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A Comparison of nonsuicidal self-injury in individuals with and without Borderline Personality Disorder

Bowe, ES 2012 , 'A Comparison of nonsuicidal self-injury in individuals with and without Borderline Personality Disorder', PhD thesis, University of Tasmania.

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The aim of the investigation was to examine differences in the motivational,
psychophysiological, psychological and cognitive responses to nonsuicidal selfinjury
(NSSI) and other impulsive behaviours of individuals with and without
Borderline Personality Disorder (BPD). Also, it was anticipated that results of this
investigation could identify whether or not individuals with BPD engage in other
impulsive, self-destructive behaviours for the same reasons that they engage in NSSI.
Essentially, this part of the research was comprised of an examination of criterion 4
and 5 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR;
APA, 2000) diagnostic criteria for BPD. To examine processes at the time of NSSI
and impulsive behaviours, a personalised, staged guided imagery methodology was
used to test the affect regulation theory of NSSI.
It was expected that both individuals with and without BPD would
demonstrate a reduction in negative emotional states with the act of NSSI. However,
it was expected that individuals with BPD would report an increase in high arousal
positive emotional states, such as excitement, with the act of NSSI whereas
individuals without BPD would report an increase in low arousal positive emotional
states. This affect regulation function, either positive or negative, also was predicted
to distinguish NSSI from control events of an accidental injury and an emotionally
neutral event. Interestingly, results indicated that when considering subjective (selfreport)
data alone, individuals with BPD and individuals without BPD (NBPD)
appeared almost indistinguishable in their responses to NSSI. However, when
examining objective (psychophysiological) responses, the two groups demonstrated
completely different reactions to NSSI. Individuals without BPD demonstrated a pattern of tension reduction which was consistent with their self-reported reduction
in anxiety and tension during the act of NSSI. The BPD group, in contrast,
demonstrated the opposite effect, whereby there was an increase in arousal, perhaps
suggesting excitement in response to NSSI. Despite this, the BPD group still reported
that they felt calm and relaxed as a result of self-injury. This has important
considerations for the affective instability of individuals with BPD, particularly in
relation to alexithymia.
Secondly, a comparison was made between NSSI and other diagnostically
relevant, impulsive behaviours. It was expected that engaging in impulsive
behaviours would elicit an excitement response for those with BPD, and a tension
reducing function for those individuals without BPD. It also was expected that the
response to the impulsive behaviours would mirror the arousal increase, excitement
response to NSSI in the BPD group and would mirror the arousal decrease, calm
response to NSSI in the NBPD group. Similarly, it was thought that the reasons for
engaging in the impulsive behaviours will relate to sensation seeking for the BPD
group but a sense of calm for the NBPD group.
Results indicated that there were few differences between the groups in terms
of motivational factors associated with impulsive behaviours and, furthermore,
psychophysiological responses to these impulsive behaviours did not mirror those
demonstrated for NSSI. Results were discussed in terms of support for the fact that
NSSI is a unique behaviour, and should not necessarily be included in the DSM-IVTR
(APA, 2000) with other Impulse Control Disorders.
Finally, the motivational and cognitive responses to NSSI for those with and without BPD were considered. In particular, consideration was given to internal and
external motivations to determine if the presence of BPD has an impact on the
reasons why people choose to self-injure. It is evident that people with BPD have
additional difficulties with interpersonal communication that are not experienced as
intensely by people without BPD (Lieb, Zanarini, Schmahl, Linehan, & Bohus,
2004). It was thought that these difficulties should influence their motivation for
engaging in behaviours that serve to regulate affect because the disturbance in affect
may be caused by interpersonal difficulties.
Results for Study 3 indicated that both of the groups endorsed internal
motivations for NSSI, but the BPD group endorsed a number of additional external
motivations for NSSI indicating that NSSI may be used as a maladaptive tool for
communicating distress. In addition, results indicated that individuals with BPD have
a range of additional difficulties with anger, irrational beliefs and perceived low
ability to control their emotions which likely contribute to NSSI. Interestingly, the
BPD group also endorsed the cognition I like to hurt myself during NSSI, which
further supports the notion that the behaviour may be associated with sensation
seeking in this group.
It was concluded that the role of affect regulation in NSSI needs to consider
the role of both positive and negative emotions, as well as increase and decrease in
arousal, rather than assume that the affect regulatory function of NSSI is always a
decrease in negative emotions. This is likely to have important implications for the
consideration of BPD in future research as well as treatment options.

Item Type: Thesis - PhD
Authors/Creators:Bowe, ES
Keywords: nonsuicidal self-injury, Borderline Personality Disorder, affect regulation, impulsive behaviour
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