Nervenheilkunde 2018; 37(12): 885-890
DOI: 10.1055/s-0038-1677371
Universitätsklinikum Ulm
Georg Thieme Verlag KG Stuttgart · New York

„I feel lonely“

Emotionen und mentale Bilder im Zusammenhang mit selbstschädigendem Verhalten im Rahmen der Borderline-Persönlichkeitsstörung“I feel lonely” – Emotions and mental images associated with self-harming behaviour in borderline personality disorder
C. Schaitz
1   Abteilung für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
,
J. Kröner
1   Abteilung für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
,
A. Maier
1   Abteilung für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
,
Z. Sosic-Vasic
1   Abteilung für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm
› Author Affiliations
Further Information

Publication History

eingegangen am: 01 October 2018

angenommen am: 16 October 2018

Publication Date:
04 January 2019 (online)

Zusammenfassung

Selbstverletzendes Verhalten spielt eine wesentliche Rolle innerhalb der Borderline-Persönlichkeitsstörung (BPS). Während bereits Einiges zur Funktion von selbstverletzendem Verhalten bekannt ist, gibt es wenig Studien über die damit assoziierten Gefühle oder mentalen Bilder. In der hier vorgestellten Studie wurden Patientinnen mit BPS hinsichtlich ihrer Gefühle bei der Ausführung selbstschädigender Verhaltensweisen befragt. Die Patientinnen berichteten überwiegend negative Gefühle, auf welche durch Selbstverletzung vornehmlich zum Zwecke der Emotionsregulation oder Selbstbestrafung reagiert wird. Zudem berichtete ein Großteil aller Befragten von sehr lebhaften und sich aufdrängenden mentalen Bildern assoziiert mit willentlichen Selbstschädigungen, welche sich bereits vor der eigentlichen Ausführung der Selbstschädigung ankündigen. Der Erfassung entsprechender mentaler Bilder könnte daher künftig eine stärkere therapeutische Bedeutung zukommen.

Summary

Self-harming plays an essential role in borderline personality disorder (BPS). While much is already known about the function of self-harming behavior, far less studies have investigated feelings or mental images associated with those. In the present study, patients with BPS were questioned about their feelings when performing self-harm. The patients reported predominantly negative feelings, causing self-harm for the purpose of emotion regulation or self-punishment. In addition, a majority of the questioned BPS patients reported very vivid and intrusive mental images associated with deliberate self-harm, occurring and announcing thems-selves before the actual execution of self-hrm. Based on these first reports, we consider the acquisition of corresponding mental images as useful for future investigation of new therapeutic interventions.

