Self-harming behaviours which cause lead poisoning: including swallowing lead pellets or fishing sinkers

By Elizabeth O’Brien, Edited by Zac Gethin-Damon

As the Manager of the Global Lead Advice and Support Service (GLASS), I have learned over the last 22 years that when children (or adults who have pica or a low IQ or self-harming behaviours) handle ammunition, there is a risk that the ammunition will be held in the mouth and / or swallowed.

Since The LEAD Group’s information and referral service (call centre and email service) on all aspects of lead poisoning prevention and management began in 1991, several adult male callers and one female from Australia have asked me whether their habit of holding the lead pellets for air rifles in their mouth (usually when they were a child or a teenager), could possibly explain their lifelong or current symptoms of lead poisoning.

One 50 year old NSW man who presumably mis-typed his first name (in his email to me) as “ames”, wrote: “when i was 10 years of age i was suxing on a mouth full of air rifle lead pellets.”

A female caller reported: “7.92 hair lead in air rifle-using man with myelofibrosis (bone marrow disorder) and anaemia.” Did he, like some air rifle users, hold the leaded ammunition in his mouth, ready for re-loading, or because he liked the sweet taste of it? Could he have accidentally or purposefully swallowed a leaded air rifle pellet?

Another male caller reported: “I swallowed an air rifle pellet, plus I renovated, and my sickness remains undiagnosed.”

Another female caller asked: “Does lead cause spina bifida?” She asked because the mother of the child born with spina bifida had sucked air rifle slugs as a teenager. A little while later the same caller emailed a request for information on the treatment of lead poisoning.

The notion that it is not safe to put lead pellets in the mouth for fear of ingesting some of the lead or accidentally swallowing the whole slug is well-known to health professionals, but surprisingly not widely understood, even by professionals in non-medical fields. As an example, an architect who was fully aware of the need to only employ paint contractors with lead paint management training, for paint removal work on heritage buildings, asked me the question: “Is it ok for teenage children to be chewing on lead air rifle pellets?” I answered with an emphatic “No!”

Case study of self-harming behaviours involving lead poisoning

One 22 year old male caller was advised by a doctor from The LEAD Group’s Technical Advisory Board, to contact our telephone advice service in 2003. The caller may well have had a mental illness but he only reported to me that since he was 18 years old, he had blood lead levels which varied between the exceptionally high level of 82 micrograms per decilitre (µg/dL) four years ago, and 75.9 µg/dL a few months before the call, down to his current level of 28 µg/dL (the goal in Australia since 1993 for non occupationally exposed individuals is to have a blood lead level below 10 µg/dL). He told me that because he had been aggressive towards hospital staff, he was not permitted to return to one of his local hospitals. That’s why he had contacted the doctor who had advised him to call me. I spent a very long time during the call asking him about every conceivable source of lead to which he might have been exposed. Included in his answers was that he has never put metal objects in his mouth but that he suspected that there's an ongoing source (perhaps the waste treatment plant 3-4 kms away or the fact that he smoked about 10 cigarettes per day) and an intermittent source of lead. He also reported that his cadmium level was slightly elevated and he was told that that was probably due to the smoking.

He said he was put on dexamphetamines as a child for learning difficulties, and that after he went completely whacko, his girlfriend would no longer talk to him. He said his parents were away overseas at the time of the phone call so I immediately sent him an email offering to ask the doctor from The LEAD Group’s Technical Advisory Board to intercede and request that the state health department come to his home to assess where his lead might be coming from. I also asked him to ask his parents when they returned, whether he had had pica as a child, in other words, whether he might have eaten lead contaminated soil among other things. He also described how he goes days and days without eating, then eats a large amount of Hungry Jacks or McDonald’s.

Two months later, after his mother arrived back from overseas, I phoned her and she said that she believes her son “has some form of epilepsy and he tries to lead poison himself - he has periods of up to 9 hours when he doesn't know what he's doing. He has also burnt himself really badly in other epileptic turns. Apart from the lead stuff he hasn't tried to harm himself for two years.” When he got lead poisoned she went through his bedroom and found lead fishing sinkers there and she knows he got some lead fishing sinkers at his last workplace. He will not agree to psychological counselling and most of what she knows about him is second-hand. It could be that he doesn't actually remember that he ingested a fishing sinker if he did. Now that she is home she makes sure that there is nutritious food available for him.

Her daughter said the hospital wanted to run some tests to determine where the lead was coming from and her son chucked a fit and the hospital would not treat him, only because he refused to be tested.

When I was also contacted by his doctor, the doctor expressed his opinion that his patient may have purposefully ingested metallic lead, as a form of self-harming behaviour.

The message to take from this article is that lead’s potential as a tool for self-harm needs to be recognised. Recognising that lead can be used to self harm is particularly vital for those who are in a position to become aware of its health and behavioural impacts; i.e. doctors and medical professionals. If blood lead tests were part of the annual health check up for everyone, then these checks would bring to attention cases where lead is used to self-harm, (as well as cases where lead exposure from earlier in life is coming out of the bone stores and raising blood pressure, slowing reaction times and generally causing health problems which are not often correctly diagnosed as being caused by lead poisoning. Incorporating blood-lead tests would also outline the current prevalence of self-harm with lead and therefore allow for properly targeted preventive educational remedies for such behaviour.