Knives and razor blades aren't things that most people would dream of swallowing -- but some doctors see patients who do just that.
A new study out of Rhode Island Hospital looked at 33 adult patients who together were responsible for 305 instances of medical intervention because of intentionally consuming foreign objects -- most commonly pens, batteries, knives and razor blades.
The bizarre cases were as expensive as they were shocking; treating patients for the swallowed objects cost the hospital more than $2 million, for which most of the payment came from Medicare and Medicaid.
The results were published in the journal Clinical Gastroenterology and Hepatology.
"After some suspicion, we were able to document these incidences, and we've learned how to deal with this with a minimum amount of disruption," said Dr. Steven Moss, a gastroenterologist at Rhode Island Hospital and lead author of the study. Moss is also a professor of Medicine at Brown University.
For the average person, it is very difficult to understand why someone would want to ingest such risky materials.
Dr. Donald Malone, director of the Center for Behavioral Health at Cleveland Clinic, said the reasons are complicated. Sometimes, it can be blamed upon developmental delays, mental retardation or autistic spectrum disorders. Sometimes, the reason might be impulsive behaviors without the rational thought process that prevents most people from doing the same thing.
For others, the reason might be is self-injury. With that self-harm comes attention, and some people want that attention whether it is in a positive or negative form.
Regardless of the motive, Malone said, prevention is difficult.
"There's not a whole you can do," Malone said. "You can't tie somebody down 24 hours a day so they don't swallow or ingest things."
While the incidents can be dangerous, doctors say that, in most instances, patients are not trying to end their lives.
"In most cases, foreign body ingestion does not represent a frank suicide attempt," said a statement by Dr. Colin Harrington, a psychiatrist at Rhode Island Hospital and co-author of the study.
Dr. Pamela Cantor, a lecturer of Psychology at Cambridge Hospital's Department of Psychiatry, specifically treats children and teenagers with self-destructive and violent behaviors. She, too, is familiar with the cases of ingestion and said parents should not confuse them with suicide attempts.
"It is important to know the difference between suicidal behaviors and self-harm," said Cantor. "Suicidal behavior is one with intention to die or call attention to their pain. Self-injury is an attempt to reduce anxiety, or it could be used as an attempt to draw attention to their psychological pain."
About 11 percent of the patients in the study came from prisons, and nearly 80 percent of the patients suffered from psychiatric illnesses like mood disorders, anxiety, substance abuse and psychotic or impulsive disorders.
Fortunately, the majority of foreign objects can be retrieved successfully through endoscopic extraction, in which a special camera snakes down the patient's esophagus or stomach and removes the foreign object.