title: Long-term and bizarre self-injurious behavior:  an approach to underlying psychological mechanisms and management.
abstract: Repeated self-harm usually presents with associated psychopathology, mostly in the form of obsessive-compulsive disorder, malingering, or personality disorders, and may persist for many years. This case presentation focuses on self-harm involving the deliberate ingestion of foreign bodies. This behavior remains poorly understood, and the relevant literature focuses almost entirely on gastroenterological and surgical management, with little or no discussion of underlying psychological mechanisms, psychopathology, or psychotherapeutic intervention. The goal of this article is to begin to fill that gap by presenting the case of a young woman who was diagnosed with borderline personality disorder and followed for 20 years, who repeatedly swallowed objects as a form of self-harming behavior. The nosological status and possible functions of this behavior are discussed, as are the difficulties of caring for patients with such long-standing, repeated selfinjury. This case illustrates how the boundaries between different self-injurious behaviors are blurred and also how different self-injurious behaviors are likely to share common patterns, functional integrity, and meanings. It should also serve to remind us how far we have to go in terms of understanding, classifying, and successfully treating certain patients who present with longterm and bizarre self-injurious behavior.
authors: Institut Clínic de Neurociències (ICN), Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain.
authors: Ricard
authors: R
authors: Navinés
authors: Fernando
authors: F
authors: Gutierrez
authors: Belen
authors: B
authors: Arranz
authors: Jose
authors: J
authors: Moreno-España
authors: María
authors: M
authors: Luisa Ímaz
authors: Victoria
authors: V
authors: Soler
authors: Mireia
authors: M
authors: Vázquez
authors: Juan
authors: J
authors: Carlos Pascual
authors: Rocío
authors: R
authors: Martín-Santos
authors: David A
authors: DA
authors: Kahn
mesh_terms: D000328:Adult; D005260:Female; D005547:Foreign Bodies / Q000209:etiology / Q000523:psychology; D006801:Humans; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D013406:Suicide, Attempted / Q000523:psychology