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Foreign body ingestion (FBI) in mental disorders is a common and often highly challenging healthcare problem. While international guidelines exist for the acute gastroenterological care of adults with FBI, the data available in the psychiatric context is very limited in terms of both quantity and quality. FBI occurs in almost all mental disorders, but is probably most common in patients with borderline personality disorder. Sharp and pointed objects, particularly large (>2.5 cm in diameter) or long (>6 cm) objects, as well as batteries, especially button cells, but also magnets, are associated with the greatest risk of FBI-related complications. Nevertheless, approximately 80% of all ingested objects are excreted in the feces without complications after 5 to 6 days. Acute psychiatric care for FBI should include a medical history regarding the type and number of foreign bodies ingested, the time of ingestion, and a physical examination focusing on general condition, abdomen, respiratory system, and vital signs. Not every ingested object needs to be removed endoscopically, which is why knowledge of gastroenterological guideline recommendations is also necessary in a psychiatric setting. In cases of repeated FBI, interdisciplinary discussions should be held to address general and case-related aspects of acute care. Standards for communication and interaction between the team and the patient should be defined with the aim of avoiding reinforcement of the patient's dysfunctional behavior. In addition, supervision and intervision should be carried out. A clinical ethics committee should be involved in particularly complex cases. For ethical, medical, and liability reasons, it cannot be recommended to refrain from endoscopy in all cases of repeated FBI. In individual cases, however, after weighing the benefits and risks and reaching an interdisciplinary consensus, gastroscopy may be delayed or avoided in order to reduce dysfunctional reinforcement and the risk of adverse effects and complications. If disorder-specific psychotherapy (e.g., DBT, MBT) is not available or feasible, important elements of treatment include defining the further course of action in a therapy contract, conducting situation analyses, and contingency management. The aspects mentioned should be documented in an acute treatment plan that has been agreed upon by an interdisciplinary team and communicated to the patient.