Affect, Relationship Schemas, And Social Cognition: Self-Injuring Borderline Personality Disorder Inpatients

Psychiatric patients who engage in nonsuicidal self-injury (NSSI) present specific challenges to therapists because they often lack the capacities necessary to understand the social and emotional triggers for their actions. This case-control study empirically explores psychodynamic concepts of NSSI by examining quality of affect, object representations, and social cognition manifest in verbatim Thematic Apperception Test narratives (Murray, 1943). Sixty-five female borderline inpatients engaging in NSSI served as the case group, while 68 matched female inpatients with BPD without NSSI served as the control group. The TAT transcripts were rated on the Social Cognition and Object Relations Scale (Hilsenroth, Stein, & Pinsker, 2007; Westen, 1995), then a priori hypotheses were subjected to statistical analysis. While both groups functioned in the pathological range on all dimensions, the NSSI group created narratives reflecting greater expectation of malevolent treatment from others, expressed interpersonal relationships in more shallow terms with little capacity for empathy, and had greater difficulty modulating aggressive feelings. Their narratives also reflected greater difficulty with splitting and boundary confusion, more primitive relationship schemas, and poorer understanding of social causality of interpersonal interactions. Results add to a growing body of evidence that NSSI is associated with more severe forms of BPD pathology, especially in domains of malevolent object representations, misinterpretation of social interactions, and expressions of hostility (Kernberg, 1984; Simpson & Porter, 1981; Stolorow & Lachmann, 1980; Yeomans, Hull & Clarkin, 1994). These results extend observations of the heterogeneity in the severity of patients diagnosed with BPD.