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

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.

To demonstrate a more recent psychodynamic approach to the concept of self-harm and to outline the clinical implementation of this approach.

The literature on self-harm was reviewed systematically, particular attention being paid to more recent psychodynamic models.

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.

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.