Deliberate Foreign Body Ingestion and Hopefulness Across Clinical Settings: An Under-Appreciated, but Significant, Non-Suicidal Self-Injury

Background: Deliberate Foreign Body Ingestion (DFBI) is a form of non-suicidal self-injury (NSSI). DFBI is a problem in longer-term care psychiatric facilities but is poorly detailed in clinical and general pediatric populations. Hopefulness is a construct that may prove useful in formulating diagnosis and treatment for youth with DFBI. Methods: Adolescents ages 11-18 years from an adolescent medicine clinic and a psychiatric inpatient unit were surveyed to estimate the prevalence and associated factors of DFBI in clinical settings. They were asked to anonymously complete a questionnaire focused on coping styles under stress that elicits basic demographics, positive and negative coping strategies, deliberate self-harm (DSH), and DFBI. Results: Survey completers, N=253 were ages 11-19 years; 229 responded to the question concerning DFBI. Prevalence of reported DFBI differed with statistical significance between the settings. Neither age nor a sense of hopefulness differed between the groups. All of the youth with DFBI reported being very or somewhat hopeful. Degree of hopefulness reported across the settings differed but for those with DFBI was not significantly different. A history of DSH was correlated with a statistically significant increased risk for DFBI. Conclusions: DFBI occurs frequently enough to warrant clinician inquiry especially in more restrictive settings in youth with histories of DSH; it should be considered within the NSSI DSM-V diagnostic classification. The sense of hopefulness in those endorsing DFBI and other NSSI should be more fully explored for its role in formulation and treatment planning.