OJPsych  Vol.4 No.2 , April 2014
Management of a Cluster of Foreign Body Ingestion Incidents in Patients with Borderline Personality Disorder
ABSTRACT

Objective: Deliberate foreign body ingestion (DFBI) has been reported in patients with personality disorders as part of a spectrum of self-harming behaviours, however the published literature is small (15 case reports). Method: This was a retrospective audit of medical and psychological management of a cluster of 12 DFBI incidents over 9 months in 4 young female patients with Borderline Personality Disorder (BPD). Results: All four patients knew one another from outpatient psychotherapy programmes. DFBI was associated with substance use in 5/12 incidents, and with precipitants (experiencing strong emotions, witnessing self-harm) in 4/12 incidents. Most DFBI involved sharp objects (razor blades, glass, safety pins). Medical intervention was initially active (endoscopy/surgery) but progressed to a more conservative, observational approach. Psychological management was initially restrictive, but also changed over time to focus on identifying distress, enhancing coping mechanisms and patient responsibility. Co-ordination of patient care management involvedintensive liaison (provision of interdisciplinary support and education) between medical, surgical and psychiatric teams. Conclusion: Management of DFBI in patients with BPD requires high levels of interdisciplinary collaboration. In this cluster of DFBI incidents, effective management was achieved with conservative medical/surgical methods (observation) and non-restrictive psychological approaches that enhanced patient self-efficacy.


Cite this paper
Dyke, J. , Hendry, K. , Hill, J. , Schultz, M. , Mason, E. and Glue, P. (2014) Management of a Cluster of Foreign Body Ingestion Incidents in Patients with Borderline Personality Disorder. Open Journal of Psychiatry, 4, 99-103. doi: 10.4236/ojpsych.2014.42014.
References
[1]   Poynter, B.A., Hunter, J.J., Coverdale, J.H. and Kempinsky, C.A. (2011) Hard to Swallow: A Systematic Review of Deliberate Foreign Body Ingestion. General Hospital Psychiatry, 33, 518-524.
http://dx.doi.org/10.1016/j.genhosppsych.2011.06.011

[2]   Palta, R., Sahota, A., Bemarki, A., Salama, P., Simpson, N. and Laine, L. (2009) Foreign-Body Ingestion: Characteristics and Outcomes in a Lower Socioeconomic Population with Predominantly Intentional Ingestion. Gastrointestinal Endoscopy, 69, 426-433. http://dx.doi.org/10.1016/j.gie. 2008.05.072

[3]   Gitlin, D.F., Caplan, J.P., Rogers, M.P., Avni-Barron, O., Braun, I. and Barsky, A.J. (2007) Foreign-Body Ingestion in Patients with Personality Disorders. Psychosomatics, 48, 162-166. http://dx.doi.org/10. 1176/appi.psy.48.2.162

[4]   Frei-Lanter, C.M., Vavricka, S.R., Kruger, T.H., et al. (2012) Endoscopy for Repeatedly Ingested Sharp Foreign Bodies in Patients with Borderline Personality Disorder: An International Survey. European Journal of Gastroenterology and Hepatology, 24, 793-797. http://dx.doi.org/10.1097/MEG.0b013e 32835403d5

[5]   Eisen, G.M., Baron, T.H., Dominitz, J.A., et al. (2002) Guideline for the Management of Ingested Foreign bodiEs. Gastrointestinal Endoscopy, 55, 802-806. http://dx.doi.org/10.1016/S0016-5107 (02)70407-0

[6]   Ikenberry, S.O., Jue, T.L., Anderson, M.A., et al. (2011) Management of Ingested Foreign Bodies and Food Impactions. Gastrointestinal Endoscopy, 73, 1085-1091. http://dx.doi.org/10.1016/j.gie.2010. 11.010

[7]   http://ethics.health.govt.nz/system/files/documents/pages/HDEC%20scope%20summary.pdf

[8]   American Psychiatric Association (2013) Diagnostic and Statistical Manual. 5th Edition, APA Press, Washington DC.

[9]   Reisner, A.D., Bornovalova, M.A., Gordish, L., Baker, R.N., Smith, K.J. and Sexton, R.E. (2013) Ingestion of Foreign Objects as a Means on Non-Lethal Self-Injury. Personality Disorders, 4, 182-189. http://dx.doi.org/10.1037/a0027954

[10]   Rashid, M. and Gosai, I. (2011) The Girl Who Swallows Knives: Uncontrollable Deliberate Self-Harm in a Teenage girl with Borderline Personality Disorder. BMJ Case Reports, 2011, bcr0720103136.
http://dx.doi.org/10.1136/bcr.07.2010.3136

[11]   Soong, C.V., Harvey, C. and Doherty, M. (1990) Self-Mutilating Behaviour and Deliberate Ingestion of Foreign Bodies. Ulster Medical Journal, 59, 213-216.

[12]   James, A.H. and Allen-Mersh, T. (1982) Recognition and Management of Patients Who Repeatedly Swallow Foreign Bodies. Journal of the Royal Society of Medicine, 75, 107-110.

[13]   Hendry, K., Glue, P., Hill, J., Schultz, M., Ingestion of Sharp Foreign Objects. A Case Series, Literature Review and Management Recommendation. Submitted manuscript.

[14]   Lieb, K., Vollm, B., Rücker, G., Timmer, A. and Stoffers, J.M. (2010) Pharmacotherapy for Borderline Personality Disorder: Cochrane Systematic Review of Randomized Trials. British Journal of Psychiatry, 196, 4-12. http://dx.doi.org/10.1192/bjp.bp.108.062984

[15]   Linehan, M.M. (1993) Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford, New York.

[16]   Stoffers, J.M., Vollm, B.A., Rücker, G., Timmer, A., Huband, N. and Lieb, K. (2012) Psychological Therapies for People with Borderline Personality Disorder. Cochrane Database of Systematic Reviews, 8, CD005652.

[17]   Connors, R. (2000) Self Injury: Psychotherapy with People Who Engage in Self-Inflicted Violence. Jason Aronson, Northvale.

 
 
Top