[Disturbed regulation of self-esteem in patients with overt versus covert self-destructive behaviour].
OBJECTIVE
According to psychoanalytic models self-harming patients are characterised by an unstable self-system and a disturbed regulation of self-esteem. This is presumed to be denied or dissociated to a greater degree by those who harm themselves secretly (factitious patients) as compared to those who show open self-harm. It is hypothesised and empirically tested that self-destructive patients have more profound disorders of narcissistic self-regulation than patients without self-destruction, and that this should be more evident in patients with overt self-destructive behaviour.


METHODS
The sample consists of 354 psychosomatic patients, 32 of whom demonstrated self-destructive behaviour (18 exclusively overt and 6 exclusively covert types of behaviour, according to Willenberg et al.). The narcissism inventory was applied.


RESULTS
Self-destructive patients showed higher levels on the "threatened self"-dimension than psychosomatic patients without self-harm. Overtly self-harming patients showed a higher degree of narcissistic self-regulation than covertly self-destructive patients.


CONCLUSIONS
This supports theoretical assumptions of a disturbed regulation of self-esteem in self-destructive patients, especially in overtly self-harming patients.
Medizinische Klinik mit Schwerpunkt Psychosomatik, Charité, Humboldt-Universität zu Berlin, Luisenstrasse 13 a, D-10117 Berlin. herbert.fliege@charite.de
Herbert
H
Fliege
Janine
J
Becker
Cora
C
Weber
Frank
F
Schoeneich
Burghard F
BF
Klapp
Matthias
M
Rose
D000293:Adolescent; D000328:Adult; D000368:Aged; D001604:Berlin; D005162:Factitious Disorders / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006778:Hospitals, Psychiatric; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D009289:Narcissism; D010555:Personality Inventory; D011602:Psychophysiologic Disorders / Q000175:diagnosis / Q000523:psychology*; D012649:Self Concept; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000523:psychology*; D012919:Social Behavior