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Inkorporation multipler Fremdkörper bei Borderlinepersönlichkeitsstörung

Literaturübersicht und Fallbeschreibung

Incorporation of multiple foreign bodies due to borderline personality disorder

Review of the literature and case report

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Zusammenfassung

Hintergrund

Selbst schädigende Verhaltensmuster stellen ein pathognomonisches Merkmal der Borderlinepersönlichkeitsstörung dar. Ein solches autoaggressives Verhalten kann in der Inkorporation von Fremdkörpern bestehen. Im Kopf-/Halsbereich führt dies zu primär oder sekundär entzündlichen Komplikationen mit sehr unterschiedlicher klinischer Manifestation. Diagnostik, Therapie und Verlauf eines solchen Falls werden im folgenden Bericht beschrieben und anhand einer Literaturauswertung kritisch diskutiert.

Fallbericht

Eine 24-jährige Patientin mit Borderlinepersönlichkeitsstörung stellte sich nach Auftreten einer infraaurikularen Schwellung in unserer Poliklinik vor. Nach antibiotischer Behandlung und persistierender Schwellung wurde eine lokale Revision mit Entfernung von 2 metallischen Fremdkörpern durchgeführt. Anschließende Röntgendiagnostik identifizierte multiple metallische Fremdkörper im Bereich des Kopfes, Halses und der Unterarme. Insgesamt 76 Fremdkörper wurden chirurgisch entfernt. Im postoperativen Verlauf inkorporierte die Patientin während der psychiatrischen Weiterbehandlung erneut Fremdkörper.

Diskussion

Der geschilderte Fall stellt eine nach Durchsicht der Literatur ungewöhnliche, für Borderlinepatienten aber charakteristische perkutane Fremdkörperinkorporation dar. Diagnostik und Therapie machen ein unterschiedlich aufwändiges Konzept notwendig, welches nur in enger Zusammenarbeit mit den behandelnden Psychiatern umgesetzt werden sollte. Sekundärer Krankheitsgewinn durch chirurgische Diagnostik und Therapie sowie die Wahrscheinlichkeit eines autoaggressiven Rezidivs müssen in die therapeutischen Überlegungen einbezogen werden.

Abstract

Background

Autoaggressive behaviour is one of the pathognomonic characteristics in patients with borderline personality disorder. Clinical symptoms of such behaviour can be the self-induced incorporation of foreign bodies. In the head and neck area, this form of autoaggressivity causes primary or secondary infectious complications with different clinical manifestations. Below follows a description of diagnosis, therapy and follow-up of such a case, comparing our own findings with the corresponding literature.

Case report

A 24-year-old woman with manifest borderline personality disorder was referred to the Department of Maxillofacial Surgery after developing a swelling in the infra-auricular region. After antibiotic therapy failed to reduce inflammatory symptoms, local revision was performed including excision of two metallic foreign bodies. Comprehensive radiological evaluation identified multiple foreign bodies in the head and neck region and lower arms. A total of 76 metallic foreign bodies was removed surgically. During early surgical follow-up and subsequent psychiatric treatment, the patient incorporated new foreign bodies.

Discussion

The case reported represents a pattern of foreign body incorporation which is unusual based on review of the literature but characteristic for patients with borderline personality disorder. Diagnostics and therapy require an individual concept which only can be implemented in close co-operation with psychiatrists. Secondary clinical benefit derived from surgical diagnostics and therapy as well as the possibility of autoaggressive relapse have to be taken into consideration.

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Authors and Affiliations

  1. Klinik für Kiefer- und Gesichtschirurgie, Universitätsklinikum Schleswig-Holstein/Campus Lübeck

    D. Hermes, K. K. Warnecke, D. Trübger, S. G. Hakim & P. Sieg

  2. Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Schleswig-Holstein/Campus Lübeck

    U. Schweiger

  3. Klinik für Kiefer- und Gesichtschirurgie, Universitätsklinikum Schleswig-Holstein/Campus Lübeck, Ratzeburger Allee 160, 23538 , Lübeck

    D. Hermes

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  1. D. Hermes
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  2. U. Schweiger
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Correspondence to D. Hermes.

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Hermes, D., Schweiger, U., Warnecke, K.K. et al. Inkorporation multipler Fremdkörper bei Borderlinepersönlichkeitsstörung. Mund Kiefer GesichtsChir 9, 53–58 (2005). https://doi.org/10.1007/s10006-004-0583-3

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