title: Exploring the inner world of self-mutilating borderline patients: a Rorschach investigation.
abstract: Psychiatric patients who engage in self-destructive behavior by cutting, burning, or abrading their skin are currently one of the most difficult-to-treat groups in both inpatient and outpatient settings. The complexities of treating these patients, the risk factors associated with this symptom, and the rise in the prevalence of self-mutilation in America's adolescents and young adults provided the impetus for the current study. This article explores aspects of aggression, dependency, object relations, defensive structure, and psychic boundary integrity that may contribute to the genesis and maintenance of self-mutilation. Rorschach protocols from 90 borderline personality-disordered inpatients (48 self-mutilators and 42 non-self-mutilators) were scored using five psychoanalytic content scales. Results indicate that self-mutilating patients exhibit greater incidence of primary process aggression, severe boundary disturbance, pathological object representations, defensive idealization, devaluation, and splitting than did a matched group of non-self-mutilating borderline patients. Clinical theory and technical recommendations are considered in light of the current empirical findings.
authors.affiliation: Erik H. Erikson Institute for Education and Research, Austen Riggs Center, Stockbridge, Massachusetts 01262, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Fowler
authors.forename: M J
authors.initials: MJ
authors.lastname: Hilsenroth
authors.forename: E
authors.initials: E
authors.lastname: Nolan
mesh_terms: D000328:Adult; D001883:Borderline Personality Disorder / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D011594:Psychometrics; D012392:Rorschach Test / Q000706:statistics & numerical data; D012652:Self Mutilation / Q000175:diagnosis / Q000523:psychology*