It has occurred to me in hearing about the self-mutilation and aggressive behavior that they follow a pathway of vulnerability -> stress. The vulnerability is based on dysfunctional attitudes such as, “if people disregard my wishes, they are hostile to me,” or “if people don’t respond to me, it means they don’t like me.” When a particular event occurs, that impinges on these beliefs, the individual becomes upset. The primary reaction is a disappointment, frustration, etc. (hurt feelings). The individual may seek relief from some self-injury. On the other hand, if the event is interpreted as an unjustified insult that calls for retaliation, the individual may respond with anger and strike out at the offender. It should be noted that much of the aggressive acting-out by men may be attributed to the borderline dysfunctional beliefs, coupled with relevant stress. Contrary to the common thesis, these individuals are not intrinsically violent. Instead, they are hyper-reactive, which leads to their violent behavior. In any event, a chain analysis is warranted to determine the nature of the stressor, the meaning to the individual, and the individual’s transformation of this meaning into maladaptive behavior. Ideally, it would be great to be able to pinpoint the dysfunctional attitudes. An ideal way to modify these maladaptive patterns of behavior is to engage the individual in roleplay. This has been successful in several instances.
There are certain types of aggressive behavior, which do not fit readily into the paradigm outlined above. For example, take the case of an individual who has not slept and has been hallucinating all night long. He might automatically strike out at the first person whom he has contact with in the morning. There are probably other sequences that we can uncover, so here is the suggestion: try to apply the paradigm outlined in the first paragraph—use chain analysis, check on dysfunctional attitudes using items from the borderline scale and use roleplays. This is a clinical intervention which we have used before and is not research, although we do want to keep track of how we effective it is when appropriately administered.