What Is Self-Embedding Disorder?

Mary E. Muscari, PhD, CPNP, APRN-BC

Disclosures

November 02, 2010

Question

What is self-embedding, and how should I approach the adolescent who does this?

Response from Mary E. Muscari, PhD, CPNP, APRN-BC
Associate Professor, Decker School of Nursing, Binghamton University, Binghamton, New York; Pediatric Nurse Practitioner, Psychiatric Clinical Specialist, and Forensic Clinical Specialist, Sex Offender Assessment Board / Pennsylvania Board of Probation & Parole, Harrisburg, Pennsylvania

Self-Embedding

Self-embedding is an extreme form of self-injury, in which people (typically adolescents) insert objects into their body parts to deliberately hurt themselves or mutilate their bodies without intending suicide.

In a recent paper from Nationwide Children's Hospital, Columbus, Ohio, evaluating self-embedding behavior, researchers described 11 adolescent patients with a mean age of 16 years. Seventy-six foreign bodies were inserted into the arm (n = 69), neck (n = 4), ankle (n = 1), foot (n = 1), or hand (n = 1) in the 11 patients. The number of foreign bodies per case ranged from 1 to 15 and included metal, plastic, graphite, glass, wood, crayon, and stone.[1]

Self-embedding is a form of self-mutilation. Although it is a symptom of a larger underlying problem, it is often overlooked because it occurs in many diverse settings, is hidden or underreported by adolescents and parents, and is underdiagnosed in healthcare settings.[2]

Self-Mutilation in Adolescents

Little is known to date about self-embedding; however, the literature does address self-mutilation, also known as self-harm and cutting. The incidence of self-mutilation in adolescents has increased in recent years, with 1 survey of 8300 college students revealing that 17% engaged in self-harm.[3] Yet self-mutilation remains difficult to diagnose.[4] This problem is classified as an Impulse Control Disorder Not Otherwise Specified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revised (DSM-IV-TR,[5]) but may be symptomatic of other disorders, including borderline personality disorder. A comparison study of 44 adolescents who reported current self-cutting and an age- and sex-matched control group showed that the following disorders were more common among self-cutting girls than among controls[6]:

  • Major depressive disorder (63% vs 5%);

  • Anxiety disorders (37% vs 12%); and

  • Eating disorders (15% vs 0%).

Self-mutilation is viewed as a maladaptive form of self-relief from inner pain. Although not a suicidal behavior, it does come under the umbrella of deliberate self-harm (DSH), which includes suicide and parasuicide.[7]

DSH differs from suicide attempts in that the intent is not death but rather improvement of a distressing psychological state.[8]Self-injurious behaviors performed in response to delusions, hallucinations, or serious mental retardation are not considered forms of DSH.[9]

Common Triggers for Self-Mutilation

Regardless of the underlying disorder, teens who engage in DSH tend to do so in response to a trigger. Mangnall and Yurkovich[10] describe common triggers:

  • Tension and Anxiety: Although both depression and anxiety are found in persons who self-harm, anxiety and tension have a unique relationship with these behaviors. Self-cutters report more anxiety than those who engage in other forms of self-harm, although the relationship with self-embedding has not been established;

  • Hostility and Impulsivity: Adolescents may turn to self-harm because of their inability to express anger. They are easily angered, yet they experience self-dislike and guilt, which may result in their directing these feelings against themselves;

  • Feelings of Derealization and Depersonalization: Feelings of unreality or the lack of a feeling state are triggers for DSH. Cutting seems to end these states, returning the adolescent to a sense of "realness"; and

  • History of Childhood Trauma: In self-harmers with a history of childhood trauma, the behavior sometimes begins in childhood. When it does, it may be particularly malignant.

The most frequently reported form of self-injury is cutting of the subdermal tissue. Severity ranges from superficial cutting to long-term disfigurement. The consequences of self-embedding can be quite serious. Wounds can become infected, and this is worsened when foreign objects are inserted deep into the tissue. Infection can travel to bone or muscle, and further damage can be caused if the adolescent hits blood vessels, nerves, or tendons. An object can also break, form an embolism, and travel to a vital organ.[11,12]

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