Body self-evaluation and physical scars in patients with borderline personality disorder: an observational study

Nikolaus Kleindienst1, Kathlen Priebe1, Elisabeth Borgmann2, Sven Cornelisse1, Antje Krüger3, Ulrich Ebner-Priemer1,4, Anne Dyer2
1Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany, Germany
2Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
3Department of Clinical Psychology and Psychotherapy, University of Muenster, Muenster, Germany
4Department of Sport and Sport Sciences, Karlsruhe Institute of Technology, Karlsruhe, Germany

Tóm tắt

Data from general psychology suggest that body self-evaluation is linked to self-esteem and social emotions. Although these emotions are fragile in individuals with borderline personality disorder (BPD), body self-evaluation is clearly understudied in BPD research. A total of 200 women took part in the study: 80 female BPD patients, and 47 healthy and 73 clinical controls including post-traumatic stress disorder (PTSD) after childhood sexual abuse (CSA). Diagnoses were established through standardised interviews conducted by experienced psychologists. The participants used the Survey of Body Areas to indicate which areas of their own bodies they liked or disliked and to mark the locations of physical scars. Compared to healthy controls, both BPD patients and patients with PTSD after CSA had a predominantly negative body self-evaluation (Cohen’s d = 1.42 and 1.38, respectively). As indicated by multilevel analyses, scars were related to a negative evaluation of the affected areas in BPD patients, but not in the control groups. Subgroup analyses revealed that the negative body self-evaluation applies to both BPD patients with and without PTSD or reported CSA. BPD patients show a negative body self-evaluation which is associated with the presence of scars but not with CSA.

