Self-Relevant Disgust and Self-Harm Urges in Patients with Borderline Personality Disorder and Depression: A Pilot Study with a Newly Designed Psychological Challenge

Abstract

BackgroundBorderline personality disorder (BPD) is a common psychiatric condition associated with self-harm. Self-harm is poorly understood and there is currently no treatment for acute presentations with self-harm urges.ObjectivesBy using a new task (Self-relevant Task; SRT), to explore emotions related to one's own person (PERSON task) and body (BODY task), to study the correlations of these emotions, specifically disgust, with self-harm urge level changes, and to test the task's potential to be developed into an experimental model of self-harming for treatment trials.Methods17 BPD patients, 27 major depressive disorder (MDD) patients, and 25 healthy volunteers performed the SRT. Emotion labels were extracted from task narratives and disgust and self-harm urge level changes measured by visual analogue scales. We used validated rating scales to measure symptom severity.ResultsThe SRT was effective at inducing negative emotions and self-harm urge changes. Self-harm urge changes correlated with borderline symptom severity. Post-task disgust levels on the visual analogue scales were higher in BPD patients than in healthy controls in the PERSON task, and higher than in both control groups in the BODY task. Changes in disgust levels during the task were significantly greater in the patient groups. Post-task disgust levels or changes in disgust were not associated with self-harm urge changes (except the latter in MDD in the PERSON task), but self-harm urge changes and disgust (but no other emotion) narrative labels were on a whole sample level.ConclusionAlthough associations with the analogue scale measures were not significant, self-disgust reported in the narrative of patients may be associated with a higher probability of self-harm urges. Further research with larger sample sizes is needed to confirm this relationship and to examine whether reducing self-disgust could reduce self-harm urges. The SRT was effective and safe, and could be standardized for experimental studies.

Eating Disorder Symptoms and Suicidal Ideation: The Moderating Role of Disgust

“…This may, in turn, lead to increased maladaptive self‐criticism, isolation from social connections and feelings that one does not belong, which are associated with increased risk for suicide‐related behaviours (Fazaa & Page, ; Hooley, Ho, Slater, & Lockshin, ; Van Orden et al, ). Consistent with the predictions, a recent study reported that self‐disgust was associated with increased urges to self‐harm (Abdul‐Hamid, Denman, & Dudas, ). Importantly, no studies or measures, to the authors' knowledge, have been devised to test the hypothesized association between disgust with life and suicidality.…”

A systematic review of the clinical utility of the concept of self‐disgust

“…Similarly, self‐disgust significantly mediated both the relationship between depression and nonsuicidal self‐injury and the relationship between childhood sexual abuse and lifetime self‐injury status (Smith et al, ), suggesting both that adverse life events exert their influence on self‐injury partially through their effects on self‐disgust and that self‐disgust in turn increases the risk of depression following self‐injury. Abdul‐Hamid et al's () experimental study lends further support to the complexity of this relationship. Specifically, when participants reflected on negative aspects of the personality and then their body (by writing a 3‐min free‐narrative on this) and rated both changes in their disgust levels and changes in their self‐harm urges subsequently, more frequent references to disgust terms in participant narratives was significantly related to an increase in urge to self‐harm.…”

“…Psychometric measures designed specifically to assess self‐disgust (e.g., Overton et al, ; Schienle, Ille, Sommer, & Arendasy, ) have only recently been developed. In the absence of standardized self‐disgust scales, the most frequently employed measures of self‐disgust have simply involved utilizing visual analogue scales asking individuals to rate the intensity with which they experience self‐disgust (e.g., Abdul‐Hamid, Denman, & Dudas, ; Badour, Bown, Adams, Bunaciu, & Feldner, ; Badour, Ojserkis, McKay, & Feldner, ; Dyer, Feldmann, & Borgmann, ). Such single‐item measures are unlikely to capture the full complexity of a self‐disgust cognitive‐affective schema and may instead capture a more transient but intense self‐disgust emotional reaction.…”

“…Effect sizes were reported for only one of these studies (Bachtelle & Pepper, 2015) and are in the moderate to large range. Self-disgust was operationalized differently across studies, with two studies (Bachtelle & Pepper, 2015;Smith, Steele, Weitzman, Trueba, & Meuret, 2015) employing a broad multi-item measure of self-disgust and one (Abdul-Hamid et al, 2014) employing a visual analogue measure. Two employed cross-sectional designs (Bachtelle & Pepper, 2015;Smith et al, 2015), and one (Abdul-Hamid et al, 2014) employed an experimental design, with studies indicating a bidirectional relationship between self-disgust and self-harm.…”

Negative emotions towards others are diminished in remitted major depression

“…One study using a questionnaire measure collapsing disgust towards one's physical appearance and personality showed high scores in a small sample of current MDD and other mental health conditions including borderline personality disorder (BPD) [21]. A further recent study separated experimentally induced personal and physical self-disgust and found physical self-disgust to be more relevant in BPD compared with MDD [1]. So far, there has been only our previous pilot study in remitted MDD to probe self-contempt/disgust, a moral form of self-disgust [18].…”