While the disturbing act of self-injury is nothing new to adolescents, researchers and physicians at Nationwide Children's Hospital have identified a more severe type of behavior that is raising some concern among medical professionals. Often misdiagnosed, ignored and under-reported, Self-Embedding Behavior (SEB) is a form of self-injurious behavior that involves inserting foreign objects into soft tissue -- either under the skin or into muscle.
A recent study, published in the June issue of Pediatrics, stresses the importance of quickly identifying this dangerous behavior while distinguishing it from other forms of self-injury to prevent future episodes.
During this three-year study period, physicians at Nationwide Children's identified 11 patients who demonstrated SEB. Of these patients, each had been diagnosed with a psychiatric disorder and 82 percent were female. In fact, the majority of the patients, 90 percent, had a history of out-of-home placements and were members of a group home or psychiatric facility at the time they engaged in SEB.
"Typically these patients first present in Emergency Departments, so medical professionals have the unique opportunity to be the first to identify this dangerous behavior," said co-author William E. Shiels, DO, chief of Radiology at Nationwide Children's Hospital. "It is important for practitioners to first understand this behavior, and then rapidly pursue targeted intervention to interrupt the cycle of self-harm."
SEB is an extreme form of self-injury and this study found it is most commonly accompanied with suicidal ideations. Nearly 75 percent of the patients involved in the study reported the purpose of engaging in SEB was due to suicidal ideations and intentionally causing serious harm to themselves. Due to the complexity of the care that is required, a multidisciplinary team is typically formed to properly manage these individuals. This team includes primary care and emergency physicians, behavioral health specialists and interventional radiologists.
Nine of the 11 patients were referred to the Department of Radiology at Nationwide Children's for diagnosis and removal of the foreign bodies. The department uses sonographic or fluoroscopic guidance to remove foreign bodies such as metal, glass, wood, plastic, graphite and crayon. The most common sites of self-injury are the arms, wrists, ankles and lower legs.
"This study helped us identify a clinical profile of adolescents who engage in self-embedding behavior," said Dr. Shiels, also a clinical professor of Radiology, Pediatrics and Biomedical Engineering at The Ohio State University College of Medicine. "These fragile adolescents require aggressive and timely interdisciplinary assessment in addition to long-term therapy to help control their dangerous behavior."
- G. H. Bennett, W. E. Shiels, A. S. Young, N. Lofthouse, L. Mihalov. Self-Embedding Behavior: A New Primary Care Challenge. Pediatrics, 2011; DOI: 10.1542/peds.2010-2877
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