TITLE:
Management of a Cluster of Foreign Body Ingestion Incidents in Patients with Borderline Personality Disorder
AUTHORS:
Julia Dyke, Kyle Hendry, Jason Hill, Michael Schultz, Evan Mason, Paul Glue
KEYWORDS:
Borderline Personality Disorder, Swallowing, Foreign Body, Clinical Management
JOURNAL NAME:
Open Journal of Psychiatry,
Vol.4 No.2,
April
15,
2014
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.