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Severe Self-Injury a Threat to Teens

Researchers Identify Self-Embedding Disorder Among Teenagers
WebMD Health News
Reviewed by Louise Chang, MD

Dec. 3, 2008 (Chicago) -- The angst of adolescence has propelled disturbed teens to graduate from self-cutting to a more severe form of self-injury in which they literally jam paper clips, stables, pencil lead, and other objects into their body, researchers say.

The first report ever on so-called self-embedding disorder "shows it is clearly worse than self-cutting: 90% [of victims] have suicidal ideations," says William E. Shiels II, DO, chief of radiology at Nationwide Children's Hospital in Columbus, Ohio.

"The stress of adolescence has reached the point that patients are looking for new ways to relieve pain and stress, with greater degrees of self-harm," he tells WebMD.

More common forms of self-injury include cutting the skin, burning or bruising the body, pulling hair, breaking bones, and swallowing toxic substances. In self-embedding disorder, objects are used to puncture the skin or are embedded into a wound after cutting, often causing swelling and inflammation.

No one knows how many teens engage in self-mutilation, but it's clear that the practice is common, especially among adolescent girls. Recent studies show that 13% to 24% of high school students in the U.S. and Canada have deliberately injured themselves at least once, according to Shiels.

He spoke at the annual meeting of the Radiological Society of North America.

Identifying Self-Embedding Disorder

The new study involved 19 episodes of self-embedding injury in nine adolescent girls ages 15 to 18. Together, they had jammed a total of 50 objects into their arms, two into their ankles and feet, and one into their hands. Among the embedded objects: metal needles, metal staples, metal paper clips, glass, wood, plastic, graphite (pencil lead), crayon, and stone.

Seventy percent suffered repeat episodes, with at least one girl injuring herself six times. One teen put seven different items in her arm at one time, including an unfolded metal paper clip more than 6 inches in length.

Using ultrasound guidance to pinpoint the exact location of the objects, the researchers inserted instruments through a one-quarter-inch incision in the skin and removed the objects.

"There was 100% successful removal," Shiels says, with minimal or no scarring and no cases of infection or other complications.

A common denominator among victims of self-embedding disorder is that they also suffer from other psychological disorders, Shiels says. Teens in the study had been diagnosed with depression, bipolar disorder, obsessive-compulsive disorder, attention deficit hyperactivity disorder, and posttraumatic stress disorder.

The key to preventing future episodes "is to interrupt the cycle," he says. "We, as parents, severely underestimate the pain of adolescence, particularly in girls. Parents need to recognize the problem and get their child into therapy quickly."

Donald Frush, MD, a radiologist and pediatrician at Duke University, adds, "If your child has inflammation and swelling due to a foreign body, and there's no clear reason, you might want to have a conversation with her doctor."

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