According to a new study, radiologists, while using ultrasound technology and a minimally-invasive procedure, are able to successfully diagnose and treat patients who engage in a troubling self-harming behavior known as self-embedding.
Self-harm (or self-injury) is the general name used to describe a variety of disturbing behaviors in which a person intentionally causes harm to his or her body with no suicidal intent. It is a troubling trend among teenagers, and surprisingly, more common in girls.
The most common forms of self-injury include cutting oneself, bruising, burning, breaking bones, hair pulling, and the swallowing of toxic substances. Self-embedding–the focus of this study– takes the behavior of cutting a step further as the person will puncture the skin in order to insert a foreign object.
Sometimes these objects are left under the skin for years, and many of them have escaped detection during typical X-ray examinations. Ultrasound technology, however, is offering new hope for diagnosing and treating patients who self-embed.
“This is a new way for radiologists to impact public and mental health,” said William E. Shiels II, D.O., the study’s senior author, president of The Children’s Radiological Institute, and also chairman of the department of radiology at Nationwide Children’s Hospital in Columbus, Ohio.
“Radiologists can be in a position to interrupt a cycle of self-harm with effective, early diagnosis and referral for appropriate behavioral health and foreign body removal,” adds Dr. Shiels.
In this study, Dr. Shiels and his colleagues observed 21 episodes of self-embedding behavior in 11 teenagers, which included nine girls and two boys between the ages of 14 and 18. Objects had been present under the skin anywhere from two days to an unknown number of years.
Through ultrasound or fluoroscopic guidance, interventional pediatric radiologists were able to successfully remove 68 of the 76 embedded foreign objects found in many parts of the body including the arms, hands, neck, ankles, and feet. The patients had inserted a variety of materials—glass, plastic, metal, wood, graphite, crayon and stone—with wood, crayons and plastic objects being commonly undetectable during regular X-ray examinations.
One particular 18-year-old patient with repetitive behavior had self-embedded 35 objects over two years, including nail polish wands, staples, a comb tooth, a fork tine, and a cotter pin.
Removal of the items was performed through small incisions in the skin that left little or no scarring and was successful in all cases. There was one incident of fragmentation, but all fragments were removed.
“Early detection and removal of these foreign bodies are key steps for these teenagers to engage in effective therapy and interrupt their cycle of self-harm, so they can recover and grow as healthy and successful adults with good coping skills,” Dr. Shiels said.
Self-harm statistics aren’t exactly known because of the secrecy involved in this behavior and, as such, many cases go unreported. Recent studies, however, have shown that one in five high school students have taken part in some kind of deliberate self-harm at least once.
This study is published in the online edition and October print issue of the journal Radiology.