I Hate You--Don't Leave Me - Jerold J. Kreisman [24]
Self-induced pain can also function as a distraction from other forms of suffering. One patient, when feeling lonely or afraid, would cut different parts of her body as a way “to take my mind off” the loneliness. Another would bang her head in the throes of stress-related migraine headaches. Relief of inner tension may be the most common reason for self-harming.31
Self-damaging behavior can also serve as an expiation for sin. One man, guilt-ridden after the breakup of his marriage for which he totally blamed himself, would repeatedly drink gin—a taste he abhorred—until reaching the point of retching. Only after enduring this discomfort and humiliation would he feel redeemed and able to return to his usual routine.
Painful, self-destructive behavior may be employed in an attempt to constrict actions that are felt to be dangerously out of control. One adolescent boy cut his hands and penis to dissuade himself from masturbation, an act he considered loathsome. He hoped that the memory of the pain would prevent him from further indulging in this repugnant behavior.
Impulsive, self-destructive acts (or threats) may result from a wish to punish another person, often a close relation. One woman consistently described her promiscuous behavior (often involving masochistic, degrading rituals) to her boyfriend. These affairs invariably occurred when she was angry and wanted to punish him.
Finally, self-destructive behavior can evolve from a manipulative need for sympathy or rescue. One woman, after arguments with her boyfriend, repeatedly slashed her wrists in his presence, forcing him to secure medical assistance for her.
Many borderlines deny feeling pain during self-mutilation and even report a calm euphoria after it. Before hurting themselves, they may experience great tension, anger, or overwhelming sadness; afterward there is a sensation of release and relief from anxiety.
This relief may result from psychological or physiological factors, or a combination of both. Physicians have long recognized that following severe physical trauma, such as battle wounds, the patient may experience an unexpected calm and a kind of natural anesthesia despite the lack of medical attention. Some have hypothesized that during such times, the body releases biological substances, called endorphins, the body’s internal opiate drugs (like morphine or heroin), which serve as the organism’s self-treatment of pain.
Radical Mood Shifts
Criterion 6. Affective instability due to marked reactivity of mood with severe episodic shifts to depression, irritability, or anxiety, usually lasting a few hours and only rarely more than a few days.
The borderline undergoes abrupt mood shifts, lasting for short periods—usually hours. His base mood is not usually calm and controlled, but more often either hyperactive and irrepressible or pessimistic, cynical, and depressed.
Audrey was giddy with excitement as she flooded Owen with kisses after he surprised her with flowers he bought on the way home from work. As he washed up for dinner, Audrey took a call from her mother, who again berated her for not calling to ask about her constant body aches. By the time Owen returned from the bathroom, Audrey had mutated into a raging harridan, screaming at him for not helping with dinner. He could only sit there, stunned and perplexed at the transformation.
Always Half Empty
Criterion 7. Chronic feelings of emptiness.
Lacking a core sense of identity, borderlines commonly experience a painful loneliness that motivates them to search for ways to fill up the “holes.”
The painful, almost physical sensation is lamented by Shakespeare’s Hamlet: “I have of late—but wherefore I know not—lost all my mirth, forgone