Preventing Wounds From Healing and Borderline Personality Symptomatology

To the Editor: Borderline personality disorder is a personality dysfunction characterized by chronic self-harm behavior. In psychiatric populations, self-harm behavior in borderline personality disorder traditionally manifests as self-mutilation (eg, cutting, scratching, burning oneself), sadomasochistic relationships with others, and suicide attempts. However, in medical settings, self-harm behavior may take on more somatic overtones and medical themes, including preventing wounds from healing. A relationship between intentionally preventing wounds from healing and borderline personality disorder symptomatology has been reported in both psychiatric¹ and internal medicine samples,^1,2 but not in obstetrics/gynecology samples.

Method. Participants consisted of 370 consecutive obstetrics/gynecology outpatients who ranged in age from 18 to 61 years (mean = 26.33, SD = 7.51). Exclusion criteria were medical or cognitive impairment of sufficient severity to preclude the successful completion of a survey. Participants were primarily white (54.3%) or African American (39.4%). Most had never been married (72.7%), with 16.5% being married, 6.9% divorced, 3.3% separated, and 0.6% widowed. Approximately 88% had at least completed high school, with 13.3% having completed a college degree. Most reported government (79.2%) or private insurance (5.5%), with the remaining 15.3% reporting self-pay or no insurance.

As patients arrived at the clinic, one researcher (J.C.) solicited each for participation, informally assessed exclusion criteria, and invited candidates to complete a 4-page survey. The cover page of the survey contained the elements of informed consent, and completion of the survey was presumed to be implied consent (specified on the cover page).

The survey contained (1) the Self-Harm Inventory,³ which has 1 particular query, “Have you ever intentionally, or on purpose, prevented wounds from healing?” and (2) the borderline personality disorder scale of the Personality Diagnostic Questionnaire-4 (PDQ-4),⁴ a 9-item, true/false, self-report version of the criteria for borderline personality disorder as described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Data were collected in October 2010. The project was approved by an institutional review board.

Results. In this sample, 13 participants (3.5%) reported preventing wounds from healing and 75 participants (20.3%) met criteria for borderline personality symptomatology according to the PDQ-4, using the traditional cutoff score of 5. The correlation between preventing wounds from healing and borderline personality symptomatology was r = 0.30. Likewise, as determined via χ² analysis, the prevalence of prevented wounds from healing among participants with borderline personality symptomatology was statistically significantly higher than among participants without borderline personality symptomatology, χ²₁ = 26.76, P < .001 (N = 370).

The potential limitations of this study include the self-report methodology, possible overinclusiveness of the borderline personality measure (ie, risk of false positives), and an atypical sample type (eg, low-income single women). However, in this sample, preventing wounds from healing was reported by nearly 1 in 25 participants and was associated with borderline personality symptomatology—a finding of high relevance to the general health care of women. It may be that preventing wounds from healing is functioning as a self-harm equivalent in the context of borderline personality disorder.