Tài liệu tham khảo

Lieb K, Zanarini MC, Schmahl C, Linehan MM, Bohus M: Borderline personality disorder. Lancet 2004, 364: 459–461. Rüsch N, Lieb K, Göttler I, Hermann C, Schramm E, Richter H, Jacob GA, Corrigan PW, Bohus M: Shame and implicit self-concept in women with borderline personality disorder. Am J Psychiatry 2007, 164: 500–508. 10.1176/appi.ajp.164.3.500 Staebler K, Helbing E, Rosenbach C, Renneberg B: Rejection sensitivity and borderline personality disorder. Clin Psychol Psychother 2011, 18: 275–283. 10.1002/cpp.705 Grogan S: Body Image: Understanding Body Dissatisfaction in Men, Women and Children. London: Routledge; 1999. Goldenberg JL, McCoy SK, Pyszczynski T, Greenberg J, Solomon S: The body as a source of self-esteem: the effect of mortality salience on identification with one’s body, interest in sex, and appearance monitoring. J Pers Soc Psychol 2000, 79: 118–130. Crocker J, Wolfe CT: Contingencies of self-worth. Psychol Rev 2001, 108: 593–623. Haaf B, Pohl U, Deusinger IM, Bohus M, Untersuchungen zum Körperkonzept bei Patientinnen mit Borderline-Persönlichkeitsstörungen: Examination of body concept on female patients with borderline personality disorder. Psychother Psych Med 2001, 51: 1–9. Kazuko T, Inoue K: Discriminative features of borderline personality disorder. Shinrigaku Kenkyu 2009, 79: 506–513. 10.4992/jjpsy.79.506 Muehlenkamp JJ, Brausch AM: Body image as a mediator of non-suicidal self-injury in adolescents. J Adol 2012, 35: 1–9. 10.1016/j.adolescence.2011.06.010 Muehlenkamp JJ, Claes L, Smits D, Peat CM, Vandereycken W: Non-suicidal self injury in eating disordered patients: a test of a conceptual model. Psychiatry Res 2011, 30: 102–108. Sansone RA, Chu JW, Wiederman MW: Body image and borderline personality disorder among psychiatric inpatients. Compr Psychiatry 2010, 51: 579–584. 10.1016/j.comppsych.2010.04.001 Sansone RA, Wiederman MW, Sansone LA, Monteith D: Obesity and borderline personality symptomatology: comparison of a psychiatric versus primary care sample. Int J Obesity 2001, 25: 299–300. 10.1038/sj.ijo.0801514 Herpertz SC: Self- injurious behaviour. Psychopathological and nosological characteristics in subtypes of self- injurers. Acta Psychiatr Scand 1995, 91: 57–68. 10.1111/j.1600-0447.1995.tb09743.x Kleindienst N, Bohus M, Ludäscher P, Limberger MF, Kuenkele K, Ebner-Priemer UW, Chapman AL, Reicherzer M, Stieglitz RD, Schmahl C: Motives for non-suicidal self-injury among women with borderline personality disorder. J Nerv Ment Dis 2008, 196: 230–236. 10.1097/NMD.0b013e3181663026 Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G, Weinberg I, Gunderson JG: The 10-year course of physically self-destructive acts reported by borderline patients and axis II comparison subjects. Acta Psychiatr Scand 2008, 117: 177–184. 10.1111/j.1600-0447.2008.01155.x Turner VJ: Secret Scars: Uncovering and Understanding the Addiction of Self-Injury. Hazelden: Center City; 2002. Renneberg B, Herm K, Hahn A, Staebler K, Lammers CH, Roepke S: Perception of social participation in borderline personality disorder. Clin Psychol Psychother 2012, 19: 473–480. 10.1002/cpp.772 Rüsch N, Holzer A, Hermann C, Schramm E, Jacob GA, Bohus M, Lieb K, Corrigan PW: Self-stigma in women with borderline personality disorder and women with social phobia. J Nerv Ment Dis 2006, 194: 766–773. 10.1097/01.nmd.0000239898.48701.dc Franzén AG, Gottzén L: The beauty of blood? Self-injury and ambivalence in an Internet community. J Youth Stud 2011, 14: 279–294. 10.1080/13676261.2010.533755 Farber SK: Self-medication, traumatic re-enactment, and somatic expression in bulimic and self-mutilating behavior. Clin Soc Work J 1997, 25: 87–106. 10.1023/A:1025785911606 Paris J: The development of impulsivity and suicidality in borderline personality disorder. Child Y Psy 2005, 17: 1091–1104. Klonsky ED, Muehlekamp JJ: Self-injury: a research review for the practitioner. J Clin Psychol 2007, 63: 1045–1056. 10.1002/jclp.20412 Walsh BW: Treating Self-Injury: A Practical Guide. New York: Guilford Press; 2006. Favazza AR, Conterio K: The plight of chronic self-mutilators. Community Ment Hlt J 1988, 24: 22–30. 10.1007/BF00755050 Evans M: Being driven mad: towards understanding borderline and other disturbed states of mind through the use of the counter-transference. Psychoanal Psychother 2007, 21: 216–232. 10.1080/02668730701535578 Weaver TL, Turner PK, Schwarze N, Thayer CA, Carter-Sand S: An exploratory examination of the meanings of residual injuries from intimate partner violence. Women Health 2007, 45: 85–102. Loranger AW, Sartorius N, Andreoli A, Berger P, Buchheim P, Channabasavanna SM, Coid B, Dahl A, Diekstra RF, Ferguson B, Lawrence B, Jacobsberg LB, Mombour W, Pull C, Ono Y, Regier DA: The international personality disorder examination: the world health organization/alcohol, drug abuse, and mental health administration international pilot study of personality disorders. Arch Gen Psychiatry 1994, 51: 215–224. 10.1001/archpsyc.1994.03950030051005 First MB, Spitzer RL, Gibbon M, Williams JBW, Benjamin LS: User’s guide forthe structured clinical interview for DSM-IV Axis I disorders (SCID-I) – clinical version. Washington: American Psychiatric Press; 1997. Bohus M, Kleindienst N, Limberger MF, Stieglitz RD, Domsalla M, Chapman AL, Steil R, Philipsen A, Wolf M: The short-version of the borderline symptom list (BSL-23): development and initial data on psychometric properties. Psychopathology 2009, 42: 32–39. 10.1159/000173701 Foa EB: The Posttraumatic Diagnostic Scale (PDS) Manual. Minneapolis: National Computer Systems; 1995. Bernstein DP, Stein JA, Newcomb MD, Walker E, Pogge D, Ahlovalia T, Stokes J, Handelsman L, Medrano M, Desmond D, Zule W: Development and validation of a brief screening version of the childhood trauma questionnaire. Child Abuse Negl 2003, 27: 169–190. 10.1016/S0145-2134(02)00541-0 Schirbel A, Reichert A, Roll S, Baumgart DC, Büning C, Wittig B, Wiedenmann B, Dignass A, Sturm A: Impact of pain on health-related quality of life in patients with inflammatory bowel disease. World J Gastroentero 2010, 16: 3168–3177. 10.3748/wjg.v16.i25.3168 Cash T: The multidimensional body-self relations questionnaire. http://www.body-images.com Metha CR, Patel NR: A network algorithm for performing fisher’s exact test in r x c contingency tables. J Am Stat Assoc 1983, 78: 427–434. Hill J, Pilkonis P, Morse J, Feske U, Reynolds S, Hope H, Charest C, Broyden N: Social domain dysfunction and disorganization in borderline personality disorder. Psychol Med 2008, 38: 135–146.