Management of a Cluster of Foreign Body Ingestion Incidents in Patients with Borderline Personality Disorder

Julia Dyke, Kyle Hendry, Jason Hill, Michael Schultz, Evan Mason, Paul Glue

Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Southern District Health Board and University of Otago, Dunedin, New Zealand.

DOI: 10.4236/ojpsych.2014.42014                

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.

Keywords

Borderline Personality Disorder, Swallowing, Foreign Body, Clinical Management

Conflicts of Interest

The authors declare no conflicts of interest.

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.