Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-22T13:25:52.410Z Has data issue: false hasContentIssue false
  • English
  • Français

Personality Disorder and Self-wounding

Published online by Cambridge University Press:  02 January 2018

Digby Tantam  and
Jane Whittaker
Digby Tantam
Affiliation:
Department of Psychology and School of Postgraduate Medical Education, University of Warwick, Coventry CV4 7AL
Jane Whittaker
Affiliation:
Withington Hospital, Manchester M20 8LR
Get access Rights & Permissions [Opens in a new window]

Abstract

At least 1 in 600 adults wound themselves sufficiently to need hospital treatment. More men than women do it, although more women receive psychological treatment. Many have a history of sexual or physical abuse. Self-wounding differs from other self-harm in being aimed neither at mutilation nor at death. Self-wounding coerces others and relieves personal distress. Repeated self-wounding is one criterion of borderline personality disorder but we prefer to consider it an ‘addictive’ behaviour rather than an expression of a wider disorder. Psychological management may need to be augmented by drug or social treatment. Carers, including professional carers, usually need help to contain the turbulence that self-wounding produces.

Type
Review Article
Information
The British Journal of Psychiatry , Volume 161 , Issue 4 , October 1992 , pp. 451 - 464
Copyright
Copyright © 1992 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorder (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
Azrin, N., Gottlieb, L., Hughart, L., et al (1975) Eliminating self-injurious behavior by educative procedures. Behavior Research and Therapy, 13, 101–111.CrossRefGoogle ScholarPubMed
Bach-y-Rita, G. (1974) Habitual violence and self-mutilation. American Journal of Psychiatry, 131, 1018–1020.CrossRefGoogle ScholarPubMed
Beck, A., Stear, R., Karass, M., et al (1985) Hopelessness and eventual suicide: a 10–year prospective study of patients hospitalised with suicidal ideation. British Journal of Psychiatry, 142, 559–562.Google ScholarPubMed
Briere, J. & Zaidi, L. Y. (1989) Sexual abuse histories and sequelae in female psychiatric emergency room patients. American Journal of Psychiatry, 146, 1602–1606.Google ScholarPubMed
Buglass, D. & Horton, J. (1974) A scale for predicting subsequent suicidal behaviour. British Journal of Psychiatry, 124, 573–578.CrossRefGoogle ScholarPubMed
Burnham, R. C. (1969) Symposium on impulsive self-mutilation. British Journal of Medical Psychology, 42, 223–227.CrossRefGoogle Scholar
Carr, E. G. (1977) The motivation of self-injurious behaviour. Psychological Bulletin, 84, 800–816.CrossRefGoogle Scholar
Carroll, J., Schaffer, C., Spersley, J., et al (1980) Family experiences of self-mutilating patients. American Journal of Psychiatry, 137, 852–853.Google ScholarPubMed
Clendenin, W. W. & Murphy, G. E. (1971) ‘Wrist cutting’. Archives of General Psychiatry, 25, 465–469.CrossRefGoogle ScholarPubMed
Coccaro, E. F., Siever, L. J., Klar, H. M., et al (1989) Serotonergic studies in patients with affective and personality disorders. Correlates with suicidal and impulsive aggressive behaviour. Archives of General Psychiatry, 46, 587–599.CrossRefGoogle Scholar
Corter, H., Wolfson, A. & Locke, B. (1971) A comparison of procedures for eliminating self-injurious behaviour of retarded adolescents. Journal of Applied Behaviour Analysis, 4, 201–213.Google Scholar
Cowdry, R. & Gardner, D. (1988) Pharmacotherapy of borderline personality disorder. Archives of General Psychiatry, 45, 111–119.CrossRefGoogle ScholarPubMed
Crabtree, L. M. (1967) A psychotherapeutic encounter with a self-mutilating patient. Psychiatry, 30, 91–100.CrossRefGoogle ScholarPubMed
Crowley, T. J., Wagner, J. E., Zerbe, G., et al (1985) Naltrexone-induced dysphoria in former opioid addicts. American Journal of Psychiatry, 142, 1081–1084.Google ScholarPubMed
