Self-embedding

Controversy

Based on the review of the literature it is unclear whether self-embedding falls under the definition of deliberate self-harm. Some studies include self-embedding as a deliberate self-harm behavior while others exclude it. Most definitions of deliberate self-harm include the stipulation that the behavior is performed without conscious suicidal intent.{{Cite journal

History

One of the first reported cases of self-embedding was in 1936 when Albert Fish, a serial killer and cannibal, was caught and executed. An X-ray of his pelvis revealed about 27–29 needles inserted into his groin; the image was used as evidence at his trial. He also embedded needles into his abdomen. In 1986 Gould and Pyle described self-embedding behavior in their book Anomalies and Curiosities of Medicine. They included reports of adult European women with hysteria who self-embedded by inserting needles into their body. In 2010 a study by Young et al. was one of the first to describe self-embedding in an adolescent population.

Epidemiology

The majority of people who engage in self-embedding are white teenage females with psychiatric diagnoses. Self-embedding has a high comorbidity with other psychological disorders such as post-traumatic stress disorder, dissociative disorder, and borderline personality disorder. Additionally, deliberate self-harm is associated with externalizing pathology such as oppositional defiant disorder and conduct disorder. Adolescents who self-injure have higher mean depression scores and report more depressive symptoms than adolescents who do not self-injure.{{Cite journal

The mean age for nonsuicidal self-injury is 13–15 years and for suicidal self-injury is 15–17 years of age. About 2% of inmates each year engage in self-injurious behavior, which includes the insertion of foreign objects into the body.{{Cite journal

Symptoms

In order to assess self-embedding different aspects of the behavior must be examined such as the type of object used, the site of insertion, the number of objects inserted, the motivation behind the behavior and if the patient has other psychiatric diagnoses. The most common symptoms for epithelial insertion of foreign objects are infection, abscess formation, or sepsis at the site of insertion. Symptoms of urethral insertion include frequent urination, painful urination, and blood in urination. Urethral stricture can occur with multiple attempts to insert an object into the urethra.{{Cite journal

Treatment

Image guided foreign body removal (IGFBR)

To treat urethral insertion of foreign objects endoscopic retrieval is utilized and an antibiotic is given. If there is an infection or abscess formation at the site of insertion, surgical removal of the object is necessary. If a patient has multiple objects inserted in a certain area surgical removal is recommended unless the risks of surgery outweigh the benefits. Percutaneous image guided foreign body removal (IGFBR) is another less invasive option for removing foreign bodies that leaves minimal scarring. Multiple studies have found IGFBR as a safe and effective technique for the removal of foreign bodies.{{Cite journal

Psychological treatments

Problem-Solving Therapy and Dialectical Behavior Therapy are two empirically supported Cognitive Behavioral Therapies for non-suicidal self-injurious behavior. Problem-Solving Therapy (PST) teaches clients problem-solving skills and general coping strategies so that they can more effectively deal with future problems. Additionally, clients learn to identify and resolve the problems they encounter. The findings for the effectiveness of PST in reducing non-suicidal self-injury have been mixed. Some studies have found that PST has reduced suicidal behaviors compared to usual treatments however maintenance beyond one year was not found.

Dialectical Behavior Therapy (DBT) aims to teach clients general coping skills and address any motivational obstacles to treatment. Therapy includes validating the client's experience and working with the client on problem-solving skills and behavioral skills such as emotional regulation. DBT has been used to treat both suicidal behaviors and non-suicidal self-injurious behaviors. DBT has been shown to reduce self-injurious behaviors in multiple studies.

Theory

The Experiential Avoidance Model (EAM)

According to this model, the maintenance of deliberate self-harm behavior is due to negative reinforcement. Deliberate self-harm is reinforced because it prevents or takes away negative emotional experiences. The experiential avoidance model was developed to account for deliberate self-harm for various populations not just ones with psychopathology. Experiential avoidance behaviors are those that “function to avoid or escape from unwanted internal experiences." The mechanism for this model involves an individual experiencing an event that evokes an aversive emotional response, which causes the individual to want to escape from that unpleasant emotional state. The individual engages in deliberate self-harm, which reduces or gets rid of the aversive emotional response. This behavior is then negatively enforced. Many studies have found that 80–94% of people report feeling better after engaging in deliberate self-harm, with relief being the most reported.{{Cite journal

The EAM provides multiple hypotheses for how deliberate self-harm provides an emotional escape. The opioid hypothesis explains that deliberate self-harm elicits endogenous opioids, which leads to analgesia and relief of emotional distress. Studies have found elevated levels of opioid peptides in people who engage in deliberate self-harm{{Cite journal | doi-access = free

Nock's Theoretical Model

Based on his review on the literature on self-injury, Matthew Nock, developed a theoretical model on the development and maintenance of self-injury. According to Nock's model self-injury is performed repeatedly because it is an immediate effective way of influencing one's social environment and regulating one's emotional and cognitive experience. Additionally, factors that contribute to problems in regulating one's affective and cognitive state and influencing one's social environment such as poor social skills lead to an increased risk of self-injury. These general risk factors also increase the likelihood of engaging in other maladaptive behaviors such as alcohol or substance abuse.

This model follows a functional perspective in which behaviors are caused by the events that immediately precede and follow them. Four types of reinforcement processes can maintain self-injury: intrapersonal negative reinforcement, intrapersonal positive reinforcement, interpersonal positive reinforcement, and interpersonal negative reinforcement. Intrapersonal negative reinforcement refers to self-injury being followed by a decrease or stop of aversive thoughts or feelings. Intrapersonal positive reinforcement involves self-injury being followed by an increase in desired thoughts or feelings such as a feeling of satisfaction. Interpersonal positive reinforcement occurs when self-injury is followed by a desired social event such as attention or support. Finally, interpersonal negative reinforcement occurs when self-injury is followed by a decrease or stop of a social event. Many studies investigating the motives reported for engaging in self-injury provide evidence for this four-function model.

References

References

1. (2011). "Self-Embedding Behavior: A New Primary Care Challenge". Pediatrics.
2. (2005). "Nonsuicidal Self-Harm Among Community Adolescents: Understanding the "Whats" and "Whys" of Self-Harm". Journal of Youth and Adolescence.
3. ''Murder Cases of the Twentieth Century – Biographies and Bibliographies of 280 Convicted or Accused Killers'', David K. Frasier, McFarland & Company (Publisher), Copyright September, 1996
4. "Albert Fish". Crime Library. Archived from the original on 16 December 2008. Retrieved 2008-12-16
5. (2010). "Self-Injury". Annual Review of Clinical Psychology.
6. (2008). "Deliberate self-harm by insertion of foreign bodies into the forearm". Journal of Plastic, Reconstructive & Aesthetic Surgery.
7. (2007). "Soft Tissue Foreign Bodies: Sonographic Diagnosis and Therapeutic Management". Ultrasound Clinics.
8. (2002). "Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder". Journal of Abnormal Psychology.
9. (2007). "Characteristics and functions of non-suicidal self-injury in a community sample of adolescents". Psychological Medicine.