 
  • Literatur

  • 1 Lieb K, Zanarini MC, Schmahl C, Linehan PMM, Bohus PM. Borderline personality disorder.. Lancet 2004; 364 9432 453-461.
  • 2 Clarkin JF. Prototypic typology and the Borderline Personality Disorder.. J Abnorm Psychol 1983; 92 (03) 263-275.
  • 3 Soloff PH, Lis JA, Kelly T, Cornelius J, Ulrich R. Self-Mutilation and Suicidal Behavior in Borderline Personality Disorder.. J Pers Disord 1994; 8 (04) 257-267.
  • 4 Edmondson AJ, Brennan CA, House AO. Non-suicidal reasons for self-harm: A systematic review of self-reported accounts.. J Affect Disord 2016; 191: 109-117.
  • 5 Pattison EM, Kahan J. The deliberate self-harm syndrome.. Am J Psychiatry 1983; 140 (07) 867-872.
  • 6 Fyer MR, Frances AJ, Sullivan T, Hurt SW, Clarkin J. Suicide attempts in patients with borderline personality disorder.. Am J Psychiatry 1988; 145 (06) 737-739.
  • 7 Linehan MM. Cognitive-behavioral therapy of borderline personality disorder.. New York: Guilford Press; 1993
  • 8 Taylor SE, Pham LB, Rivkin ID, Armor DA. Harnessing the Imagination: Mental Simulation, Self-Regulation, and Coping.. Am Psychol 1998; 53 (04) 429-439.
  • 9 Zanarini MC, Frankenburg FR, Ridolfi ME, Jager-Hyman S, Hennen J, Gunderson JG. Reported Childhood Onset of Self-Mutilation Among Borderline Patients.. J Pers Disord 2006; 20 (01) 9-15.
  • 10 Shearer SL. Phenomenology of self-injury among inpatient women with boderline personality disorder.. J Nerv Ment Dis 1994; 182 (09) 524-6.
  • 11 Dubo ED, Zanarini MC, Lewis RE, Williams AA. Childhood antecedents of self-destructiveness in borderline personality disorder.. Can J Psychiatry 1997; 42 (01) 63-69.
  • 12 Plener PL, Allroggen M, Kapusta ND, Brähler E, Fegert JM, Groschwitz RC. The prevalence of Nonsuicidal Self-Injury (NSSI) in a representative sample of the German population.. BMC Psychiatry 2016; 16 (01) 353.
  • 13 Brunner R, Parzer P, Haffner J, Steen R, Roos J, Klett M. et al. Prevalence and psychological correlates of occasional and repetitive deliberate self-harm in adolescents.. Arch Pediatr Adolesc Med 2007; 161 (07) 641-649.
  • 14 Glenn CR, Klonsky ED. Prospective Prediction of Nonsuicidal Self-Injury: A 1-Year Longitudinal Study in Young Adults.. Behav Ther 2011; 42 (04) 751-762.
  • 15 Muehlenkamp JJ, Claes L, Havertape L, Plener PL. International prevalence of adolescent non-suicidal self-injury and deliberate self-harm.. Child Adolesc Psychiatry Ment Health 2012; 6 (01) 10.
  • 16 Klonsky ED. The functions of deliberate self-injury: A review of the evidence.. Clinical Psychology Review 2007; 27 (02) 226-239.
  • 17 World Health Organisation.. ICD-10 Version: 2016.. WHO: 2016
  • 18 American Psychiatric Association.. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).. American Psychiatric Pub: 2013
  • 19 Bjureberg J, Sahlin H, Hellner C, Hedman-Lager-löf E, Gratz KL, Bjärehed J. et al. Emotion regulation individual therapy for adolescents with non-suicidal self-injury disorder: A feasibility study.. BMC Psychiatry 2017; 17 (01) 411.
  • 20 Chapman AL, Gratz KL, Brown MZ. Solving the puzzle of deliberate self-harm: The experiential avoidance model.. Behaviour Research and Therapy 2006; 44 (03) 371-394.
  • 21 Taylor PJ, Jomar K, Dhingra K, Forrester R, Shahmalak U, Dickson JM. A meta-analysis of the prevalence of different functions of non-suicidal self-injury.. J Affect Disord 2017; 227: 759-769.
  • 22 Klonsky ED, Glenn CR, Styer DM, Olino TM, Washburn JJ. The functions of nonsuicidal self-injury: Converging evidence for a two-factor structure.. Child Adolesc Psychiatry Ment Health 2015; 9 (01) 44.
  • 23 Turner BJ, Chapman AL, Layden BK. Intrapersonal and interpersonal functions of non suicidal self-injury: Associations with emotional and social functioning.. Suicide Life-Threatening Behav 2012; 42 (01) 36-55.
  • 24 Klonsky ED. The functions of self-injury in young adults who cut themselves: Clarifying the evidence for affect-regulation.. Psychiatry Res 2009; 166 2–3 260-268.
  • 25 Kleindienst N, Bohus M, Ludäscher P, Limberger MF, Kuenkele K, Ebner-Priemer UW. et al. Motives for nonsuicidal self-injury among women with borderline personality disorder.. J Nerv Ment Dis 2008; 196 (03) 230-236.
