[Disturbed regulation of self-esteem in patients with overt versus covert self-destructive behaviour]

OBJECTIVES: According to psychoanalytic models self-harming patients are characterised by an unstable self-system and a disturbed regulation of self-esteem. This is presumed to be denied or dissociated to a greater degree by those who harm themselves secretly (factitious patients) as compared to those who show open self-harm. It is hypothesised and empirically tested that self-destructive patients have more profound disorders of narcissistic self-regulation than patients without self-destruction, and that this should be more evident in patients with overt self-destructive behaviour.

METHODS: The sample consists of 354 psychosomatic patients, 32 of whom demonstrated self-destructive behaviour (18 exclusively overt and 6 exclusively covert types of behaviour, according to Willenberg et al.). The narcissism inventory was applied.

RESULTS: Self-destructive patients showed higher levels on the "threatened self"-dimension than psychosomatic patients without self-harm. Overtly self-harming patients showed a higher degree of narcissistic self-regulation than covertly self-destructive patients.

CONCLUSIONS: This supports theoretical assumptions of a disturbed regulation of self-esteem in self-destructive patients, especially in overtly self-harming patients.