Clinical Images  |   November 2017
Self-inflicted Abdominal Trauma
Author Notes
  • From the Department of Psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, Pennsylvania. Dr Faden is a second-year resident. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Justin Faden DO, Lewis Katz School of Medicine at Temple University, 100 E Lehigh Ave, Ste 305B, Philadelphia, PA 19125-1012. E-mail:
Article Information
Emergency Medicine / Imaging / Clinical Images
Clinical Images   |   November 2017
Self-inflicted Abdominal Trauma
The Journal of the American Osteopathic Association, November 2017, Vol. 117, 724. doi:
The Journal of the American Osteopathic Association, November 2017, Vol. 117, 724. doi:
A 52-year-old woman with a history of borderline personality disorder was admitted to the inpatient psychiatric unit for attempted suicide by insulin overdose. She had been admitted 1 month previously for 2 weeks with a self-inflicted abdominal stab wound using a crochet needle, necessitating surgical repair (image A). When she was admitted after the suicide attempt, repetitive, self-inflicted abdominal wounds using her bare hands, crayons, and the teeth of a comb delayed healing. The day before she was scheduled to be discharged, the patient inserted a purple crayon into her wound because she did not want to leave the hospital (image B). This pathologic behavior characterizes aspects of factitious disorder, in which the patient is motivated to produce or feign symptoms in efforts to obtain sympathy and attention from the caregiver.1 
Patients with borderline personality disorder often display a pervasive pattern of unstable interpersonal relationships, identity, and affect, as well as impulsivity, self-injurious behavior, and fear of abandonment.1 In patients with borderline personality disorder and factitious disorder, the motive for self-injurious behavior may not be readily apparent.2 
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association Publishing; 2013.
Roden-Foreman JW, Warren AM, Reynolds M, Foreman ML. Recurrent hospitalization for self-injuries and suicide attempts: case study of a super-utilizer. Proc (Bayl Univ Med Cent). 2015;28(3):331-333. [PubMed]