Some interpersonal aspects of self-mutilation in a borderline patient

Some interpersonal aspects of self-mutilation and vampiristic blood rituals in borderline states are discussed, as these were clarified in the therapeutic relationship established with a hospitalized young woman. The therapeutic stance during the period of inpatient treatment discussed emphasized consistent reinforcement of boundaries and limits in order to facilitate a mutual exploration of the interpersonal context in which her symptoms emerged. Blood rituals repeatedly expressed primitive identifications with intrusive, controlling, and sadistic aspects of a psychotic mothering figure. These were reflected in the treatment in her crazed, angry demands--through her symptoms--for a "caring" response from the therapist, whom she deliberately and vengefully assaulted through the medium of her own blood. Her manipulative and controlling efforts to maintain a human attachment highlighted her anxieties about separation and abandonment. In subsequent phases of the psychotherapeutic work, her relation to her own blood reflected struggles with womanhood and sexuality.