From the Chicago Tribune. In the picture, Dr. William E. Shiels II, chief of radiology at Nationwide Children's Hospital in Columbus, Ohio, shows an X-ray of a girl who has a straightened paper clip embedded in her arm.Researchers evaluating a new technique for locating and removing objects accidentally embedded in the body say they may have uncovered a new form of self-mutilating behavior in which teenagers intentionally insert objects into their flesh.
Personnel at Nationwide Children's Hospital in Columbus, Ohio, report extracting 52 foreign objects that 10 teenage girls deliberately embedded in their arms, hands, feet, ankles and necks over the last three years, including needles, staples, wood, stone, glass, pencil lead and a crayon.
One patient had inserted 11 objects, including an unfolded metal paper clip more than 6 inches long.The study, presented Wednesday at the annual meeting of the Radiological Society of North America in Chicago, is the first to report on this type of self-inflicted injury among teenagers, the researchers said. They call the behavior "self-embedding disorder."
Dr. William E. Shiels II, (pictured) the study's principal investigator and the hospital's chief of radiology, said that uncovering the behavior was unexpected but that researchers are now hearing about cases in other cities. The hospital recently set up a national registry to track incidents and conduct research.
Self-injury is a disturbing trend among teenagers, particularly girls. The size of the problem is unclear because many cases go unreported, but recent studies have reported that 13 to 24 percent of high school students in the U.S. and Canada have deliberately injured themselves at least once.
More common forms of self-injury include cutting of the skin, burning, bruising, hair pulling, breaking bones or swallowing toxic substances. In cases of self-embedding disorder, objects are used to puncture the skin or are forced into a wound after cutting.
At Linden Oaks Hospital at Edward, in Naperville, teens and young adults who injure themselves are treated through an outpatient program. At least two teens have disclosed instances of self-embedding, said Terry Ciszek, the hospital's director for outpatient services.
Both girls had intentionally inserted pencils under their skin and then broke off the lead to keep it lodged there. But Ciszek said he believes such cases are rare.
"In self-injury, if there is not an intervention, I do see an escalation in the amount, type and frequency of it," Ciszek said. "Self-injury is seen as a way to express emotion and sometimes to relive the trauma that might have taken place. We often see that the physical pain is an expression of and/or an avoidance of the emotional pain."
In the new study, the researchers set out to evaluate the use of minimally invasive, image-guided treatment to improve the removal of objects accidentally lodged in the body, such when a child steps on a shard of glass.
By using ultrasound, they sometimes detected the presence and precise location of objects that would not be visible on X-rays, such as wood, crayons and plastic. The researchers learned later that some of the items had been intentionally forced into the body.
"Radiologists are in a unique position to be the first to detect self-embedding disorder, make the appropriate diagnosis and mobilize the health-care system for early and effective intervention and treatment," Shiels said.
The objects were removed through small incisions in the skin.All the cases in the Ohio study involved girls living in foster homes, group homes or mental health facilities. Many had experienced or witnessed physical or sexual abuse, and most had been diagnosed with depression, anxiety or other mental health problems.
But until more information is gathered, it cannot be known if teens living outside the homes of their birth families are at higher risk for this behavior, said Dr. Jarrod M. Leffler, clinical psychologist at Nationwide Children's.
Dr. Elizabeth Berger, a spokeswoman for the American Academy of Child and
Adolescent Psychiatry, said parents should know that most teens do not injure themselves. But some teens might be at risk, and professionals who work with young people should be made aware of the study, she said.
"The take-home message would be that children who have it tough, carry psychological wounds and disability as the result," Berger said. "Tortured people internalize the torture."