Dawson, D. (1988) Treatment of the borderline patient, relationship management. Canadian Journal of Psychiatry, 33, 370–374.CrossRefGoogle ScholarPubMed
Emerson, L. E. (1914) A preliminary report of psychoanalytic study and treatment of a case of self-mutilation. Psychoanalytic Review, 1, 42–52.Google Scholar
Evans-Wentz, R. (1968) The Tibetan Book of the Great Liberation. Oxford: Oxford University Press.Google Scholar
Favazza, A. (1987) Bodies Under Siege. Baltimore: Johns Hopkins University Press.Google Scholar
Favazza, A. (1989) Why patients mutilate themselves. Hospital and Community Psychiatry, 40, 137–145.Google ScholarPubMed
Favazza, A. & Conterio, K. (1989) Female habitual self-mutilators. Acta Psychiatrica Scandinavica, 79, 283–289.CrossRefGoogle ScholarPubMed
Feldman, M. D. (1988) The challenge of self mutilation, a review. Comprehensive Psychiatry, 29, 252–269.CrossRefGoogle ScholarPubMed
Fox, K. & Weissman, M. (1975) Suicide attempts and drugs: contradiction between method and intent. Social Psychiatry, 10, 31–38.CrossRefGoogle Scholar
Gardner, A. R. & Gardner, A. J. (1975) Self-mutilation, obsessionality and narcissism. British Journal of Psychiatry, 127, 127–132.CrossRefGoogle ScholarPubMed
Gardner, A. R. & Cowdry, R. (1986) Positive effects of carbamazepine on behavioral dyscontrol in borderline personality disorder. American Journal of Psychiatry, 143, 519–522.Google ScholarPubMed
Gossop, M., Cobb, J. & Connell, P. (1975) Self-destructive behaviour in oral and intravenous drug-dependent groups. British Journal of Psychiatry, 126, 266–269.CrossRefGoogle ScholarPubMed
Graff, H. & Mallin, R. (1967) The syndrome of the wrist cutter. American Journal of Psychiatry, 124, 36–42.CrossRefGoogle ScholarPubMed
Greenspan, G. S. & Samuel, S. E. (1989) Self cutting after rape. American Journal of Psychiatry, 146, 789–790.Google Scholar
Grunebaum, N. M. & Klerman, G. L. (1967) Wrist-slashing. American Journal of Psychiatry, 124, 527–534.CrossRefGoogle ScholarPubMed
Gupta, M. A., Gupta, A. K. & Haberman, H. F. (1986) Neurotic excoriations: a review and some new perspectives. Comprehensive Psychiatry, 27, 381–386.CrossRefGoogle ScholarPubMed
Hawton, K., Osborn, M., O'Grady, J., et al (1982) Classification of adolescents who take overdoses. British Journal of Psychiatry, 140, 124–131.CrossRefGoogle ScholarPubMed
Herman, J. L. (1989) Childhood trauma in borderline personality disorder. American Journal of Psychiatry, 146, 490–495.Google ScholarPubMed
Johnson, F., Frankel, B., Ferrence, R., et al (1975) Self-injury in London, Canada: a prospective study. Canadian Journal of Public Health, 66, 307–316.Google ScholarPubMed
Jones, I., Congiu, L., Stevenson, J., et al (1979) A biological approach to two forms of self-injury. Journal of Nervous and Mental Disease, 167, 74–78.CrossRefGoogle ScholarPubMed
Jones, F. H., Simmons, J. Q. & Frankel, F. (1974) An extinction procedure for eliminating self destructive behaviours in a 9-year-old autistic girl. Journal of Autism and Childhood Schizophrenia, 4, 241–250.CrossRefGoogle Scholar
Kafka, J. (1969) The body as a transitional object: a psychoanalytic study of a self-mutilating patient. British Journal of Medical Psychology, 42, 207–212.CrossRefGoogle ScholarPubMed
Kahan, J. & Pattison, E. (1984) Proposal for a distinctive diagnosis: the deliberate self-harm syndrome. Suicide and Life Threatening Behaviour, 14, 17–35.CrossRefGoogle ScholarPubMed
Kendall, P. C. & Braswell, L. (1984) Cognitive-Behavioural Therapy for Impulsive Children. New York: Academic Press.Google Scholar
Kernberg, O. (1987) A psychodynamic approach. Journal of Personality Disorders, 1, 344–346.CrossRefGoogle Scholar
