Letter to the editor: Head-Banging: Relationships with Borderline Personality Symptomatology

| January 5, 2013 | 0 Comments

Jan_Cover_2013Randy A. Sansone, MD; Michael W. Wiederman, PhD
Dr. Sansone is a professor in the Departments of Psychiatry and Internal Medicine at Wright State University School of Medicine in Dayton, Ohio, and Director of Psychiatry Education at Kettering Medical Center, in Kettering, Ohio. Dr. Wiederman is a professor of psychology in the Department of Human Relations at Columbia College in Columbia, South Carolina.

Innov Clin Neurosci. 2013;10(1):10–11

Funding and disclaimers: There was no funding for this study and no reported conflicts of interest by the authors.

Head-banging, which is clinically associated with developmental, psychotic, and personality disorders, has undergone little empirical investigation beyond the presentation of case reports. For example, with the exception of one study examining head-banging in relationship to sex differences in borderline personality disorder,[1] little is empirically known about this unusual behavior and this specific personality dysfunction. In this study, we examined the relationship between banging one’s head and borderline personality symptomatology (BPS).

Participants consisted of men and women, ages 18 years or older, recruited from an identical clinical setting (an internal medicine outpatient clinic staffed predominantly by resident providers) during four research projects that were undertaken over a two-year period (2009–2011).[2–5] We compiled these cross-sectional datasets to maximize the current sample size for investigation. The resulting sample consisted of 1,493 patients: 491 men, 1,001 women, and one individual who did not indicate gender. Ages of participants ranged from 18 to 97 years (median [M]=50.79, SD=15.64), and 87.9 percent were white/Caucasian.

During clinic hours, each incoming patient was approached by a research assistant, who excluded individuals unable to successfully complete a survey (mostly because of severe illness and/or language difficulties). With potential candidates, the recruiter reviewed the focus of the project and invited each to participate by completing a multipage survey. In addition to demographic queries, we examined BPS through two self-report measures—the borderline personality scale of the Personality Diagnostic Questionnaire-4 (PDQ-4)[6] and the Self-Harm Inventory (SHI),[7] both with diagnostic scores of 5 or higher. As for inquiries about head-banging, SHI item 5 asks, “Have you ever intentionally, or on purpose, banged your head?” As the focus of the current investigation, this item was not included in the total scoring of the SHI.

These four projects were reviewed and exempted by the institutional review boards of the study site and the university. Completion of the survey was assumed to function as implied consent, which was explicitly clarified on the cover page of the booklet.

Of the 1,493 respondents, 156 (10.4%) endorsed the item pertaining to head-banging, with statistically significantly more men (13.2%) than women (9.1%) indicating such behavior (chi-squared=6.05, P<0.02). Point-biserial correlation coefficients revealed that those who endorsed head-banging tended to be younger (r= -0.23, P<0.001), and scored higher on the PDQ-4 (r=0.40, P<0.001) and the SHI (r=0.57, P<0.001). Similarly, when compared with respondents who denied ever having banged their head on purpose, those who did were more likely to exceed the clinical cut-off score on the PDQ-4 (50.6% vs. 10.8%, chi-squared=174.82, P<0.001) and the SHI (67.3% vs. 11.6%, chi-squared= 301.22, P<0.001).

Although the potential limitations of this study include the self-report nature of the data, including the measures for borderline personality, and possible participant overlap in the four databases, findings in this large and consecutive primary-care sample of four studies indicate clear relationships between head-banging and BPS—a novel finding in this literature. Head-banging may represent a self-injury equivalent among individuals who have BPS.

1. Sansone RA, Lam C, Wiederman MW. Self-harm behaviors in borderline personality: an analysis by gender. J Nerv Ment Dis. 2010;198:914–915.
2. Sansone RA, Farukhi S, Wiederman MW. Disruptive behaviors in the medical setting and borderline personality. Int J Psychiatry Med. 2011;41:355–363.
3. Sansone RA, Lam C, Wiederman MW. Borderline personality disorder and reckless driving. J Clin Psychiatry. 2010;71:507.
4. Sansone RA, Lam C, Wiederman MW. The relationship between illegal behaviors and borderline personality symptomatology among internal medicine outpatients. Compr Psychiatry. 2012;53:176–180.
5. Sansone RA, Leung JS, Wiederman MW. Litigious history and borderline personality symptomatology. Prim Care Companion. In press.
6. Hyler SE. Personality Diagnostic Questionniare-4. New York: Author; 1994.
7. Sansone RA, Wiederman MW, Sansone LA. The Self-Harm Inventory (SHI): development of a scale for identifying self-destructive behaviors and borderline personality disorder. J Clin Psychol. 1998;54:973–983.

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Category: Letters to the Editor, Past Articles, Personality Disorders, Psychiatry

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