The meaning of self-injury and overdosing amongst women fulfilling the diagnostic criteria for 'borderline personality disorder'

Abstract

Objectives: To explore the meanings of self-injury and overdosing, and the relationship of each to the other, for women who have fulfilled the diagnostic criteria for borderline personality disorder.

Design: Four women with a history of both self-injury and overdosing were recruited through a local psychotherapy service and interviewed following a semi-structured framework.

Methods: The interview transcripts were systematically analysed utilizing interpretative phenomenological analysis.

Results: The analysis lead to the construction of three interrelated themes: (a) The context of distress. Examples were inclusive of temporally distal factors such as childhood abuse and loss, and proximal factors ranging from the interpersonal (e.g., conflict) through to the intra-personal (e.g., negative thoughts relating to self). (b) The progressive management of distress. An overdose was depicted as a last resort once self-injury had become insufficient a means of self-help to manage feelings of desperation and isolation. (c) Ambivalence in relation to death. The clearly stated intention of an overdose was 'to die'. However, both words and (descriptions of) deeds suggested considerable ambivalence in relation to this--overdoses appearing to depict an attempt to resolve unbearable feelings through an unarticulated 'cry for help' rather than suicide completion.

Conclusions: The overall impression gained was of a group of women in a world of problematic relations (to both self and others) struggling to know how best to attract support and understanding. In discussion, links are made to the literature on reflectivity/reflexivity through Fonagy's notion of 'mentalization'.