Medically self-sabotaging behavior encompasses a range of phenomena where individuals intentionally worsen their medical situations or prevent healing. This behavior extends beyond the clinically identified syndrome of factitious disorder, which is noted as the most rare form. Existing studies indicate associations between factitious disorder and borderline personality disorder (BPD), as well as other psychiatric disorders. Population surveys reveal that other forms of medically self-sabotaging behavior occur in both medical and psychiatric populations. Two specific behaviors—making medical situations worse on purpose and preventing wounds from healing—have undergone empirical investigation. These behaviors are far more common than factitious disorder and exhibit higher rates in populations with greater psychiatric loading, demonstrating associations with BPD. The association between medically self-sabotaging behavior and BPD is likely explained through the clinical feature of self-harm behavior. Self-harm behavior is an inherent feature of BPD, and medically self-sabotaging behavior may represent a "medicalized" version of self-harm behavior. If these behaviors are self-injury equivalents, they probably function to elicit caring responses from others, control negative emotions, and/or reinforce a dysfunctional identity. Currently, there is no known or recommended treatment approach specifically for individuals who engage in medical self-sabotage. However, clinical prudence suggests being alert to the existence of these behaviors and managing such patients conservatively.
Defining Medically Self-Sabotaging Behavior
Medically self-sabotaging behavior is defined as intentionally sabotaging one’s own medical care, driven by an overall psychological need to maintain numerous physical symptoms, whether authentic or not. This behavior correlates with reporting multiple somatic symptoms during a review of systems. In a study involving men and women aged 18 years or older in an outpatient internal medicine clinic, researchers explored this correlation. Participants were approached in the lobby, and exclusion criteria included medical, intellectual, cognitive, or psychiatric symptoms that would preclude the ability to complete a survey. The survey included a demographic query and three items from the Self-Harm Inventory related to medical sabotage: "Have you ever intentionally, or on purpose, prevented wounds from healing," "made medical situations worse on purpose," or "abused prescription medication?" Additionally, a symptom checklist of 35 items was adapted from a preappointment questionnaire. The results of this study provide data supporting the link between these behaviors and multiple somatic symptoms.
Broader Context of Self-Sabotage
Self-sabotage generally refers to behavior that creates problems in daily life and interferes with long-standing goals. Common self-sabotaging behaviors include procrastination, self-medication with drugs or alcohol, comfort eating, and forms of self-injury such as cutting. Individuals are not always aware that they are sabotaging themselves, and connecting a behavior to self-defeating consequences does not guarantee disengagement from it. However, it is possible to overcome almost any form of self-sabotage. Behavioral therapies can aid in interrupting ingrained patterns of thought and action while strengthening deliberation and self-regulation. Motivational therapies can also help reconnect people with their goals and values.
Self-sabotage occurs when a person inhibits their own success through any behavior that undermines their progress or prevents them from reaching their goals. It can affect every aspect of a person’s life, including work and relationships. People may self-sabotage in various ways, such as procrastination, perfectionism, and blaming others. At its core, self-sabotage refers to behaviors or thoughts that keep a person from what they desire most. The internal conflict arises between wanting success and fearing it, manifesting in procrastination, self-doubt, and other self-limiting behaviors. For some people, it is an internal critical voice, a set of emotions, or a visceral response. Some people are not even aware of what they are doing to themselves. It leads to actions, decisions, and thoughts that block us from feeling comfortable, content, or confident.
Common Examples of Self-Sabotaging Behavior
Mental health practitioners have identified common examples of the ways people self-sabotage. Three easy-to-identify examples include procrastination, perfectionism, and self-medication.
- Procrastination: People who self-sabotage often procrastinate. Procrastination is a way to show others one is never ready and to put off a good outcome. This often stems from a fear of disappointing others, failing, or succeeding.
- Perfectionism: Holding oneself to an impossible standard causes delays and setbacks. While aiming for things to go as planned without a hitch seems like a positive strategy, perfectionism hampers success. When something does go wrong, as it inevitably will, perfectionists come undone. They end up feeling ashamed, prone to depression, and feel like they are letting everyone down.
- Self-Medication: This involves using substances like drugs or alcohol to cope with underlying issues, which ultimately undermines well-being and goals.
Psychological Drivers of Self-Sabotage
There are many reasons why a person might act in a way that proves damaging to his or her own well-being. Some individuals spend much of their lives struggling with powerful cravings for food, drink, gambling, or other temptations that come at a painful cost to their health or relationships. Self-esteem, childhood trauma, and a need to maintain control can all cause a person to engage in self-sabotaging behaviors.
Understanding one’s own thought patterns, setting small goals, and seeking support can help an individual overcome the behaviors associated with self-sabotage. If self-sabotaging behaviors begin to affect a person’s daily life and relationships or cause emotional distress, a person may wish to contact a mental health professional.
The Role of Trauma and Control
Childhood trauma is a significant factor in the development of self-sabotaging behaviors. Traumatic experiences can alter a person's self-esteem and their ability to regulate emotions, leading to patterns that undermine their success. The need to maintain control is another powerful driver. When individuals feel a lack of control in their environment or internal states, they may engage in self-sabotage as a maladaptive way to assert autonomy or prevent perceived inevitable failure.
Clinical Implications and Management
The connection between medically self-sabotaging behavior and borderline personality disorder is particularly strong. Because self-harm is a core feature of BPD, medically self-sabotaging behavior can be viewed as a variant of this. The functions of this behavior—eliciting care, controlling negative emotions, and reinforcing identity—align with the interpersonal and emotional dysregulation seen in BPD.
Clinicians in primary care and specialty settings should be vigilant for signs of medically self-sabotaging behavior. The presence of multiple somatic symptoms without clear medical etiology, or a history of wounds failing to heal despite appropriate care, should raise suspicion. The use of specific screening questions, such as those derived from the Self-Harm Inventory, can be a useful tool in identifying these behaviors.
Treatment Considerations
While there is no specific, evidence-based treatment protocol for medically self-sabotaging behavior, general principles of managing such patients involve conservative care and awareness. The documentation suggests that being alert to these behaviors is the primary recommendation. This implies that standard therapeutic approaches for self-harm and BPD may be relevant, although direct evidence is not provided in the source material. Behavioral therapies that focus on interrupting ingrained patterns and strengthening self-regulation could be beneficial. Motivational therapies might help reconnect individuals with their goals and values, potentially reducing the need for self-sabotage.
For individuals engaging in broader forms of self-sabotage, such as procrastination or perfectionism, behavioral interventions are key. These therapies work by helping individuals recognize their patterns and develop new, more adaptive responses. The goal is to move away from behaviors that undermine success and toward actions that support well-being and goal attainment.
Conclusion
Medically self-sabotaging behavior is a significant clinical issue that is more common than factitious disorder and is closely linked to borderline personality disorder and general self-harm behaviors. It represents a "medicalized" form of self-injury that serves functions such as emotional regulation and seeking care. While no specific treatment exists, clinical awareness and conservative management are essential. Broader self-sabotage, including procrastination and perfectionism, affects many areas of life and can be addressed through behavioral and motivational therapies. Understanding the psychological roots, such as low self-esteem, trauma, and the need for control, is vital for effective intervention. Individuals experiencing distress from these behaviors should seek support from mental health professionals.