QUESTION:

Dear Dr. Heller,

What exactly is self mutilation and what are some causes and effects of it? How could it be cured?

DR. HELLER'S ANSWER:

In adults it's virtually always due to the BPD (borderline personality disorder). Under stress borderlines experience a horrible neurological sensation called "dysphoria" (anxiety, rage, depression and despair). Borderlines desperately try to find ways for it to go away, and self-destructive behaviors such as binge eating, binge spending and substance use are used because they temporarily work.

Some borderlines discover that scratching or cutting the skin in a linear manner doesn't hurt, but stops the dysphoria. Interestingly all of us employ this technique when we have an unbearable neurological sensation that responds to this treatment - scratching insect bites.

The treatment is medication. Borderlines need to use medication that works in 10 minutes (Haldol) rather than self-mutilating. Self mutilation causes fear in others and borderlines recognize that it's not good for them. I share their belief that they need relief, and that's what medication is for.

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