QUESTION:
Dear Dr. Heller,
What exactly is self mutilation and what are some causes and effects of it? How could it be cured?
ANSWER:
In adults it's virtually always due to the BPD (borderline personality disorder).
Under stress borderlines experience a horrible neurological sensation called
"dysphoria" (anxiety, rage, depression and despair). Borderlines desperately try
to find ways for it to go away, and self-destructive behaviors such as binge eating, binge
spending and substance use are used because they temporarily work.
Some borderlines discover that scratching or cutting the skin in a linear manner
doesn't hurt, but stops the dysphoria. Interestingly all of us employ this technique
when we have an unbearable neurological sensation that responds to this treatment -
scratching insect bites.
The treatment is medication. Borderlines need to use medication that works in 10 minutes
(Haldol) rather than self-mutilating. Self mutilation causes fear in others and
borderlines recognize that it's not good for them. I share their belief that they
need relief, and that's what medication is for.
