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For the past 70 years analysts have worked to comprehend the unconscious structures that are thought to be responsible for the development and maintenance of masochistic character formation (Bollas, 1992; Bonaparte, 1952; Deutsch, 1930; Doctors, 1981; Freud, 1923, 1924; Kernberg, 1984; Menninger, 1938; Reich, 1940; Smirnoff, 1969; Stolorow & Lachmann, 1980). Masochism, in the form of bodily self-destruction, negativism, and negative therapeutic reactions has consistently presented a perplexing theoretical problem, as well as a serious challenge to effective treatment of neurotic, borderline, and psychotic disorders (Freud, 1924; Joseph, 1982; Olinick, 1964; Riviere, 1936). Clinicians who treat severely disturbed borderline and narcissistic patients face similar theoretical complications in understanding and treating the underlying psychic disturbance of self-mutilation because the chaotic nature of the patient's inner world is played out in the transference through obscuring negative therapeutic reactions and masochistic transference impasses. Faced with such complexities and confusions in the consulting room, the potential clarity of a large-scale empirical study of self-mutilation seemed promising.
In an effort to empirically study the unconscious correlates of repetitive self-mutilation, my colleagues and I (Fowler, Hilsenroth, & Nolan, in press) devised a psychoanalytically based Rorschach study of potential differences between two groups of inpatients with a primary diagnosis of borderline personality disorder. The final sample of 90 psychiatric inpatients constituted two groups only by the fact that approximately half (n = 48) of the patients engaged in repetitive self-mutilation, while the remainder