Deliberate Foreign Body Ingestion in a 35-Year-Old Woman With Borderline Personality Disorder and Several Psychiatric Comorbidities

Abstract

Deliberate foreign body ingestion (DFBI) is a rare psychopathological disorder that involves the swallowing of non-nutritive objects to cause self-harm. It is most commonly associated with borderline personality disorder (BPD). Very scant literature has been published on the psychopathological understanding or psychopharmacological interventions. Mostly, gastroenterological and surgical management regarding the removal of the foreign body has been discussed in the literature. DFBI can be very challenging in terms of the treatment of the patient and the morale of the health providers-it exhausts the patient and the family and evokes frustration among the medical staff due to its resistance to remission. By presenting the case of a patient in this article, we will discuss what is known about the poorly understood DFBI and the challenges and difficulties encountered while treating these patients. Further, we will discuss how a biopsychosocial approach can be used in treating these patients.

“Fighting for the Last Gasp”—Severe Borderline Personality Disorder and Posttraumatic Stress Disorder, Chronic Deliberate Ingestion of Foreign Bodies, and Palliative Struggles in Intensive Care

“…They also reported potential benefit from pharmacotherapy to reduce arousal and the effect of opioid reward circuits associated with self-harm, but it is not clear that these latter approaches are generalizable to self-harm by DFBI. 5 We were unable to find any other case reports describing a fatal outcome from chronic DFBI related to BPD, although there is at least 1 case of death as a result of DFBI involving a woman suffering from schizophrenia. 6 Cases of DFBI associated with BPD may be associated with complex team dynamics with powerful countertransference feelings testing liaison relationships, engendering potential compassion fatigue, and in certain circumstances, posing ethical challenges.…”

“…These authors reiterated the potential benefits of engagement in dialectical behavior therapy. They also reported potential benefit from pharmacotherapy to reduce arousal and the effect of opioid reward circuits associated with self-harm, but it is not clear that these latter approaches are generalizable to self-harm by DFBI 5. We were unable to find any other case reports describing a fatal outcome from chronic DFBI related to BPD, although there is at least 1 case of death as a result of DFBI involving a woman suffering from schizophrenia 6.…”

“…Acute management, which incorporates strict limit setting with the patient and, at times, intensive liaison to manage intense countertransference reactions with the treating staff, has an unclear impact on frequency of presentation. 2 A recent case report published by Bangash and colleagues 5 described the case of a patient with BPD, DFBI, and other psychiatric comorbidities. These authors reiterated the potential benefits of engagement in dialectical behavior therapy.…”