Intentional Foreign Body Ingestion: A Problem Across Age and Debility

Abstract: Intentional foreign body ingestion (FBI) refers to the consumption of inedible objects, typically intended as a means of self-harm or attention-seeking behavior. FBI occurs in a wide range of ages, intellectual levels, and psychiatric disorders. (Klein 2012).

Many unique obstacles are present in treating patients who engage in FBI. The primitive and regressive nature of these actions can cause crises of countertransference and empathy amongst treatment teams. Management of these patients in the hospital setting also becomes both emotionally and economically costly (Huang et al, 2010).

In our interactive workshop, we will specifically discuss the role of early development and early trauma in providing a psychodynamic framework for FBI. We will highlight specific challenges and relevant strategies in liaising with teams who are treating patients with FBI. Ethical and logistical controversies that arise in this population will be discussed across the gamut from the doctor patient dyad to the perspective of hospital administration. Finally, we will discuss two cases together in a small group, “Problem Based Learning” (PBL) environment, to further explore treatment challenges and strategies.

10 minutes: Elsa Thomas, a senior psychiatry resident, will present a challenging case of a young adult patient with FBI. Using interactive polling, she will survey the participants to see what decisions they would make in real time regarding treatment.

10 minutes: Shamik Mukherji, a CL psychiatrist, will briefly discuss the developmental and neurologic pathology of intentional FBI and differentiate it from other medical illness that involve foreign body swallowing. He will also review treatment options.

15 minutes: David Karol, a double boarded internal medicine and psychiatry physician, will discuss the difficulties that this patient population presents to hospital administration, primary services, and consulting services. He will also review ethical concepts that are at play.

15 minutes: Samuel Greenstein, a CL psychiatrist, will discuss the psychodynamic theory behind this patient population with a focus on the role of early development and attachment theory as it pertains to the patient as well as treating physicians.

10 minutes: Rory Rivendale, who is double boarded in psychiatry and family medicine, will discuss treating this patient population in both the inpatient CL and outpatient family medicine setting. She will specifically highlight the different objectives and treatment plans in these settings.

Small Group (PBL) Discussion - 15 minutes: We will breakout into small groups to discuss the management of two hypothetical FBI cases at different Eriksonian developmental stages. A worksheet will be provided that will help guide the small groups.

Questions, Answers, and Reflection - 15 minutes

References:

1. Klein, Carolina A. Intentional Ingestion and Insertion of Foreign Objects: A Forensic Perspective. Journal of the American Academy of Psychiatry and the Law Online Jan 2012, 40 (1) 119-126.

2. Huang, Brian L et al. “Intentional swallowing of foreign bodies is a recurrent and costly problem that rarely causes endoscopy complications.” Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association vol. 8,11 (2010): 941-6. doi:10.1016/j.cgh.2010.07.013

Content Contributors:

Diversity, Equity, and Inclusion: Patients with recurrent foreign body ingestion may be subject to certain unconscious biases from the providing teams. Our submission underscores the importance of recognizing certain developmental and attachment pathology that may help explain the behavior of this patient population which ultimately can enhance patient care and patient outcome.
Lastly, our speakers represent a wide range of training levels and clinical backgrounds which will promote a well-balanced and thorough approach to our discussion.