  • 26 Chapman AL, Dixon-Gordon KL. Emotional Antecedents and Consequences of Deliberate Self-Harm and Suicide Attempts.. Suicide Life-Threatening Behav 2007; 37 (05) 543-552.
  • 27 Coid JW. An affective syndrome in psychopaths with borderline personality disorder?. Br J Psychiatry 1993; 162 (05) 641-650.
  • 28 Brain KL, Haines J, Williams CL. The psychophysiology of self-mutilative behaviour: A comparison of current and recovered self-mutilators.. In: Suicide prevention: The global context.. Boston, MA: Springer; 1998: 211-222.
  • 29 Briere J, Gil E. Self-mutilation in clinical and general population samples: Prevalence, correlates, and functions.. Am J Orthopsychiatry 1998; 68 (04) 609-620.
  • 30 American Psychiatric Association.. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).. American Psychiatric Pub: 2013
  • 31 Hackmann A, Clark DM, McManus F. Recurrent images and early memories in social phobia.. Behav Res Ther 2000; 38 (06) 601-610.
  • 32 Wild J, Hackmann A, Clark DM. When the present visits the past: Updating traumatic memories in social phobia.. J Behav Ther Exp Psychiatry 2007; 38 (04) 386-401.
  • 33 Holmes EA, Crane C, Fennell MJV, Williams JMG. Imagery about suicide in depression-“Flash-forwards“?. J Behav Ther Exp Psychiatry 2007; 38 (04) 423-434.
  • 34 Ng RMK, Di Simplicio M, Holmes EA. Mental imagery and bipolar disorders: Introducing scope for psychological treatment development?. Int J Soc Psychiatry 2016; 62 (02) 110-113.
  • 35 Crane C, Shah D, Barnhofer T, Holmes EA. Suicidal imagery in a previously depressed community sample.. Clin Psychol Psychother 2012; 19 (01) 57-69.
  • 36 Selby EA, Anestis MD, Joiner TE. Daydreaming about death: Violent daydreaming as a form of emotion dysregulation in suicidality.. Behav Modif 2007; 31 (06) 867-879.
  • 37 Morina N, Deeprose C, Pusowski C, Schmid M, Holmes EA. Prospective mental imagery in patients with major depressive disorder or anxiety disorders.. J Anxiety Disord 2011; 25 (08) 1032-1037.
  • 38 Gregory JD, Brewin CR, Mansell W, Donaldson C. Intrusive memories and images in bipolar disorder.. Behav Res Ther 2010; 48 (07) 698-703.
  • 39 Holmes EA, Geddes JR, Colom F, Goodwin GM. Mental imagery as an emotional amplifier: Application to bipolar disorder.. Behav Res Ther 2008; 46 (12) 1251-1258.
  • 40 Wittchen HU, Zaudig M, Fydrich T. SKID-II. Strukt Klin Interview für DSM-IV Achse I Psych Störungen/Achse II Persönlichkeitsstörungen.. Göttingen: Hogrefe; 1997
  • 41 Ackenheil M, Stotz-Ingenlath G, Dietz-Bauer R, Vossen A. MINI Mini International Neuropsychiatric Interview, German Version 5.0.0, DSM IV. Psychiatr Univ München 1999
  • 42 Rickels K, Howard K, Guy W. Clinical global impressions.. ECDEU Assessment Manual for Psychopharmacology/Rev. ed. US Government Printing Office 1976: 218-222.
  • 43 Gollwitzer PM. Implementation intentions: Strong effects of simple plans.. Am Psychol 1999; 54 (07) 493-503.
  • 44 Carroll JS. The effect of imagining an event on expectations for the event: An interpretation in terms of the availability heuristic.. J Exp Soc Psychol 1978; 14 (01) 88-96.
  • 45 Libby LK, Shaeffer EM, Eibach RP, Slemmer JA. Picture yourself at the polls: Visual perspective in mental imagery affects self-perception and behavior.. Psychol Sci 2007; 18 (03) 199-203.
  • 46 Conway MA. Sensory-perceptual episodic memory and its context: Autobiographical memory.. Philos Trans R Soc B Biol Sci 2001; 356 1413 1375-1384.
  • 47 Knäuper B, McCollam A, Rosen-Brown A, Lacaille J, Kelso E, Roseman M. Fruitful plans: Adding targeted mental imagery to implementation intentions increases fruit consumption.. Psychol Heal 2011; 26 (05) 601-617.
  • 48 Nock MK, Joiner TE, Gordon KH, Lloyd-Richardson E, Prinstein MJ. Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts.. Psychiatry Res 2006; 144 (01) 65-72.
  • 49 David Klonsky E, May AM, Glenn CR. The relationship between nonsuicidal self-injury and attempted suicide: Converging evidence from four samples.. J Abnorm Psychol 2013; 122 (01) 231-237.