Some Interpersonal Aspects of self-Mutilation in a Borderline Patient

To the limited extent to which they are identified in the literature, patients who mutilate their own bodies are most often described as adolescent or young adult unmarried women. Most of these young women are described as having in common early developmental difficulties in differentiating from a disturbed/ withdrawn mother (Graff and Mallin, 1967; Grunebaum and Klerman, 1967; Offer and Barglow, 1960). Frequently (e.g., Novotny, 1972; Pao, 1969), the cases reported on have not been psychotic (either clinically or on psychological tests), but conform most to the borderline category. They exhibit a striking paradox: they are neither deliberately suicidal nor overtly psychotic, and yet they cut.

Pao (1969) reports on the group of 27 such cases seen at Chestnut Lodge Sanitarium over a ten-year period and concludes that the cutting takes place in an altered ego state “in which patients give up interaction with the external environment by becoming self-engrossed, auto-erotic, and totally unrelated to contemporary objects and to enter a regressed ego state with surrendering of autonomous ego functioning to a drive-dominated act which was simultaneously sadistic and masochistic” (p. 198). Both Pao (1969) and Asch (1971) report clinical data documenting their inference that these patients suffer from extreme vulnerability to separation anxiety. Rosenthal et al. (1972), reporting from Mt.