title: Self-Embedding Behavior in Adults: A Report of Two Cases and a Systematic Review.
abstract: Self-embedding behavior (SEB) is the repeated insertion of sharp objects, such as needles or pins, into the soft tissues of abdomen, limbs, and other body parts. In this study, two cases of SEB were reported and the scientific worldwide literature reviewed. Thirty-two cases of SEB were identified through systematic searches in the main bibliographic databases. Mean age was 35 years (SD = 8.97). Just over two-thirds of the patients were female. Although the number of embedded objects could be as high as 200, major clinical and surgical complications were uncommon and mortality was null. Patients with SEB presented three major diagnoses: psychotic (25%), personality (21.9%), and factitious (28.1%) disorders. The practice of SEB largely went undetected as the patients themselves did not bring it to the attention of family members or physicians and usually denied they have engaged in SEB. A high level of suspicion is required to avoid a missed diagnosis.
authors.affiliation: Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.|Centro Psiquiátrico do Rio de Janeiro (CPRJ), Praça Coronel Assunção, SN, Rio de Janeiro, RJ, Brazil.
authors.forename: Victor S
authors.initials: VS
authors.lastname: Mannarino
authors.affiliation: Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.
authors.forename: Débora C S
authors.initials: DCS
authors.lastname: Pereira
authors.affiliation: Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.|Centro Psiquiátrico do Rio de Janeiro (CPRJ), Praça Coronel Assunção, SN, Rio de Janeiro, RJ, Brazil.
authors.forename: Wagner S
authors.initials: WS
authors.lastname: Gurgel
authors.affiliation: Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.|Centro Psiquiátrico do Rio de Janeiro (CPRJ), Praça Coronel Assunção, SN, Rio de Janeiro, RJ, Brazil.
authors.forename: Carolina B F
authors.initials: CBF
authors.lastname: Costa
authors.affiliation: Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.|Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Rua Marquês do Paraná, 303 - 3° andar do Prédio Anexo, Niterói, RJ, Brazil.
authors.forename: Alexandre M
authors.initials: AM
authors.lastname: Valença
authors.affiliation: Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.|Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Rua Marquês do Paraná, 303 - 3° andar do Prédio Anexo, Niterói, RJ, Brazil.|D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro, 30, Rio de Janeiro, RJ, Brazil.|School of Psychological Sciences & Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, 3800, Australia.
authors.forename: Leonardo F
authors.initials: LF
authors.lastname: Fontenelle
authors.affiliation: Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.|Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Rua Marquês do Paraná, 303 - 3° andar do Prédio Anexo, Niterói, RJ, Brazil.
authors.forename: Mauro V
authors.initials: MV
authors.lastname: Mendlowicz
mesh_terms: D001883:Borderline Personality Disorder / Q000175:diagnosis / Q000523:psychology; D005260:Female; D005547:Foreign Bodies / Q000000981:diagnostic imaging / Q000523:psychology*; D005555:Forensic Psychiatry; D006801:Humans; D009110:Munchausen Syndrome / Q000175:diagnosis / Q000523:psychology; D016728:Self-Injurious Behavior / Q000523:psychology*; D014951:Wounds, Stab / Q000523:psychology*; D055815:Young Adult
keywords: deliberate self-harm; factitious disorders; forensic psychiatry; forensic science; personality disorders; self-injurious behavior