Characteristics and Development of Nonsuicidal Super Self-Injury among Borderline Inpatients

Nonsuicidal self-injury (NSSI) is a key feature of borderline personality disorder (BPD), which is strongly associated with childhood traumatization. To the best of our knowledge, there has been a lack of studies investigating extensively the characteristics of borderline patients who engage in extremely high numbers of NSSI, and their features of NSSI, trauma history and psychopathology. The aim of this study is to identify groups of borderline inpatients on the basis of the lifetime number of NSSI, and to explore the characteristics of these groups regarding the onset, reasons and methods of NSSI, history of childhood traumatization, and severity of psychopathology.

80 psychiatric inpatients with BPD were included in the study, of whom 63 had a history of NSSI and 17 had not. The frequency and characteristics of NSSI were assessed by the Ottawa Self-Injury Inventory and the childhood traumatization were assessed by the Traumatic Antecedents Questionnaire and the Early Trauma Inventory.

In this study among self-injuring borderline inpatients a super self-injuring group was identified, who engaged in extremely high numbers of NSSI (75.0±28.4 acts/lifetime). Compared to moderate self-injurers, super self-injurers began harming themselves at a younger age (p=0.008), used more severe forms of NSSI, and all of them reported an anti-dissociation function of NSSI. Adverse childhood experiences were more prevalent in the super self-injuring group. The strongest predictors of the lifetime number of NSSI were early sexual abuse (p<0.001), intrafamilial physical abuse (p<0.001), a higher cumulative trauma score (p=0.030) and a greater number of BPD criteria (p<0.001).

Our results suggest that the frequency of NSSI in borderline inpatients can be seen as an indicator of clinically-relevant anamnestic data, namely, of the severity, complexity and onset of childhood traumatization, and of the severity of current borderline psychopathology.