A New Form of Self-Injury: Self-Embedding

by Katie Jeffries on November 18, 2009 at 10:48 am

It is estimated that 3 million people in the United States choose to deliberately cut, burn or cause pain to themselves. A new form of self-injury is taking the medical spotlight and WHIZ’s Katie Jeffries traveled to Columbus to speak with the nation’s foremost expert about this new fad.

Everyday items such as pencils, crayons or staples can be found in homes across the country. While these objects appear harmless, some teenagers are using them to take self-injury to the next level.

 This is a long paper clip she had unfolded and embedded under the skin and into the bicep muscle and this is a staple, four staple fragments, this is pencil led graphite fragments from a number two pencil under the skin,” says Dr. William Shiels, Chief of Radiology at Nationwide Children’s Hospital, as he explains an X-ray.

 A behavior now termed “Self-Embedding” was discovered by Dr. William Shiels and research intern Adam Young in 2005. Dr. Shiels says teenagers who self-embed put items under their skin to intentionally cause pain.

 “This is an incomplete act of self-injury that is very severe and yes it is much more severe than traditional forms of self-injury which are cutting and burning, which is rather commonplace in the adolescent population unfortunately,” tells Dr. Shiels.

 Dr. Shiels and his team of Interventional Radiologists have treated and studied 11 teenagers who repeatedly self-embed and found many similarities.

 “All of the children were in foster care, all the children lived outside their native homes, all the children had multiple behavioral abnormalities and diagnoses. Self-embedding centers around disorders like depression or anxiety disorder or ADHD.  These children have a more severe constallation of abnormalities and each child had at least two if not three or four more of the diagnoses," says Dr. Shiels. 

While self-embedding is rare, Dr. Shiels says in every city he has presented his findings, health care workers have said they have seen at least once case that could be self-embedding. To remove these items, Dr. Shiels and his team of Interventional Radiologists developed a technique called Ultrasound Guided Foreign Body Removal. After administering novocain to the patient, ultrasound equipment is used to locate items under the skin and then Dr. Shiels, or a member of his team, uses forceps to go into the muscle to remove the items. This technique leaves minimal scarring and Dr. Shiels teaches it to fellow doctors around the world.

 There are signs a parent or caregiver can look for to know if a child or teen may be self-embedding.

 “The best things to look for are injuries or wounds that don’t make sense. Children when they fall they don’t tend to fall and get wounds on the inside of their elbows or the inside of their forearm. So if they start seeing nicks and bruises and band aides in places they don’t have an explanation for, that is a tip-off,” explains Dr. Shiels.

 These children are by no means a lost cause. Dr. Shiels says with the help of a behavioral health team, there is no reason they cannot live a full and normal life.

 “It is a really a message of hope more than it is a message of morbid concern and the hope that indeed if we do intervene that we can indeed help these children learn coping skills that translate into living a healthy life as an adult,” tells Dr. Shiels.

 A representative from the Genesis Healthcare System says Muskingum County has not seen a case of self-embedding, yet.



Katie Jeffries