What Predicts Self-Harm in People With Borderline Personality Disorder?


The majority of people affected by borderline personality disorder (BPD) engage in a form of self-harm known as non-suicidal self-injury (NSSI). Underlying reasons for this behavior can vary widely from person to person. In a study published in the journal Borderline Personality Disorder and Emotional Dysregulation, researchers examined the factors that help predict non-suicidal self-injury in young adults affected by BPD. The researchers concluded that some classic borderline personality disorder symptoms are linked to increased risks for NSSI, while the presence of other BPD symptoms apparently reduces the risks for self-harm participation.

Borderline Personality Disorder

All personality disorders are forms of adult mental illness centered on habitual thoughts and behavioral patterns that harm affected individuals and reduce their ability to function in daily social life. Specific problems that distinguish borderline personality disorder include loss of the ability to regulate changes in thinking or mood, loss of the ability to control moment-to-moment impulses and loss of the ability to establish and maintain mutually beneficial relationships with other people. The American Psychiatric Association has officially recognized the existence of BPD since 1980. The condition’s name is an outdated relic of a once-popular theory that placed affected people “on the border” of a diagnosis for schizophrenia or other disorders capable of producing a highly damaging mental state called psychosis.

Doctors know relatively little about the underlying causes of borderline personality disorder. However, the illness apparently has a prominent genetic component and passes largely through family bloodlines. A BPD diagnosis requires the presence of at least five out of nine possible symptoms. In addition to suicidal or self-harming behavior, these symptoms include an inability to develop an accurate sense of self, frequent displays of impulsive conduct, volatile and unpredictable moods, a recurring or persistent sense of meaninglessness, the development of paranoia or dissociation (separation from the “self”) in stressful situations and the maintenance of chaotic or unstable relationships with family, intimate partners or acquaintances.

Non-Suicidal Self-Injury

The term non-suicidal self-injury describes any form of significant self-harm that’s not intended to result in loss of life. Specific potential forms of self-harming behavior include cutting your skin with knives or other sharp objects, burning your skin, punching yourself, headbutting stationary objects and scratching through the top layers of your skin. Some people engage in a single form of NSSI, while others engage in multiple forms. While some forms of non-suicidal self-injury are relatively minor, others merit the prompt attention of a medical professional. However, most self-harmers do not seek medical attention for their injuries.

What Predicts Self-Harm?

In the study published in 2014 in Borderline Personality Disorder and Emotional Dysregulation, researchers from Temple University and Mississippi State University used self-reports submitted by 724 young adults attending college to identify some of the underlying factors that help predict self-harming behavior in people with borderline personality disorder. The researchers undertook this project, in part, because no one really knows why 65 percent to 80 percent of all people diagnosed with BPD engage in at least one self-injuring activity. Before beginning the project, their working theory was that a loss of emotional regulatory control largely accounts for involvement in NSSI.

The researchers concluded that four specific borderline personality disorder symptoms are statistically associated with heightened risks for involvement in non-suicidal self-harm. These symptoms are a previous history of suicidal thinking or suicidal behavior, recurring participation in impulsive behavior, having an unstable or inaccurate sense of self and having recurring or persistent feelings of meaninglessness. The researchers also concluded that the development of dissociation tends to increase the frequency of self-harming behavior in people affected by BPD. Conversely, risks for non-suicidal self-injury generally go down in people with borderline personality disorder who have prominent difficulties maintaining stable relationships.

The study’s authors found that BPD-affected women enrolled in college have higher chances of participating in self-harm than their male counterparts. In addition, they found that BPD-affected individuals with a European-American racial/ethnic background have higher chances of participating in self harm than their counterparts from other racial/ethnic backgrounds. The authors also found that, generally speaking, people with borderline personality disorder who engage in non-suicidal self-injury typically have more overall BPD symptoms than their counterparts who don’t engage in non-suicidal self-injury. In descending order, the most common forms of self-harm among the study enrollees were cutting, headbutting or head banging, self-pinching and skin scratching.

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