title: Self-embedding behavior: a new primary care challenge.
abstract: OBJECTIVE
  The goal of this study was to define self-embedding behavior (SEB), develop a clinical profile of adolescents who engage in SEB, and emphasize the importance of rapid, targeted, and effective identification and intervention.
  
  
  METHODS
  As part of a retrospective study with a database evaluating 600 patients percutaneously treated for soft-tissue foreign body removal, adolescents were identified with self-embedded soft-tissue foreign bodies. We describe patients' gender, age, and psychiatric diagnoses; SEB age of onset, frequency, and self-reported reasons; and the number, type, location of, and removal technique for objects.
  
  
  RESULTS
  Eleven patients (9 females) who engaged in SEB were identified. Ten of the 11 patients were members of a group home or psychiatric facility at the time they engaged in SEB. All patients had previous and multiple psychiatric diagnoses. SEB mean age-of-onset was 16 years, and mean number of SEB episodes per patient was 1.9. The most common self-reported purpose for SEB was suicidal ideation (6 of 8 [75%]) versus nonsuicidal ideation (2 of 8 [25%]), with 3 cases lacking this documentation. The mean number of objects embedded in a single episode was 2.4, usually composed of metal and embedded in the arm. Seventy-six foreign bodies were percutaneously removed (using ultrasound or fluoroscopic guidance), including metal, glass, wood, plastic, graphite, and crayon.
  
  
  CONCLUSIONS
  SEB is an extreme form of self-injury requiring aggressive and timely interdisciplinary assessment and treatment. An understanding of SEB allows medical professionals to pursue rapid, targeted, and effective intervention to interrupt the cycle of self-harm and institute appropriate long-term therapy.
authors.affiliation: Department of Radiology, Nationwide Children's Hospital, Columbus, OH 43205, USA.
authors.forename: Gregory H
authors.initials: GH
authors.lastname: Bennett
authors.forename: William E
authors.initials: WE
authors.lastname: Shiels
authors.forename: Adam S
authors.initials: AS
authors.lastname: Young
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lofthouse
authors.forename: Leslie
authors.initials: L
authors.lastname: Mihalov
mesh_terms: D000293:Adolescent; D005260:Female; D005500:Follow-Up Studies; D005547:Foreign Bodies / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000379:methods*; D012189:Retrospective Studies; D016728:Self-Injurious Behavior / Q000517:prevention & control* / Q000523:psychology; D059020:Suicidal Ideation