CHICAGO -- "Urethral polyembolokoilamania" may be symptomatic of a problem with impulse control, Sandra Antoniak, MD, said at the annual meeting of the American Academy of Psychiatry and the Law held here.
Antoniak, a psychiatrist in private practice in Kingston, N.Y., presented a poster of a case report Saturday of a 14-year-old male patient at a residential treatment facility in upstate New York. The patient had an intellectual disability and was behaviorally dysregulated.
Although the patient was referred to Antoniak for behavioral dysregulation, it was also apparent that he had a medical problem due to placing various cylindrical objects -- including pens, pins, straws, and other objects -- into his urethra. While uncommon, the behavior has been described often enough to acquire the 10-syllable label.
Although polyembolokoilamania is often classified as a paraphilia, "to me it seemed more like an impulse control disorder" in this case, she told MedPage Today in a phone interview.
"The concern was if he caused any more damage to himself he may require a catheter," Antoniak said.
This activity appeared to happen in response to life stressors, she said. "The issue that we found dynamically going on with him ... was that whenever they made two steps forward with his behavior, his self-abuse would go up. So whenever he was stressed about something else, this was a coping mechanism he employed to balance stress he was feeling."
Further inquiry into the patient's background revealed that the patient's mother had hit him in the genitals whenever he had an erection, "so he had the feeling of 'Whenever I have these feelings, it has to hurt,'" Antoniak said. "And this is a way he could probably hurt himself."
To treat the problem, staff members worked with the patient on coping skills and gave him something else to do with his hands. "It wasn't completely effectual; it took him a long time to be able to [make the substitution]," Antoniak said. "Also, when he was stressed enough, he would revert back to his old behavior."
Antoniak spoke with other staff members and found that "there were about five kids they could think of that had similar behaviors. I'm thinking this is a little more common than what we had expected."
Her patient has since been lost to follow-up; however, he has not had to come back to the treatment facility so that may be a good sign, she added.
Clinicians treating this type of behavior have to be aware of the subtleties involved, according to Antoniak. She described another patient at the facility who was taking apart toilets and "doing things with the tubing" similar to the first patient, but unlike the first patient, the second one was getting pleasure from it.
"So even within this same group of kids, they're not all homogenous," she said. "The treatment is the same, but for the second [patient], I would probably reach more for medications and less for therapy, because there's less to work with."
Antoniak noted that not only was the second patient being socially isolated by other residents because of his activities, facility staff members were also avoiding him. "That's one of things we as physicians" would have to deal with when treating such patients, she said.