Aspiration of foreign bodies in adults with personality disorders: impact on diagnosis and recurrence

Abstract

Most cases of foreign-body aspiration are accidental events in children, whereas the majority of adults will have neurological dysfunction, trauma, alcohol abuse, or psychological disorders. Much has been written about psychiatric patients engaging in self-mutilation such as cutting and burning, but little is recorded about deliberate aspiration of objects in these patients, who clinically can be separated into 4 groups: (1) malingering, (2) psychosis, (3) pica, and (4) personality disorders. The immediate psychological gain for these patients is unclear, as the act is insidious with no evidence of intentional harm or immediate danger. Thus, they are considered as being parasuicidal events designed to diminish other psychological processes. Aspirated objects that are not immediately dislodged by coughing, choking, or gagging require surgical intervention. Most of these patients usually come to the attention of a psychiatrist, but such intervention does not prevent recurrences. We discuss a schizophrenic patient who aspirated multiple coins while under psychiatric treatment for prior episodes of aspiration of coins, ingestion of objects, and insertion of others in his urethra and rectum, while also reviewing some of the diagnostic and therapeutic challenges inherent in the management of these patients.