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Autistic and Dissociative Processes in Borderline Self-Harming Patients: The Relationship To Psychoses

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Length: 18 minutes

Sharon Klayman Farber, PhD, BCD

Comparing the dissociative and autistic features of patients who harm themselves through self-injury or eating disorders raises intriguing questions about the relationship between autistic and dissociative processes and their relationship to psychoses.

Frances Tustin’s work with autistic children can help us to understand such behavior as a counterphobic regression to an encapsulated autistic black hole. Whether cutting or burning or starving themselves or bulimic purging or other self-harm, these acts can help vulnerable people to feel powerful and omnipotent. They often occur in a dissociated state, experienced as an alien, demonic force preying upon the self. Like the autistic child who fears she is at the brink of falling into madness, the self-harmer throws herself into madness, merging the boundaries between self and other in a dedifferentiated, dissociated state. Inflicting pain and injury on oneself is a protective mechanism that can arise when one experiences the terror of feeling utterly alone and helpless, at the mercy of terrifying predators. Having lacked the ability to develop transitional objects for self-soothing, self-harmers instead prey upon themselves with hard autistic objects, a perverse form of self-soothing. Comparing the dissociative and autistic features of self-harm raises intriguing questions about the relationship between autistic and dissociative processes and their relationship to psychoses. The case of a woman with a long history of self-mutilation is presented, in which autistic and dissociative elements are paramount.


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