Radiologists identify new self-embedding disorder plaguing teens

A new kind of self-mutilation is creeping into the teenage population, one that involves inserting objects into the body, according to radiologist Dr. William E. Shiels, II, who presented the first study of the adolescent phenomenon at the RSNA conference Wednesday.

Shiels, the chief of radiology at Nationwide Children's Hospital in Columbus, OH, calls it "self-embedding disorder." What sets it apart from other kinds of self-injury is the suicidal behavior he has noticed in 90% of the patients he has seen with it.

"The children who cut and bruise don't have the kind of severe behavioral health disorders that these patients do," he said.

Although there has been another case report involving six men with objects embedded in their eyes, Shiels said so far there has been nothing involving adolescents.

Shiels and his colleagues at Nationwide Children's Hospital have developed an image-guided method to remove the objects. They use ultrasound to locate the objects and excision techniques that minimize scarring to an average of ¼ inch, or about the size of a freckle, Shiels said.

A number of instances go unreported, he said, but radiologists are in a unique position to detect the problem before physicians or even parents discover it.

"The radiologist can take one look at an x-ray and realize what the diagnosis is, call the emergency physician, call the pediatrician, and immediately mobilize an interdisciplinary healthcare team to intervene in this patient's life and hopefully stop the cycle of self-harm," he said.

Shiels' team has so far removed 53 objects from nine of 10 patients in the study. All extractions so far have been successful, and only one included an episode of fragmentation. The 10th patient did not require treatment, he said.

The objects, mostly embedded in the arms, included staples, pencil graphite, and paper clips. Sizes ranged from 2 mm wide to 160 mm long.

"When these patients are trying to inflict pain, they feel the need to use 160 millimeters worth of pain in order to resolve their internal conflict," Shiels said.

Shiels said there was no racial or socioeconomic predictor in the disorder. But he noted at least one disturbing trend: 70% of them repeated the behavior after treatment, and almost three-fourths of those repeated with increased intensity.

To help combat the emergence of the disorder, Shiels said an interdisciplinary team should include not only radiologists, who remove the objects, but other doctors who can provide psychological treatment. They also began a web-based national registry last month to which physicians and hospitals can add cases of self-embedding disorder.

"The bottom line is, we now know what we're dealing with," Shiels said. "We have a name that we can put on this."