반복적 자해의 정신역동적 이해
Psychodynamic Understanding of Repetitive Self-Mutilation
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Repetitive self-mutilation or non-suicidal self-injury (NSSI) refers to the intentional destruction of one’s own body tissue without suicidal intent and for purposes not socially sanctioned. Common examples include cutting, scratching, and hitting. Although NSSI generally has been considered a characteristic symptom of borderline personality disorder, its onset and prevalence typically occur in mid-adolescence, whereas the typical onset of borderline personality disorder is in early adulthood. Therefore, NSSI should be considered separately from borderline personality, but also from a psychodynamic perspective. From the classical psychoanalytic viewpoint, self-mutilation is associated with the failure to control aggressive drives. In ego psychology, self-mutilation is seen as an attempt of the fragile ego to re-establish boundaries with the external environment and avoid being overcome with uncontrollable emotions. In object-relation theory, it is seen as an effort to reconstruct unclear boundaries between ego and object or ego and reality by cutting the skin-the fundamental separation between them. Self-mutilation- can interfere with the psychotherapy by increasing or decreasing transference or causing strong countertransference. The therapist might experience helplessness or anger at repetitive self-mutilations and, with an adolescent patient, might be conflicted about telling the facts to parents or maintaining the patient’s confidentiality. In conclusion, consideration of various psychodynamic aspects is important in understanding and treating patients with NSSI.
Abstract
Repetitive self-mutilation or non-suicidal self-injury (NSSI) refers to the intentional destruction of one’s own body tissue without suicidal intent and for purposes not socially sanctioned. Common examples include cutting, scratching, and hitting. Although NSSI generally has been considered a characteristic symptom of borderline personality disorder, its onset and prevalence typically occur in mid-adolescence, whereas the typical onset of borderline personality disorder is in early adulthood. Therefore, NSSI should be considered separately from borderline personality, but also from a psychodynamic perspective. From the classical psychoanalytic viewpoint, self-mutilation is associated with the failure to control aggressive drives. In ego psychology, self-mutilation is seen as an attempt of the fragile ego to re-establish boundaries with the external environment and avoid being overcome with uncontrollable emotions. In object-relation theory, it is seen as an effort to reconstruct unclear boundaries between ego and object or ego and reality by cutting the skin-the fundamental separation between them. Self-mutilation- can interfere with the psychotherapy by increasing or decreasing transference or causing strong countertransference. The therapist might experience helplessness or anger at repetitive self-mutilations and, with an adolescent patient, might be conflicted about telling the facts to parents or maintaining the patient’s confidentiality. In conclusion, consideration of various psychodynamic aspects is important in understanding and treating patients with NSSI.
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