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The Connection Between Borderline Personality Disorder and Self-Harm

Borderline Personality Disorder (BPD) is a complex mental health disorder marked by emotional instability, intense interpersonal relationships, and a distorted sense of self. It is a difficult illness to live with, and many who experience it do not receive the care and treatment needed to live a full life with BPD. 

For many with BPD they may resort to self-harm for a variety of reasons, causing great distress not only to themselves, but also those who love them. Understanding the connection between this coping strategy and BPD is crucial for effective treatment and support, offering hope and recovery for those affected.

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Understanding Borderline Personality Disorder (BPD)

Borderline Personality Disorder (BPD) is a mental health disorder that is characterised by pervasive instability in moods, behaviour, self-image, and functioning. These disturbances often result in impulsive actions and unstable relationships with others. 

Some key aspects of BPD include: 

  • Emotional Instability: Rapid, intense mood swings that can last for hours or days, often triggered by interpersonal stresses.
  • Impulsive Behaviours: Engaging in behaviour that is potentially self-damaging, such as reckless driving, binge eating, or substance abuse.
  • Intense Interpersonal Relationships: Patterns of unstable and intense relationships, swinging from idealisation to devaluation.
  • Fear of Abandonment: People with BPD have severe dread of being alone or abandoned, and this fear can lead to frantic efforts to avoid real or imagined abandonment.

The core of BPD often lies in significant difficulties in emotion regulation. Individuals with BPD experience emotions intensely and for extended periods of time, and it is often harder for them to return to a stable baseline after an emotionally triggering event.

In the United States, BPD affects about 1.6% of the adult population, though some estimates are as high as 5.9%. The disorder is often misunderstood and stigmatised, which can lead to difficulties in diagnosis and treatment. 

Diagnosing BPD can be complex due to its overlap with other mental health disorders such as bipolar disorder, depression, and anxiety disorders. It is important to note that those under the age of 18 years old cannot be diagnosed with a personality disorder, as many of the typical behaviours overlap with standard adolescent development. Most professionals will avoid diagnosing BPD in individuals younger than 25 years old. 

Research suggests that BPD results from a combination of genetic and environmental factors. Environmental factors, such as childhood trauma, neglect, and abuse, play a critical role in the development of the disorder.

The Connection Between BPD and Self-Harm

Self-harm includes any behaviour where someone intentionally injures themselves as a way to cope with or express deep distress. This may include behaviours such as cutting, burning, and other forms of physical injury. 

However, it may also include putting oneself in risky situations whereby they may, or will likely, come to harm. While not exclusive to BPD, self-harm is notably prevalent among those suffering from the disorder. Part of this is due to the impulsivity associated with BPD also plays a critical role, as the immediate decision to self-harm often occurs in the heat of a distressing moment.

Self-harm can serve multiple functions as a coping strategy. Those suffering BPD experience intense emotional episodes of anger, anxiety, and distress that can often feel intolerable. Self-harm can offer a physical means of distraction oneself from emotional pain through physical pain. 

Some people describe this sensation as a ‘relief’, that their emotional distress was immediately calmed by the act of physical pain. For others, the physical pain distracted them enough to where they could tolerate their emotional distress or were temporarily distracted from their distressing thoughts. 

The second reason those with BPD are more likely to engage in self-harm, is that they perceive the act of self-harm as a way to mediate and influence relationships within their lives. For example, they are unclear about how to ‘make’ someone show they care about them, so they engage in self-harm in order to create a scenario in which they receive the love and care that they desperately crave. 

Stigmatising language such as ‘attention seeking’ has been used to describe this behaviour in the past. However, with a more empathetic lens, we can view this as the attempts of a person who struggles to understand affection and relationships to connect with others. There is something missing from them emotionally and they are using whatever means necessary to attempt to fill it. 

Furthermore, it is important to remember that self-harm is a practice that is millenia old – still used in some indigenous cultures to express grief, loss, anger, and other intense emotions. While self-harm is still an unhealthy and dangerous coping strategy, it is not a ‘new trend’, and we have much evidence to suggest that this is a behaviour humans resort to when all other avenues are exhausted. 

