Autistic and Dissociative Features in Eating Disorders and Self-Mutilation

This paper explores the meaning of self-harm behavior and the treatment of patients who engage in it. Vulnerable individuals can derive a feeling of power and omnipotence from cutting, burning, or starving themselves or engaging in bulimic purging or other self-harm. The case of a woman with a long history of self-mutilation is presented, in which autistic and dissociative elements are paramount. Like the autistic child who fears she is at the brink of falling into madness, the self-harmer throws herself into madness, merging the boundaries between self and other in a dedifferentiated, dissociated state. Inflicting pain and injury on oneself is a protective mechanism that can arise when one experiences the terror of feeling alone and helpless, at the mercy of predators. Having lacked the ability to develop transitional objects for self-soothing, self-harmers instead prey upon themselves with hard autistic objects, a perverse form of self-soothing. In comparing the dissociative and autistic features of self-harm, the paper raises questions about the relationship between autistic and dissociative processes and their relationship to psychoses.