Is There a Rationale for Self-Injury?

Borderlines and Self-Injury

By: THEODORE MILLON and

      Seth Grossman

      Carrie Millon

      Sarah Meagher

      Rowena Ramnath

Most researchers make a distinction between self-injurious behavior and self-mutilation (Herpertz, 1995).

Self-injurious refers to moderate forms of self-inflicted bodily injury such as cutting, carving, and burning of the skin, as well as manipulative suicidal behavior. Such moderate forms of harm to self are characteristic of the borderline personality.

Self-mutilation is generally considered to be a wider category that includes self-injurious behavior and other forms of more severe self-harm, such as enucleation, castration, and amputation of body parts. These more severe forms are generally associated with schizophrenic disorders and, on occasion, psychotic breakdowns of transsexual subjects.

Although self-mutilating borderlines usually show more serious suicidal ideation and have more recent suicide attempts than non-mutilators (Soloff, Lis, Kelly, Cornelius, & Ulrich, 1994), self-injurious borderlines generally deny suicidal intent, and the wounds they inflict on themselves are not life threatening.

Research (Herpertz, 1995) suggests what may be a consistent set of characteristics. Self-injurious behavior occurs mostly in women, starting in early adulthood and peaking between the ages of 18 and 24. Frustrating external events and a buildup of overwhelming emotions—dysphoria, anger, despair, and anxiety—usually precede an episode of self-injurious behavior. The episode itself seems impulsive in nature and is usually followed by a quick release of tension; it is especially motivating in that most patients report a marked reduction in pain during the episode.

In fact, some researchers (Liebenluft, Gardner, & Cowdry, 1987) have found that half of self-injurious borderlines typically report feeling no pain during the episode. These “analgesic” patients appear to constitute a separate subcategory of self-injurious individuals who reinterpret painful sensations and are more prone to dissociative disorders (Russ et al., 1996).

What developmental factors might increase the likelihood of self-injurious behaviors?

Parental sexual abuse and emotional neglect during childhood, also related to the genesis of the borderline personality, are significantly related to self-injurious behaviors (Dubo, Zanarini, Lewis, & Williams, 1997). Moreover, self-injurious behavior seems to abate with age, just as borderlines tend to burn out with age.

Sadly, for some subjects, self-injurious behavior remains a lifelong practice. At an advanced age, it may include the same self-injurious behaviors along with sabotage of treatment, starvation, and poly-pharmacy (Wijeratne, Stern, & Howard, 1996).

References

Personality Disorders in Modern Life, second edition, 2000, 2004 by John Wiley & Sons, Inc.

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