Understanding the Why: Causes and Triggers of Self-Harm in BPD

Self-harm in BPD can be triggered by perceived rejection, criticism, or loneliness. These triggers are profoundly distressing due to the intense fear of abandonment and unstable relationships characteristic of BPD. Many individuals with BPD also report a history of trauma and abuse, which can exacerbate tendencies towards self-harm as a coping mechanism.

Strategies for Managing and Treating Self-Harm in BPD

Effective management and treatment of self-harm in individuals with Borderline Personality Disorder require a multifaceted approach. This includes various therapeutic modalities, medication management, and supportive interventions tailored to meet the unique needs of each person. Below are some strategies that have proven effective:

Dialectical Behavior Therapy (DBT)

DBT is a specialised form of cognitive-behavioural therapy specifically designed to treat personality disorders. It focuses on teaching skills in four key areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. DBT helps individuals identify and change harmful behaviours by incorporating coping skills to manage distress without resorting to self-harm. Its effectiveness in reducing self-harming behaviours has been well-documented, making it a cornerstone of BPD treatment.

Cognitive Behavioral Therapy (CBT)

While DBT focuses more on regulating emotions and behaviours through acceptance and change, traditional CBT helps in identifying and challenging distorted thinking patterns and beliefs. It teaches individuals to replace harmful behaviours with healthier ones and is effective in treating a variety of mood and anxiety disorders that can co-occur with BPD.

Medication Management

While there are no medications specifically approved for BPD, medications are often used to treat co-occurring symptoms or conditions, such as depression, anxiety, or mood swings. Commonly prescribed medications include antidepressants, mood stabilisers, and at times, antipsychotics. A psychiatrist can tailor medication types and dosages to an individual’s specific needs, which can help stabilise mood swings and reduce impulsivity.

Psychoeducational Interventions

Psychoeducation involves educating the individual with BPD, and their loved ones, about the disorder and its management. This type of intervention helps patients and their families understand the nature of BPD and the reasons behind behaviours like self-harm. Knowledge empowers patients and families to recognise early signs of distress and intervene before self-harming behaviours occur.

Support Groups and Peer Support

Support groups can provide a safe space for sharing experiences and coping strategies among individuals facing similar challenges. Peer support, especially from those who have made progress in managing their symptoms, can be particularly motivating and comforting.

Crisis Management Plans

Developing a crisis management plan is vital for individuals prone to self-harm. This plan includes identifying triggers, early warning signs of emotional distress, and strategies that have been effective in past crises. It also involves listing contact information for mental health professionals, trusted individuals, and crisis helplines.

Family Therapy and Involvement

Involving family members in therapy can be beneficial as it helps them understand the disorder, recognise symptoms, and learn how to support their loved one effectively without reinforcing self-harm behaviours. Family therapy can improve communication, reduce family conflict, and strengthen family functioning.

By employing a comprehensive and personalised treatment plan that combines these strategies, individuals with BPD can learn to manage their emotions better and reduce or eliminate self-harm behaviours. These interventions, provided in a consistent and supportive environment, can lead to significant improvements in overall well-being and quality of life.

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Clinic Les Alpes Can Help

Understanding the link between Borderline Personality Disorder and self-harm is essential in fostering empathy and providing effective support. It’s important for individuals affected by these conditions to recognize their ability to lead fulfilling lives through appropriate treatment and support. 

We encourage anyone struggling with BPD or self-harm to reach out for help and begin their journey toward recovery. Clinic Les Alpes can offer personalised individual treatment plans for people with BPD; for more information, please do not hesitate to get in contact in full confidentiality.

Clinically Reviewed By

Brittany Hunt

Brittany Hunt is an internationally experienced clinician, specialised in treating addictions and co-occurring disorders. Having worked in the public and private sector, she utilises holistic and evidence-based approaches designed to empower the patients in their recovery journeys. A graduate of The University of Auckland, she has a Bachelor of Health Sciences majoring in Mental Health and Addictions, a diploma in Psychology and Counselling and a Post-Graduate degree in Health Sciences, majoring in Addictions. She is a fully registered practitioner under the Drug and Alcohol Association of Aotearoa New Zealand (DAPAANZ).

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