campo, chief of child and adolescent psychiatry at Nationwide Children's Hospital and Ohio State University, also in Columbus, said in an interview that the self-embedding behaviors “might represent one extreme of nonsuicidal self-injury or perhaps even a distinct problem.”

However, he added, “This is a clinical case series–no more and no less–so we do need to be careful about making excessive generalizations.”

CHICAGO – Reports by radiologists showing multiple cases of self-mutilation by adolescents involving the deliberate embedding of foreign objects must be kept in perspective, according to Dr. Louis Kraus, chief of child psychiatry at Rush Medical Center, Chicago.

“This is not novel,” he said in an interview. “In my practice, I've seen kids self-embedding for more than 20 years. The important thing is to understand the psychopathology behind it and how best to intervene.”

In one such report by radiologist William Shiels II, a pattern of self-injury was discovered during an ongoing longitudinal study of a novel percutaneous, image-guided, minimally invasive technique to remove soft tissue foreign bodies (STFBs) in pediatric patients.

Data on 505 patients over 13 years of age have demonstrated the technique's safety and effectiveness in removing STFBs with minimal scarring. In the vast majority of patients treated with the procedure, the injuries were accidental (stepping on a piece of glass, for example); however, in 10 patients, the injuries clearly were self-inflicted. One patient had inserted unfolded paper clips measuring 16 cm in length bilaterally into her biceps muscles.

Dr. Shiels, who is chief of radiology at Nationwide Children's Hospital, Columbus, Ohio, presented the results of a study of 10 patients at the annual meeting of the Radiological Society of North America.

Of these patients, 90% demonstrated suicidal ideation or behavior, and all had multiple psychiatric comorbidities, such as bipolar disorder, borderline personality disorder, depression, posttraumatic stress disorder, attention-deficit/hyperactivity disorder, and obsessive compulsive disorder.

All of the children had histories of psychological, physical and/or sexual abuse, had been removed from their families, and were living in foster homes or group homes. The children crossed all socioeconomic strata and racial groups; 90% of the patients were girls. Seventy percent of the patients embedded objects more than once, and of these, 71% demonstrated an escalating pattern of self-injury with increasingly large, painful objects.

The patients presented to the emergency department for treatment for one of three reasons: pain, shame, or guilt about their embedding behavior, and complications (usually an infection).

For the most part, adolescents who engage in these behaviors are not suicidal, Dr. Kraus said. “Typically, this behavior is seen in kids who have difficulty expressing some type of psychic pain. This is essentially a superficial form of self-mutilation.”

Dr. John Campo, chief of child and adolescent psychiatry at Nationwide Children's Hospital and Ohio State University, also in Columbus, said in an interview that the self-embedding behaviors “might represent one extreme of nonsuicidal self-injury or perhaps even a distinct problem.”

However, he added, “This is a clinical case series–no more and no less–so we do need to be careful about making excessive generalizations.”