Self-immolation in borderline personality disorder: A cultural perspective

To the Editor

Self-immolation has been reported in patients with borderline personality disorder (Scully and Hutcherson, 1983). Importantly, there is an increased risk of self-immolation because of social factors such as social isolation and family issues during the COVID-19 pandemic (Rezaie and Schwebel, 2020). We herein present a case of self-immolation in borderline personality from a cultural perspective. We have obtained informed consent from the patient.

Case

A 35-year-old single unemployed Vietnamese woman with borderline personality disorder and depression was hospitalised following an attempt to self-immolate in a petrol station. She presented with high suicidal risk and so she was treated in intensive care area initially. She subsequently improved with acute treatment that included antidepressant and a course of electroconvulsive therapy. Five years ago, there was an attempt of self-immolation that resulted in significant burns, admission to a burn ward and scars.

When her mental state improved, we attempted to understand her reasoning behind self-immolation. She informed that she practised Buddhism, and she had witnessed a monk who self-immolated for the purpose of re-birth. Because her life involved great suffering due to psychiatric illnesses and life circumstances, she wanted to die from self-immolation so that she would have a better life when reborn.

Discussion

Recurrent self-immolation behaviour that we noted in our patient has not been reported before. Self-immolation in borderline personality disorder (Scully and Hutcherson, 1983) has been documented.

Self-immolation of a Vietnamese Buddhist monk in 1963 is a well-known socio-political event, but suicide is not endorsed in Buddhism as it can hinder spiritual progress or karma (Kelly, 2011). Thus, our patient’s explanation to carry out self-immolation appears to represent a self-generated theory that is not justified by the religion but by the expected hope for a new birth with a better self in the background of cultural examples. Overall, we would like to underscore the need to explore socio-cultural factors of suicidal behaviour in patients.