Recurrent Deliberate Foreign Body Ingestion: Psychiatric Comorbidities, Management Strategies, and Ethical Considerations

Abstract

PURPOSE OF REVIEW: Recurrent deliberate foreign body ingestion (DFBI) is a high-risk, resource-intensive behavior most often associated with underlying psychiatric conditions. Although medical and surgical complications are well documented, the psychiatric drivers and optimal management of DFBI are less well characterized. This review synthesizes current evidence on the epidemiology, psychiatric comorbidities, behavioral mechanisms, management strategies, and ethical challenges associated with DFBI [1, 2, 4, 6]. RECENT FINDINGS: Recent work highlights the roles of emotion dysregulation, personality pathology-particularly borderline personality disorder-and reinforcement mechanisms in perpetuating recurrent ingestion [1, 3, 10]. A small subset of individuals accounts for a disproportionate share of hospitalizations, underscoring the chronic and relapsing nature of this behavior and its substantial healthcare costs [1, 4]. Effective care requires coordinated multidisciplinary management that integrates medical stabilization with psychiatric treatment, including structured behavioral plans, consistent team-based responses, and attention to countertransference [2, 7]. Psychotherapeutic modalities, particularly dialectical behavior therapy and borderline personality disorder-informed models, are central to long-term management, while pharmacologic interventions primarily target comorbid conditions rather than ingestion [10-12]. Ethical considerations, including assessment of decision-making capacity, perceptions of futility, and resource allocation, further complicate care [13-15]. DFBI is a complex, recurrent behavior driven by diverse psychiatric, behavioral, and systemic factors. Effective management requires coordinated multidisciplinary care that integrates medical stabilization, psychiatric treatment, structured behavioral interventions, and ethical decision-making to reduce recurrence and improve outcomes.