Self-embedding

Self-embedding is the insertion of foreign objects either into soft tissues under the skin or into muscle. Self-embedding is typically considered deliberate self-harm, also known as nonsuicidal self-injury, which is defined as "deliberate, direct destruction of tissues without suicidal intent."

Self-embedding is the insertion of foreign objects either into soft tissues under the skin or into muscle. Self-embedding is typically considered deliberate self-harm, also known as nonsuicidal self-injury, which is defined as "deliberate, direct destruction of tissues without suicidal intent." ==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. The connection between self-embedding and suicidal ideation is unclear. Although most self-injurious behaviors are not associated with suicidal intentions, self-embedding has been found to be associated with suicidal ideation. A study found that suicidal ideation is the most commonly reported reason for self-embedding, however not all acts of self-embedding are accompanied with suicidal ideations. Additionally, most people that partake in self-embedding behavior report having previous suicidal attempts and suicidal ideations. Other distinctions between self-embedding and other self-injurious behaviors are that self-embedding is highly comorbid with behavioral health diagnoses and has a high prevalence of repetitive behavior. Self-embedding is similar to other forms of self-injury in that one of the purposes of engaging in the behavior is to relieve emotional distress by inflicting physical pain. with 27 inserted needles]] needles driven into the flesh by a psychiatric patient.]] ==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. They also report more symptoms of anxiety. Life stressors such as sexual abuse, witnessing family violence or experiencing a traumatic event have also been found to be associated with deliberate self-harm. The frequency and the presence of deliberate self-harm are correlated with the number of stressful life events adolescents report. Adolescents with a history of deliberate self-harm report more stressful life events and those with higher rates for these experiences were more likely to repetitively engage in the behavior. Empirical studies have identified risk factors and correlates for self-injurious behavior. Some of these factors include a history of childhood abuse, the presence of a mental disorder, poor verbal skills, and identifying with Goth subculture. 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. The lifetime prevalence rates of deliberate self-harm in adolescence ranges from 13%–56% in non-clinical community samples. Approximately 4% of the United States population and 13–23% of adolescents report a history of nonsuicidal self-injury. The most commonly used objects for insertion are long and thin such as sewing needles and paperclips. Also urethral insertion of foreign objects is more common in males than females with a 1.7:1 ratio. ==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. Mucosal tears are associated with multiple objects being inserted or with multiple attempts as well. In order to assess the size, location and number of foreign objects a radiological evaluation is needed. Symptoms for vaginal insertion are vaginal pain, discharge, bleeding, and foul odor, which can indicate infection. ==Treatment== ==Theory== ==References==

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