Borderline personality disorder(BPD) is a relatively common psychiatric disorder, characterized by emotional instability, impulsivity, fear of abandonment, and dissociation. Self-harm can occur as a result of these symptoms, but also due to frustration from external events and the overwhelming amount of emotions that people with BPD experience. The correlation between the disorder and the urge to self-harm is that it makes their unbearable psychological pain into a more manageable form of physical pain.
What leads someone with BPD to self-injurious episodes?
Self-injury in BPD is most common in women. It starts in early adolescence and peaks between the age of 18 and 24. The cause of self-injury in this category is often a buildup of frustration from external events or an overwhelming amount of emotions. These emotions might be anger, dysphoria(a state of generalized unhappiness and frustration), and despair.
Borderliners struggle with chronic feelings of emptiness and states of emotional hollowness that leave them feeling drained from life. The injurious episode has an impulsive nature and leads to a release in tension, which is what the sufferer is ultimately seeking. Research has shown that most patients that suffer from BPD experience reduced pain during a self-injurious episode. And half of the people feel no pain(these sufferers are also called "analgesic patients").
Not only is self-injury registered as painless for a big part of the sufferers, but what follows after self-harm is a rush of endorphins similar to what you would get while on drugs. Endorphins are happiness hormones. Self-harming quite literally becomes a drug to which borderlines can grow dependent and resistant.
Resistance leads them, just like a drug, to search for more severe and dangerous forms of self-harm that can cause more pain, and doing so releases even more endorphins.
Simply put, people with BPD engage in self-injury to make their unbearable psychological pain into a more manageable form of physical pain. In some ways, self-harm can give the individual a sense of control, something that often feels lacking when suffering from a mental illness. The reason why this form of relief is so common in borderliners is that their inner emotional turmoil is far louder than what neurotypical people experience, so they need to find a way to release the pain.
For this reason, they feel a higher need to escape their psychological pain, and self-harm is sadly often their answer. But it doesn't have to be.
Is it possible to have BPD without self-harming behavior?
The answer is yes. Someone with BPD does not necessarily have to practice self-harm physically. However, it is important to realize that they often hurt or sabotage themselves in other ways. Inadequate self-care can be seen as a form of self-harm.
Examples of this are:
Staying in a toxic relationship
Self-harm without suicidal intentions
When self-harm does not have suicidal intention, it is called Non-Suicidal Self-Injury (NSSI). NSSI is extremely forthcoming in borderlines, with an incidence rate of 65-80%. Even though most forms of self-harm are non-suicidal, sometimes death can be incidental; for example, if cutting goes wrong, an excessive amount of blood might be lost, which can lead to death.
The difference when it comes to how NSSI and suicide are viewed by others is that ongoing self-harm is condemned and judged negatively, while suicide attempts gain concern and support from the community. This makes it even harder for those engaging in self-harm.
What is self-harm?
Self-harm can be subdivided into self-injury and self-mutilation.
Self-injury refers to moderate forms of self-inflicted injury like cutting, carving, and burning of the skin. Headbanging, biting, and picking the skin until it bleeds are also common. People who self-harm sometimes intentionally keep their wounds from healing to be able to relive the experience over and over.
Self-mutilation is somewhat more severe and includes actions such as castration and amputation of body parts. The first type of self-harm is more common in borderlines, while self-mutilation is found more commonly in schizophrenia and psychotic breakdowns.
Signs someone with BPD is self-harming
It might not always be clear if someone is self-harming, but there are a couple of signs to take into consideration when trying to spot someone that has engaged in self-injury: you should look for visible scars, often on arms and legs. If the limbs are often covered by long sleeves and pants, and if the individual refuses to wear revealing clothes, it could also be a sign that he/she is self-harming.
If you find bloody tissues or bloodstains on the clothes of the individual, or if he/she expresses excessive secrecy like long periods alone in a room, that could also be a sign. Finally, you wanna look out for emotional rollercoasters, social isolation, and lack of self-worth.
BPD treatments for self-harm
Thankfully, self-harming behavior is treatable. There are many techniques used by professionals; Commonly used is talk therapy, used to discover what is troubling the patient. Self-harm is frequently committed by BPD sufferers due to their emotional turmoil. If not the emotional turmoil, we have seen that the chronic emptiness and sense of disassociation and distance also play a role in the reasons for self-harm. A therapist can help BPD patients understand why they feel the way they are feeling. This can give the patient some relief. Additionally, the therapist can help with different types of techniques such as:
Physical Exercise (Non-Competitive)
Playing/Listening to Music
The therapist can then go on and teach the patient about the Subjective Units of Distress Scale (SUDS Scale), which explains how relaxed/distressed the patient is feeling at that moment through a scale (0 = most relaxed, 100 = the most distressed).
This scale can be used before and after practicing one of the skills listed above to see how it affects the individual.
Another therapy is called Negative Replacement Behavior, which replaces self-harming with other actions such as:
Snapping an elastic band on the wrist to mimic the pain, but without the cutting
Marking the body with a red felt-tipped marker
Stroking the body with a brush