title: [A psychodynamic approach to self-harm in patients with a borderline personality disorder].
abstract: BACKGROUND
  Self-harm means deliberate tissue damage inflicted without suicidal intent. It occurs very frequently in patients with personality disorders, particularly in patients with a borderline personality disorder (BPD). Earlier psychodynamic theories were concerned with the symbolic meaning of this type of behaviour, e.g. self-inflicted punishment. More recent theories, however, focus on the role of self-harm in basic psychic functioning, such as affect regulation.
  
  
  OBJECTIVE
  To demonstrate a more recent psychodynamic approach to the concept of self-harm and to outline the clinical implementation of this approach.
  
  
  METHODS
  The literature on self-harm was reviewed systematically, particular attention being paid to more recent psychodynamic models.
  
  
  RESULTS
  Three dimensions of the psychic change are implemented in hospital-based treatment. Instead of the focus being on the symptoms, it is now on a broader psychotherapeutic process which aims at achieving a structural change in personality. The relation between the basic layer of this process and the therapeutic effect on self-harm in BPD is discussed.
  
  
  CONCLUSIONS
  The described approach to self-harm plays an important role in the psychodynamic treatment of patients with BPD. Current psychodynamic models of the treatment of BPD provide a theoretical background which can be implemented in the actual clinical treatment.
authors.affiliation: KLIPP, Universitair Psychiatrisch Centrum (UPC) KU Leuven, Kortenberg, België. Rudi.vermote@uc-kortenberg.be
authors.forename: R
authors.initials: R
authors.lastname: Ghijsens
authors.forename: B
authors.initials: B
authors.lastname: Lowyck
authors.forename: R
authors.initials: R
authors.lastname: Vermote
mesh_terms: D001883:Borderline Personality Disorder / Q000523:psychology* / Q000628:therapy; D006801:Humans; D011613:Psychotherapy; D012307:Risk Factors; D012652:Self Mutilation / Q000523:psychology* / Q000628:therapy; D012927:Social Control, Informal