Konicki, P. E. & Schulz, S. C. (1989) Rationale for clinical trials of opiate antagonists in treating patients with personality disorders and self-injurious behaviour. Psychopharmacology Bulletin, 25, 556–563.Google Scholar
Kraupl Taylor, F. (1969) Prokaletic measures derived from psychoanalytic techniques. British Journal of Psychiatry, 115, 407–419.CrossRefGoogle Scholar
Kreitman, N. (1990) Research issues in the epidemiological and public health aspects of parasuicide and suicide. In The Public Health Impact of Mental Disorder (eds D. Goldberg & D. Tantam), pp. 73–82. Stuttgart: Hogrefe and Huber.Google Scholar
Kreitman, N. & Casey, P. (1988) Repetition of parasuicide: an epidemiological and clinical study. British Journal of Psychiatry, 153, 792–800.CrossRefGoogle ScholarPubMed
Kwawer, J. (1980) Some interpersonal aspects of self-mutilation in a borderline patient. Journal of the American Academy of Psychoanalysis, 8, 203–216.Google Scholar
Lacey, J. H. & Evans, C. D. H. (1986) The impulsivist: a multi-impulsive personality disorder. British Journal of Addiction, 81, 641–649.CrossRefGoogle ScholarPubMed
Lansky, M. (1988) The subacute hospital treatment of the borderline patient – I: an educational component. Hillside Journal of Clinical Psychiatry, 10, 24–37.Google ScholarPubMed
Lemert, E. (1967) Human Deviance, Social Problems and Social Control. Englewood Cliffs, New Jersey: Prentice-Hall.Google Scholar
Lester, D. & Beck, A. (1980) What the suicide's choice of method signifies. Omega, 81, 271–277.Google Scholar
Lewis, G. & Appleby, L. (1988) Personality disorder: the patients psychiatrists dislike. British Journal of Psychiatry, 153, 44–49.CrossRefGoogle Scholar
Linehan, M., Camper, P., Chiles, J., et al (1987) Interpersonal problem solving and parasuicide. Cognitive Therapy and Research, 11, 1–12.CrossRefGoogle Scholar
Lion, J. R. & Conn, L. M. (1982) Self mutilation: pathology and treatment. Psychiatric Annals, 12, 782–787.CrossRefGoogle Scholar
Lovaas, O. I. & Simmons, J. Q. (1969) Manipulation of self destruction in three retarded children. Journal of Applied Behaviour Analysis, 2, 143–157.CrossRefGoogle ScholarPubMed
Lycacki, H., Josef, N. & Munetz, M. (1979) Stimulation and arousal in self-mutilators. American Journal of Psychiatry, 136, 1223–1224.Google Scholar
Main, T. F. (1957) The ailment. British Journal of Medical Psychology, 30, 129–145.CrossRefGoogle ScholarPubMed
Malan, D. & Berardi, D. (1987) Hypnosis with self-cutters. American Journal of Psychotherapy, 41, 531–541.CrossRefGoogle Scholar
Markovitz, P., Calabrese, J., Schulz, S., et al (1991) Fluoxetine in the treatment of borderline and schizotypal personality disorders. American Journal of Psychiatry, 148, 1064–1067.Google ScholarPubMed
Masson, J. M. (1985) The Assault on Truth: Freud's Suppression of the Seduction Theory. Harmondsworth: Penguin.Google Scholar
Menninger, K. A. (1935) A psychoanalytic study of the significance of self mutilations. Psychoanalytic Quarterly, 4, 408–466.CrossRefGoogle Scholar
Morgan, H. G. (1979) Death Wishes. Chichester: John Wiley.Google Scholar
Montgomery, S. & Montgomery, D. (1982) Pharmacological prevention of suicidal behaviour. Journal of Affective Disorders, 4, 291–298.CrossRefGoogle ScholarPubMed
Murphy, G. & Guze, S. (1960) Setting limits: the management of the manipulative patient. American Journal of Psychotherapy, 14, 30–47.CrossRefGoogle ScholarPubMed
Myers, E. (1988) Predicting repetition of deliberate self-harm: a review of the literature in the light of a current study. Acta Psychiatrica Scandinavica, 77, 314–319.CrossRefGoogle ScholarPubMed
Nelson, S. & Grunebaum, H. (1971) A follow-up study of wrist slashers. American Journal of Psychiatry, 127, 1345–1349.CrossRefGoogle ScholarPubMed
Novotny, P. (1972) Self-cutting. Bulletin of the Menninger Clinic, 36, 505–514.Google ScholarPubMed
Pao, P. (1969) The syndrome of delicate self-cutting. British Journal of Medical Psychology, 42, 195–206.CrossRefGoogle ScholarPubMed
