Exploring the inner world of self-mutilating borderline patients: A Rorschach investigation

Psychiatric patients who engage in self-destructive behavior by cutting, bu rning, or abrading their skin are currently one of the most difficult-to-tr eat groups in both inpatient and outpatient settings. The complexities of t reating 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 explo res aspects of aggression, dependency, object relations, defensive structur e, and psychic boundary integrity that may contribute to the genesis and ma intenance of self-mutilation. Rorschach protocols from 90 borderline person ality-disordered inpatients (48 self-mutilators and 42 non-self-mutilators) were scored using five psychoanalytic content scales. Results indicate tha t self-mutilating patients exhibit greater incidence of primary process agg ression, 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.