KMID : 0385320210320010011
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Journal of Korean Psychoanalytic Society 2021 Volume.32 No. 1 p.11 ~ p.20
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Psychodynamic Understanding of Repetitive Self-Mutilation
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Hong Su-Min
Ha Jee-Hyun
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Abstract
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Repetitive self-mutilation or non-suicidal self-injury (NSSI) refers to the intentional destruction of one¡¯s own body tissue without suicidal intent and for purposes not socially sanctioned. Common examples include cutting, scratching, and hitting. Although NSSI generally has been considered a characteristic symptom of borderline personality disorder, its onset and prevalence typically occur in mid-adolescence, whereas the typical onset of borderline personality disorder is in early adulthood. Therefore, NSSI should be considered separately from borderline personality, but also from a psychodynamic perspective. From the classical psychoanalytic viewpoint, self-mutilation is associated with the failure to control aggressive drives. In ego psychology, self-mutilation is seen as an attempt of the fragile ego to re-establish boundaries with the external environment and avoid being overcome with uncontrollable emotions. In object-relation theory, it is seen as an effort to reconstruct unclear boundaries between ego and object or ego and reality by cutting the skin-the fundamental separation between them. Self-mutilation- can interfere with the psy?chotherapy by increasing or decreasing transference or causing strong countertransference. The therapist might experience helplessness or anger at repetitive self-mutilations and, with an adolescent patient, might be conflicted about telling the facts to parents or maintaining the patient¡¯s confidentiality. In conclusion, consideration of various psychodynamic aspects is important in understanding and treating patients with NSSI.
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KEYWORD
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Self mutilation, Self-injurious behavior, Psychotherapy, Psychodynamic
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