Dissertations, Theses, and Capstone Projects

Date of Degree


Document Type


Degree Name





I. H. Paul

Committee Members

Louis Gerstman

Diana Fosha

Subject Categories

Clinical Psychology


The syndrome of delicate self-mutilation is reviewed with emphasis on the psychoanalytic interpretations that have been offered to explain this behavior. These interpretations generally find a symbolic meaning in this symptom, while also noting the pre-verbal level of development that is a marked aspect of these patient's functioning. The alternate hypothesis is offered that delicate self-mutilators suffer from a deficit in their capacity to create symbolic symptoms.

The work of Joyce McDougall with patients manifesting sexual perversions and psychosomatic symptomology is reviewed. She hypothesizes that these patients suffer a deficit in their capacity for symbolic functioning, and she coins the notion of the "action symptom", which is a 'sign' rather than a 'symbol', to explain this deficit.

The 'sign' and the 'symbol' are distinguished with respect to both psychoanalysis and philosophy.

McDougall's notion of the action symptom is then related to the differing functions of the 'sign' and the 'symbol'.

Finally, the population of delicate self-mutilators is compared to the population described by McDougall with respect to their capacity to create symbolic symptoms. The considerable similarity between these populations is found to warrant consideration of the hypothesis offered in this dissertation.


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