Borderline Personality and Cutting

Borderline Personality and Cutting

Self-mutilation: A review.
Conn, Lois M.. and Lion, John R.
Psychiatric Medicine, Vol 1(1), Jan, 1983. pp. 21-33.

Discusses diagnostic groupings of self-mutilators as an aid to the clinician. Self-mutilation in anxiety (neurotic) and borderline personality disorders includes self-inflicted dermatoses and wrist-cutting. The more dramatic occurrences of self-harm are generally associated with psychotic, most often schizophrenic disorders. The self-mutilating behavior of psychotic patients differs markedly from that of neurotic individuals in that psychotic persons injure themselves in response to profound disorders of perception or thought and do not recognize the irrationality of their actions. They typically do not feel any pain. Self-mutilation in those with organic mental disorders, such as the mentally retarded, is a widespread problem. It is also seen in other neurological conditions such as Gilles de la Tourette syndrome. Self-mutilative acts associated with manipulative behavior in incarcerated populations are also discussed. Predictors of self-mutilation and treatment considerations are described. (71 ref)

Self-harm behaviors across the life cycle: A pilot study of inpatients with borderline personality disorder.
Sansone, Randy A.,
Comprehensive Psychiatry, Vol 43(3), May-Jun, 2002. pp. 215-218.

Explored, throughout the life cycle, the prevalence of self-harm behaviors among 18-60 yr old psychiatric inpatients with and without borderline personality disorder (BPD). 43 psychiatric inpatients with BPD were compared to 40 without BPD with regard to self-reported self-harm behaviors during their lifetime. The mean number of self-harm behaviors, including high-lethal behaviors (i.e., suicide attempts, cutting oneself, overdosing), among those with BPD dramatically increased between the ages of 18 and 24 yrs and was sustained through ages 50 to 59 yrs. Non-BPD patients showed a similar pattern, but the means were notably less. These data suggest that the behavioral ‘burn out’ theory of personality disorders does not necessarily occur among inpatients with BPD.

Identifying clinically distinct subgroups of self-injurers among young adults: A latent class analysis.
Klonsky, E. David, and Olino, Thomas M.
Journal of Consulting and Clinical Psychology, Vol 76(1), Feb, 2008. Suicide and Nonsuicidal Self-Injury. pp. 22-27.

High rates of nonsuicidal self-injury (NSSI; 14%-17%) in adolescents and young adults suggest that some self-injurers may exhibit more or different psychiatric problems than others. In the present study, the authors utilized a latent class analysis to identify clinically distinct subgroups of self-injurers. Participants were 205 young adults with a history of 1 or more NSSI behaviors. Latent classes were identified on the basis of method (e.g., cutting vs. biting vs. burning), descriptive features (e.g., self-injuring alone or with others), and functions (i.e., social vs. automatic). The analysis yielded 4 subgroups of self-injurers, which were then compared on measures of depression, anxiety, borderline personality disorder, and suicidality. Almost 80% of participants belonged to 1 of 2 latent classes characterized by fewer or less severe NSSI behaviors and fewer clinical symptoms. A 3rd class (11% of participants) performed a variety of NSSI behaviors, endorsed both social and automatic functions, and was characterized by high anxiety. A 4th class (11% of participants) cut themselves in private, in the service of automatic functions, and was characterized by high suicidality. Clinical and research implications are discussed.

Les conduites automutilatrices : Étude portant sur 30 patients.
Translated Title: Self-mutilating behaviour: A study on 30 inpatients.
Baguelin-Pinaud, A.,
L’Encéphale: Revue de psychiatrie clinique biologique et thérapeutique, Vol 35(6), Dec, 2009. pp. 538-543.

