Bloodletting, Bulimia Nervosa and Borderline Personality Disorder

Some recent case-reports in the psychiatric literature have presented patients who bloodlet and suggested that theirs is a rare pathological behaviour which is part of the purgative psychopathology associated with bulimia nervosa. Other reports have construed bloodletting as a self-mutilative behaviour and indicative of severe personality disorder. We review the literature to ascertain whether it supports either of the above claims or whether there are patients who conform to both or neither stereotype. We present two further cases, which highlight the importance of (1) eliciting Axis I and Axis II psychopathology in the assessment of all patients and (2) eliciting the patient's view of the motivation and meaning of the behaviour. There is strong evidence to suggest that bloodletting is not solely a feature of eating disorders and that it may be more generally related to personality disorder, where, even in the absence of Axis-I pathology, it may be an indicator of severity of psychopathology. *c 1998 John Wiley & Sons, Ltd and Eating Disorders Association.