Ghijsens R, Lowyck B, Vermote R
KLIPP, Universitair Psychiatrisch Centrum (UPC) KU Leuven, Kortenberg, België.
Tijdschr Psychiatr. 2010;52(5):321-30.
Self-harm means deliberate tissue damage inflicted without suicidal intent. It occurs very frequently in patients with personality disorders, particularly in patients with a borderline personality disorder (BPD). Earlier psychodynamic theories were concerned with the symbolic meaning of this type of behaviour, e.g. self-inflicted punishment. More recent theories, however, focus on the role of self-harm in basic psychic functioning, such as affect regulation.
To demonstrate a more recent psychodynamic approach to the concept of self-harm and to outline the clinical implementation of this approach.
The literature on self-harm was reviewed systematically, particular attention being paid to more recent psychodynamic models.
Three dimensions of the psychic change are implemented in hospital-based treatment. Instead of the focus being on the symptoms, it is now on a broader psychotherapeutic process which aims at achieving a structural change in personality. The relation between the basic layer of this process and the therapeutic effect on self-harm in BPD is discussed.
The described approach to self-harm plays an important role in the psychodynamic treatment of patients with BPD. Current psychodynamic models of the treatment of BPD provide a theoretical background which can be implemented in the actual clinical treatment.
自我伤害是指在无自杀意图的情况下故意造成的组织损伤。它在人格障碍患者中非常常见，尤其是在边缘型人格障碍（BPD）患者中。早期的心理动力学理论关注这种行为的象征意义，例如自我惩罚。然而，最近的理论则侧重于自我伤害在基本心理功能中的作用，如情感调节。
展示一种关于自我伤害概念的更新的心理动力学方法，并概述该方法的临床应用。
系统回顾了关于自我伤害的文献，特别关注了更新的心理动力学模型。
心理改变的三个维度在基于医院的治疗中得以应用。现在关注的不是症状，而是一个更广泛的心理治疗过程，其目的是实现人格的结构性改变。讨论了该过程的基础层面与对BPD患者自我伤害的治疗效果之间的关系。
所描述的自我伤害方法在BPD患者的心理动力学治疗中起着重要作用。当前BPD治疗的心理动力学模型提供了一个理论背景，可在实际临床治疗中应用。
