Management of a Cluster of Foreign Body Ingestion Incidents in Patients with Borderline Personality Disorder

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. Coordination of patient care management involved intensive 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.