Long-Term and Bizarre Self-Injurious Behavior

Abstract

Repeated self-harm usually presents with associated psychopathology, mostly in the form of obsessive-compulsive disorder, malingering, or personality disorders, and may persist for many years. This case presentation focuses on self-harm involving the deliberate ingestion of foreign bodies. This behavior remains poorly understood, and the relevant literature focuses almost entirely on gastroenterological and surgical management, with little or no discussion of underlying psychological mechanisms, psychopathology, or psychotherapeutic intervention. The goal of this article is to begin to fill that gap by presenting the case of a young woman who was diagnosed with borderline personality disorder and followed for 20 years, who repeatedly swallowed objects as a form of self-harming behavior. The nosological status and possible functions of this behavior are discussed, as are the difficulties of caring for patients with such long-standing, repeated selfinjury. This case illustrates how the boundaries between different self-injurious behaviors are blurred and also how different self-injurious behaviors are likely to share common patterns, functional integrity, and meanings. It should also serve to remind us how far we have to go in terms of understanding, classifying, and successfully treating certain patients who present with longterm and bizarre self-injurious behavior.

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

“…They can be overtaken by sudden, recurrent impulses to harm themselves and usually do not resist these urges. [4] Our patient, who was diagnosed with BPD and PTSD, had suffered childhood sexual abuse for several years before the age of 15. The patient had internalized feelings of shame and guilt and wanted to punish herself for being a part of those sexual acts.…”

“…1. Serotonergic and combined serotonin-norepinephrine reuptake inhibitors (SSRIs, SNRIs) for anxiety, depression, and impulsivity; there is an interaction between the 5-HTTLPR polymorphism and early life events, which may lead to the development of impulsivity in patients with BPD [4];…”

“…Repeated DFBI is mainly associated with borderline personality disorder (BPD) [4]. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) defines borderline personality disorder as "a pervasive pattern of instability of interpersonal relationships, self-image, and affects" [5].…”

“…The lifetime prevalence of BPD is 0.5%-5.9%. Self-harming behaviors are very common in BPD patients; around 80% of BPD patients will self-harm at some point, and over two-thirds make suicide attempts [4].…”