A patient with borderline personality disorder cut her wrists while out on a pass. For future planning, staff should consider that the reason for the self-mutilation is probably related to:
a. an inherited disorder that manifests itself as an incapacity to tolerate stress.
b. fear of abandonment associated with relationships or increasing autonomy.
c. use of projective identification and splitting to bring anxiety to manageable levels.
d. a constitutional inability to regulate affect, predisposing to psychic disorganization.
B
Fear of abandonment is a central theme for most patients with borderline personality disorder. This fear is often exacerbated when the patients experience success or growth or begin to develop relationships with others, because these changes increase anxiety and renew fears of abandonment. Research does not indicate that self-injurious behavior is genetic, nor that difficulty regulating affect is constitutional (integral to the person and unchanging) in nature. Although splitting is a frequently demonstrated defense mechanism in borderline personality disorder, projective identification is less common; neither is related to self-injurious behavior.
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