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Long-Term and Bizarre Self-Injurious Behavior: An Approach to Underlying Psychological Mechanisms and Management

NAVINÉS, RICARD MD, PhD; GUTIERREZ, FERNANDO PhD; ARRANZ, BELEN MD, PhD; MORENO-ESPAÑA, JOSE MD, PhD; LUISA ÍMAZ, MARÍA MD; SOLER, VICTORIA MD; VÁZQUEZ, MIREIA MD; CARLOS PASCUAL, JUAN MD, PhD; MARTÍN-SANTOS, ROCÍO MD, PhD; KAHN, DAVID A. MD

Journal of Psychiatric Practice: January 2013 - Volume 19 - Issue 1 - p 65–71
doi: 10.1097/01.pra.0000426329.34149.b6
Clinical Case Discussion

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. (Journal of Psychiatric Practice 2013;19:65–71)

NAVINÉS and IMAZ: Institut Clínic de Neurociències (ICN), Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain, and Parc de Salut Mar-IMIM, Barcelona; GUTIÉRREZ, MORENO-ESPAÑA, SOLER, and VÁZQUEZ: Institut Clínic de Neurociències (ICN), Hospital Clínic, IDIBAPS, CIBERSAM; ARRANZ: Parc Sanitari Sant Joan de Deu, CIBERSAM (Sant Boi de Llobregat), Barcelona; PASCUAL: Hospital de la Santa Creu i Sant Pau, CIBERSAM, Barcelona, and Parc de Salut Mar-IMIM; MARTÍN-SANTOS: Institut Clínic de Neurociències (ICN), Hospital Clínic, IDIBAPS, CIBERSAM, Parc de Salut Mar-IMIM, and University of Barcelona; KAHN: Columbia University College of Physicians and Surgeons, New York.

This work was supported in part by the Agency of University and Research Funding Management of the Catalonia Government (SGR2009/1435).

© 2013 Lippincott Williams & Wilkins, Inc.