The Phenomenology of Self-Mutilation in a General Hospital Setting*

Simpson, Michael A.

doi:10.1177/070674377502000601

Cited by 95 publications

(66 citation statements)

References 13 publications

(14 reference statements)

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“…The following description is based on our clinical observation of over 200 patients meeting criteria for borderline personality disorder (in our specialised treatment programme) and concurs with descriptions already found in the literature [7,8].…”

Section: Clinical Descriptionsupporting

confidence: 80%

Why do patients meeting criteria for borderline personality disorder deliberately harm themselves? Some hypothesised neurobiological correlates

2004

Swiss Arch Neurol Psychiatr

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SummaryMcQuillan A. Why do patients meeting criteria for borderline personality disorder deliberately harm themselves? Some hypothesised neurobiological correlates. Schweiz Arch Neurol Psychiatr 2004; 155:212-6.The majority of patients meeting criteria for borderline personality disorder deliberately harm themselves at some time in their lives. This deliberate self-harm is nearly always subsequent to interpersonal loss. This paper postulates that the physiological arousal, which precedes deliberate self-harm, has a distinctive pattern specific to borderline personality disorder. The clinical manifestations are: baseline distress, followed by an environmental trigger factor (separation), which sets off an acute response of increasing distress, usually accompanied by ruminations.This develops into an intensely disagreeable subjective state, with simultaneous cutaneous anaesthesia or dissociative symptoms. It is this highly unpleasant state which is rapidly and very effectively relieved by soft tissue injury.In borderline personality disorder a dysfunctional stress response is hypothesised to underlie the acute subjective distress and the accompanying somatic symptoms that occur prior to deliberate self-harm. Central neuro-humoral mechanisms, via peripheral afferent stimulation as a result of soft tissue injury, are hypothesised to relieve the subjective tension by re-establishing homoeostasis. This paper examines the underlying biological aspects of separation distress and the mechanism by which it is relieved. In this sense separation distress is conceptualised in behavioural terms as the reaction to an environmental event. The psychological mechanisms of attachment and separation are not examined.Deliberate self-harm in borderline personality disorder may thus be understood as a coping mechanism, a potent means of overcoming unbearable subjective distress. A clearer understanding of the mechanisms of this behaviour may lead to more effective and compassionate treatments.

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Section: Clinical Descriptionsupporting

confidence: 80%

Why do patients meeting criteria for borderline personality disorder deliberately harm themselves? Some hypothesised neurobiological correlates

2004

Swiss Arch Neurol Psychiatr

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“…Dissociation has also been correlated with self-mutilation in the literature (Bach-y-Rita, 1974;Brodsky et al, 1995;Greenspan & Samuel, 1989;Pao, 1969;Simpson, 1975;Waltzer, 1968). Turell and Armsworth (submitted for publication) used the Dissociative Events Scale (DES) to measure current dissociation.…”

Section: Psychological Issuesmentioning

confidence: 93%

“…In addition, questions about memory loss, amnesia and difficulty in remembering periods of one's life solicited information about past dissociation, again consistent with previous research (Table 4). As a dissociative method, substance abuse has been associated with self-mutilation behavior by a number of investigators (Ensick, 1992;Kahan & Pattison, 1984;Pattison & Kahan, 1983;Simpson, 1975). The findings in Table 4 indicate that self-mutilators report more substance use/abuse.…”

Section: Psychological Issuesmentioning

confidence: 96%

Differentiating incest survivors who self-mutilate

Turell

Armsworth

2000

Child Abuse & Neglect

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Objective: This study was an exploratory analysis of the variables which differentiated incest survivors who self-mutilate from those who do not. Method: A sample of women incest survivors (N ϭ 84) were divided into two groups based on the presence or absence of self-mutilation. Participants included both community and clinical populations. A packet consisting of a demographic questionnaire, Sexual Attitudes Survey, Diagnostic Inventory of Personality and Symptoms, Dissociative Events Scale and the Beck Depression Inventory was completed by each participant. Results: Demographic, incest, and family of origin variables distinguished the self-mutilating women from those who did not. These include ethnicity and educational experiences; duration, frequency, and perpetrator characteristics regarding the incest; and multiple abuses, instability, birth order, and loss of mother in one's family of origin. Psychological and physical health concerns also differentiated between the two groups. Conclusions: Many variables may differentiate between women incest survivors who self-mutilate from those who do not. A rudimentary checklist to describe the lives of incest survivors who self-mutilate resulted from these findings. The importance of the concept of embodiment is also discussed.

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“…Smith & Fiddes (1955) 19 and Simpson (1975) 20 described suicidal stab wounds of the neck as rare, but Gee (1972) 21 has quoted that self-inflicted stab wounds of the neck were an acceptable mode of suicide in ancient Rome. West (1981) 22 , observed that the suicidal stab wounds are usually seen on areas of body overlying vital organs and he simultaneously concluded that certain sites of the body would be impossible targets for suicidal injury or self-inflicted injury i.e, back of chest, abdomen, buttocks etc.…”

Section: Accessibility Of the Part Injuredmentioning

confidence: 99%