Background: While guidelines exist regarding the surgical treatment of deliberate foreign body ingestion (DFBI), there is a paucity of research regarding its psychiatric management, particularly in patients with cluster B personality pathology. This review synthesizes and characterizes available literature on DFBI in patients with cluster B pathology and consolidates proposed management principles.

Methods: A systematic search identified case reports, case series, retrospective studies, and reviews describing DFBI in patients with cluster B pathology. Data from high-quality case reports were synthesized by diagnosis, treatment, and outcomes. Across retrospective studies, the prevalence of Borderline Personality Disorder (BPD) among patients with DFBI presentations was pooled. Management principles were synthesized narratively.

Results: 21 articles were included. Among retrospective studies, the prevalence of BPD among patients presenting for DFBI ranged from 23% to 63%. Among case studies ( n  = 15), the most common diagnoses were BPD and PTSD (73%). Nearly all cases reported psychiatric polypharmacy to address DFBI, including antipsychotics, mood stabilizers, and antidepressants. Subjective improvement in case studies was most commonly attributed to DBT, naltrexone, and ECT; however, no cases reported long-term resolution of DFBI. Collectively, the reviewed literature emphasized individualized management plans, cautious use of psychiatric hospitalization, continuous supervision during admissions, attention to staff countertransference, and early transition to supervised outpatient care, integrating a trauma-informed approach.

Conclusion: Specific psychiatric management of DFBI in patients with cluster B pathology remains largely guided by case studies. This review summarizes reported treatment efficacy and consolidates management principles to inform care for this challenging population.