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Tijdschrift voor Psychiatrie 52 (2010) 5, 321 - 330

Review article

A psychodynamic approach to self-harm in patients with a borderline personality disorder

R. Ghijsens, B. Lowyck, R. Vermote

summary
background
Self-harm means deliberate tissue damage inflicted without suicidal intent. It occurs very frequently in patients with personality disorders, particularly in patients with a borderline personality disorder (bpd). Earlier psychodynamic theories were concerned with the symbolic meaning of this type of behaviour, e.g. self-inflicted punishment. More recent theories, however, focus on the role of self-harm in basic psychic functioning, such as affect regulation.
aim To demonstrate a more recent psychodynamic approach to the concept of self-harm and to outline the clinical implementation of this approach.
method The literature on self-harm was reviewed systematically, particular attention beingpaid to more recent psychodynamic models.
results Three dimensions of the psychic change are implemented in hospital-based treatment. Instead of the focus being on the symptoms, it is now on a broader psychotherapeutic process which aims at achieving a structural change in personality. The relation between the basic layer of this process and the therapeutic effect on self-harm in bpd is discussed.
conclusion The described approach to self-harm plays an important role in the psychodynamic treatment of patients with bpd. Current psychodynamic models of the treatment of bpd provide a theoretical background which can be implemented in the actual clinical treatment.

keywords borderline personality disorder, mentalisation, psychodynamic, self-harm