Pattinson, E. M. & Kahan, J. (1983) The deliberate self-harm syndrome. American Journal of Psychiatry, 140, 867–872.Google Scholar
Pierce, D. (1977) Suicidal intent in self-injury. British Journal of Psychiatry, 130, 377–385.CrossRefGoogle ScholarPubMed
Podvoll, E. M. (1969) Self-mutilation within a hospital setting: a study of identity and social compliance. British Journal of Medical Psychology, 42, 213–221.CrossRefGoogle ScholarPubMed
Reilly, S. P. (1983) A Study of Self-Mutilation and Prognosis in Personality Disorder. MSc Thesis, University of Manchester.Google Scholar
Robinson, A. & Duffy, J. (1989) A comparison of self-injury and self-poisoning from the Regional Poisoning Treatment Centre, Edinburgh. Acta Psychiatrica Scandinavica, 80, 272–279.CrossRefGoogle ScholarPubMed
Rosen, F. M. & Walsh, B. W. (1989) Patterns of contagion in self mutilation epidemics. American Journal of Psychiatry, 146, 656–658.Google ScholarPubMed
Ross, R. R. & Mackay, H. B. (1979) Self Mutilation. Lexington: Lexington Books.Google Scholar
Ryle, A., Poynton, A. & Brockman, B. (1989) Cognitive Analytic Therapy. Chichester: John Wiley.Google Scholar
Salkovkis, P., Atha, C. & Storer, D. (1990) Cognitive-behavioural problem solving in the treatment of patients who repeatedly attempt suicide. A controlled trial. British Journal of Psychiatry, 157, 871–876.CrossRefGoogle Scholar
Shapiro, S. (1987) Self-mutilation and self-blame in incest victims. American Journal of Psychotherapy, 41, 46–54.CrossRefGoogle ScholarPubMed
Silver, D. (1985) Psychodynamics and psychotherapeutic management of self-destructive character-disordered patient. Psychiatric Clinics of North America, 8, 357–375.CrossRefGoogle ScholarPubMed
Simpson, M. A. (1976) Self-mutilation. British Journal of Hospital Medicine, 16, 430–438.Google Scholar
Sneddon, I. & Sneddon, J. (1975) Self-inflicted injury. A follow-up of 40 patients. British Medical Journal, iii, 527–530.CrossRefGoogle Scholar
Sneddon, I. (1988) Personality disorders. In Recent Advances in Clinical Psychiatry (ed. Granville-Grossman, K.). Edinburgh: Churchill Livingstone.Google Scholar
Sneddon, I. & Whittaker, J. (1992) Self-wounding and personality disorder. In Personality Disorders (eds P. Tyrer & G. Stein). London: Gaskell Press.Google Scholar
Vaernet, K. & Madsen, A. (1970) Stereotaxic amygdalotomy and basofrontal tractotomy in psychotics with aggressive behaviour. Journal of Neurology, Neurosurgery and Psychiatry, 33, 856–863.CrossRefGoogle ScholarPubMed
Van Egmond, M. & Jonker, D. (1988) Sexual abuse and physical assault: risk factors for recurrent suicidal behaviour in women. Tijdschraft die Psychiatrie, 30, 21–38.Google Scholar
Waldenberg, S. S. A. (1972) Wrist-Cutting: a Psychiatric Enquiry. M. Phil Dissertation, University of London.Google Scholar
Walsh, B. W. (1987) Adolescent Self-Mutilation: an Empirical Study. Unpublished doctorial dissertation. Boston College Graduate School of Social Work.Google Scholar
Walsh, B. W. & Rosen, P. M. (1988) Self-Mutilation: Theory, Research, and Treatment. New York: Guilford Press.Google Scholar
Weissman, M. M. (1975) Wrist-cutting. Archives of General Psychiatry, 32, 1166–1171.CrossRefGoogle ScholarPubMed
Winnicott, D. (1949) Hate in the counter-transference. International Journal of Psychoanalysis, 30, 69–74.Google Scholar
Wolf, M. M., Risley, T., Johnston, M., et al (1967) Application of operant conditioning procedures to the behaviour problems of an autistic child: a follow-up and extension. Behaviour Research and Therapy, 5, 103–111.CrossRefGoogle Scholar
Zanarini, M. C., Gunderson, J. G., Marino, M. F., et al (1989) Childhood experiences of borderline patients. Comprehensive Psychiatry, 30, 18–25.CrossRefGoogle ScholarPubMed
Submit a response

eLetters

No eLetters have been published for this article.