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Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care

BMJ 2017; 359 doi: (Published 18 October 2017) Cite this as: BMJ 2017;359:j4351

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Are New Forms of Adolescent Self-Harm Being Ignored?

Morgan et al highlight an important public health issue(1). However their methods potentially overlook and omit newer forms of self-harm in children and adolescents, notably foreign body insertion(2,3,4,5). This is also variously known as self-embedding and polyembolokoilamania. It is becoming increasingly common in the child and adolescent population; as evidenced by both a growing body of medical literature and increasing reference made to it, both in social and mainstream media (2,3,4,5). It is most frequently observed in adolescent girls (2,3,4); the cohort in which the authors observed the most precipitous rise in self-injury(1).

This behaviour remains slow to be recognised by the medical community notwithstanding the attention it has attracted in society at large(5). It possibly first crystallised in the medical consciousness as discrete phenomenon as recently as 2010(3), with isolated extreme case reports prior to this(2,3,4). NICE guidance on self-harm makes no mention of it; neither does the latest 2016 iteration of NICE Self-Harm Quality Standard algorithm, with both addressing only self-cutting amongst physical self-injurious behaviours(6). The coding paradigm used by the authors potentially excludes self-embedding behaviours(1). It is important however to appreciate that self-harm in children and adolescents is a dynamic and evolving phenomenon and does not encompass the same cluster of behaviours as a decade ago. Effort must be made to identify and attend to all those who engage in self-injurious behaviours and not only those who suffer the recognised and well-characterised modes of self-injury.

(1) Morgan C, Webb RT, Carr MJ, Kontopantelis E, Green J, Chew-Graham CA, Kapur N, Ashcroft DM. Incidence, clinical management, and mortality risk following self-harm among children and adolescents: cohort study in primary care. BMJ. 2017 Oct 18;359:j4351.
(2) Bennett GH, Shiels WE 2nd, Young AS, Lofthouse N, Mihalov L. Self-embedding behavior: a new primary care challenge. Pediatrics. 2011; 127:e1386-91
(3) Unruh BT, Nejad SH, Stern TW, Stern TA. Insertion of foreign bodies (polyembolokoilamania): underpinnings and management strategies. Prim Care Companion CNS Disord 2012;14(1).
(4) Young AS, Shiels WE 2nd, Murakami JW, Coley BD, Hogan MJ. Self-embedding behavior: radiologic management of self-inserted soft-tissue foreign bodies. Radiology. 2010 Oct;257(1):233
(5) Teens' Latest Self-Injury Fad: Self-Embedding Time Magazine:,8599,1865995,00.html

Competing interests: No competing interests

26 October 2017
Jagdeeva Mehet
Sanchez Franco LC, Sanchez Campoy A, Gascon Conde I, Uzoigwe CE,
London, UK