Introduction: Deliberate self-injury is defined as the intentional, direct injuring of body tissue without suicidal intent. There are different types of deliberate self-mutilating behavior: self cutting, phlebotomy, bites, burns, or ulcerations. Sometimes, especially among psychotic inpatients, eye, tongue, ear or genital self-mutilations have been reported. In fact, self-mutilation behavior raises nosological and psychopathological questions. A consensus on a precise definition is still pending. Many authors consider self-mutilating behavior as a distinct clinical syndrome, whereas others hold it to be a specific symptom of borderline personality disorder. Self-mutilating behavior has been observed in 10 to 15% of healthy children, especially between the age of 9 and 18 months. These self mutilations are considered as pathological after the age of 3. Such behavior is common among adolescents, with a higher proportion of females, and among psychiatric inpatients. Patients use different locations and methods for self-mutilation. Deliberate self harm syndrome is often associated with addictive behavior, suicide attempt, and personality disorder. Clinical material: We report on an observational study including 30 inpatients and we compared the data with the existing literature. As a matter of fact, until now, most of the papers deal with case reports or with very specific patterns of self-mutilation (eye, tongue or genital self-mutilations). Otherwise, papers report the relationships between self-mutilation and somatic or personality disorders (Lesh Nyhan syndrome, borderline personality disorder, dermatitis artefacta, self-mutilation in children following brachial plexus related to birth injury, mental retardation…). Our study included all self harmed patients who had been admitted to our psychiatric hospital (whatever the location and type of self-mutilation). Patients suffering from brain injury or mental retardation were excluded. Results: In our sample, there was a higher percentage of women (29 women and 1 man) and the mean age was 18 (12 to 37). More than half of the patients were aged under 18. Single parent families were reported in 30% of cases. Thirty percent of patients had been physically or sexually abused during childhood. Sixty percent had a comorbid psychiatric disorder, 63% had been hospitalised previously (half of them twice or more). Seventy-three percent of patients had previously attempted suicide (notably deliberate self-poisoning and cutting) that was not considered as self-mutilating behavior by the patients themselves. Each patient had self harmed themselves at least twice and most often different methods and locations were used (deliberate self harm of forearms 90%, thighs 26.7%, legs 16.7%, chest 10%, belly 10%, hands 6.9%, face 6.9%, arms 6.7%, and feet 3.3%). Addictive disorders, such as substance abuse (tobacco 46.7%; alcohol 23.3%; illicit drugs 16.7% mostly cannabis or cocaine) and eating disorders (33.3% and among them 50% of cases were restrictive anorexia nervosa) were often associated with a deliberate self harm syndrome. Three psychiatric diagnoses were often observed in our cohort: depressive disorder 36.7%; personality disorder 20%; psychosis 10% and depressive disorder associated with personality disorder 33.3%. In our sample, psychotic patients differed on several clinical aspects: the atypical location (abdomen, nails) and method (needles) of self-mutilating behavior. None of them had been abused during childhood and none was suffering from addictive disorders.

Nonsuicidal self-injury and suicide: Differences between those with and without borderline personality disorder.
Levine, Alina Z.,
Journal of Personality Disorders, Vol 34(1), Feb, 2020. pp. 131-144.

Nonsuicidal self-injury (NSSI) is associated with borderline personality disorder (BPD), but it also occurs in nonclinical samples (Briere & Gil, 1998), inflicting serious harm and serving as a precursor to suicide attempts (Klonsky, May, & Glenn, 2013). Therefore, the DSM-5 proposed a nonsuicidal self-injury disorder (NSSID) and suicidal behavior disorder. Because this addition requires reconciliation with current BPD criteria, the authors’ study evaluated type and frequency of NSSI and suicide attempts in 3,795 outpatients. Both were found in those without BPD, although the behaviors increased when some symptoms and full criteria for BPD were met. Wound/skin picking, scratching, and hitting were most common. Cutting was the fifth most common self-injury for those with BPD and the eighth most common for those without the disorder. Therefore, increased clinical attention is warranted for such self-injury, which may go unnoticed but indicate significant distress. Findings suggest that NSSID/suicidal behavior disorder may account for self-injury outside of BPD.