The Risk of Self-Harm Among People Who Have Borderline Personality Disorder

The average life expectancy of people with borderline personality disorder (BPD) may be as much as 20 years shorter than the expected lifespan of those who do not have this condition.

The prevalence of suicidality among people who have BPD is one of the main causes of this disparity. But it is not the only one. Impulsivity, poor self-care, substance abuse, and poor diet are among the many other influences that experts believe contribute to the early death rate among people with borderline personality disorder.

An elevated risk for self-harm may also be a contributing factor.

Self-harm is not limited to people who have borderline personality disorder. Millions of Americans – including many who do not have this disorder – intentionally injure themselves every year. However, the likelihood that a person will engage in self-harm is much greater among people who have BPD than it is among the general public.

What Is Self-Harm?

Self-harm can be defined as intentionally causing pain or injury to one’s own body, without conscious suicidal intent. Self-harm is also referred to by other terms, including self-injury, non-suicidal self-injury (NSSI) and self-mutilation.  

People who engage in self-harm may use a variety of techniques to hurt themselves. One of the most common forms of self-injury is cutting. This typically involves the use of razor blades, knives, pieces of glass, or other sharp objects to cut one’s own skin.

To hide their behaviors from others, people who engage in cutting often repeatedly cut their thighs, upper arms, chest, stomach, and other areas that can be easily covered with clothing.

Other common types of self-injury include:

  • Burning the skin
  • Inserting needles or other objects under the skin
  • Hitting one’s head or other body parts against hard objects
  • Punching oneself
  • Pulling out one’s hair
  • Drinking poisonous liquids

Self-harm is most common among adolescents, but it can occur at any age. The American Psychological Association (APA) reports that about 17% of adolescents and about 5% of adults engage in self-harm.

Risk factors for self-harm include gender (the behavior is more common among women than among men), a history of being bullied or harassed, low self-esteem, being a member of the LGBTQIA+ community, and having certain mental health disorders.

Self-Harm & Borderline Personality Disorder

Borderline personality disorder (BPD) is a complex, potentially debilitating mental illness. The primary characteristics of BPD are impulsivity and instability. People who have borderline personality disorder often exhibit symptoms such as the following:

  • Dramatic swings in self-confidence and sense of self
  • History of brief, intense, and highly unstable relationships
  • Frantic efforts to avoid being abandoned
  • Recurring threats of suicide, suicidal behaviors, and self-harm
  • Inappropriate and uncontrolled anger
  • Episodes of paranoia and dissociation
  • Impulsive spending, gambling, substance abuse, and sex

The symptoms listed above are from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). According to the DSM-5, self-harm is not a requirement for a diagnosis of borderline personality disorder. However, research indicates that self-injurious behaviors are extremely common among people who have BPD.

For example, a 2008 article in the French journal L’Encéphale found a strong link between self-harm and borderline personality disorder. The authors of this article reviewed literature about BPD, suicide, and self-harm that had been published over a 26-year period. Their findings included the following:

  • Between 50% and 80% of people with borderline personality disorder engage in self-harm. (As noted in the previous section, the rate of self-harm among the general public in the United States is less than 18%.)
  • Repetitive self-harm is common among people with borderline personality disorder. More than 40% of BPD patients have harmed themselves more than 50 times.

Self-Harm, BPD, & Suicide

Suicide is a significant concern for people who have borderline personality disorder. A 2019 article in the journal Medicina reported that as many as 10% of people with BPD will die by suicide. For comparative purposes, the suicide rate in the United States in 2020 was about 0.014%.

Although acts of self-harm can accidentally be fatal, it is important to understand that people who engage in this behavior are not trying to end their own lives.

In fact, the authors of the 2008 study in L’Encéphale found that people with BPD may use self-harm to bring themselves out of dissociative states that could otherwise lead to suicide. Thus, in certain circumstances, self-harm can have a protective benefit. However, the study’s authors also noted that self-harm can also be a predictive factor for suicide among patients with borderline personality disorder.

Within the population of patients with BPD, the authors reported, people who engaged in self-harm were more than twice as likely to attempt suicide than were those who did not have a history of harming themselves.

A possible reason for this is that once a person with BPD no longer experiences relief through self-harm, they may be more likely to act on their suicidal urges.

Why Do People With BPD Engage in Self-Harm?

The authors of the 2008 study in L’Encéphale suggested that people who have borderline personality disorder often harm themselves for the following reasons:

  • To experience relief from negative mood
  • To reduce distress
  • To end a dissociative state
  • To attract the attention of caregivers
  • To express their emotions

In 2020, the journal Frontiers in Psychiatry published a small study from Italy that also addressed the question of why people with BPD have such a high risk of self-harm. This study focused on self-harm among people with bipolar disorder as a means of reducing the intensity of a dissociative state.

The pain of self-harm, the authors proposed, may help people with BPD regain a sense of ownership over their bodies when they are having dissociative symptoms. It can also signal to the individual that they are regaining control of their thoughts and behaviors, which the authors referred to as having “a sense of agency.”

Self-Harm & Dissociation

Dissociation causes a person to feel separated from themselves and their environment. According to a 2021 study in the journal Current Psychiatry, about 80% of people with BPD have dissociative symptoms. During a dissociative episode, a person may experience the following:

  • Feeling that they have become detached from their body, their thoughts, and their emotions
  • Feeling that they are floating away or observing themselves from a distance
  • Believing that the people and objects around them are not real
  • Being unable to feel pain
  • Not being able to remember who they are or where they came from
  • Speaking and acting as though they are one or more different people
  • Feeling as though they have lost control of their identity

The 2020 Italian study from Frontiers in Psychiatry involved 20 adults with borderline personality disorder and a control group of 20 adults who had no history of mental illness. The researchers divided the subjects with BPD into two groups: nine who were currently exhibiting signs of self-harm and 11 who were not engaging in self-injurious behaviors.

Among the researchers’ findings:

  • Among the adults who had BPD, dissociative symptoms were greater in the self-harm group.
  • Clinical reports suggest that the study’s subjects experienced the onset of dissociative symptoms before they engaged in acts of self-harm.
  • Self-reporting from the study’s subjects revealed that self-harm brings about “a new set of emotional and physical sensations which allow the individual to feel alive again.”
  • The fact that people who self-injure continue to experience episodes of dissociation indicates that self-injury does not lead to a reduction in future dissociative symptoms.

The Italian researchers also noted that self-harming behaviors among people with borderline personality disorder may point to greater challenges.

“Our data suggest that BPD patients who enact [non-suicidal self-injury] behaviors present a more complex psychiatric profile than those patients who do not engage in NSSI behaviors,” they wrote.

Help for Borderline Personality Disorder & Self-Harm

Crownview Psychiatric Institute specializes in treating adults whose lives have been disrupted by complex mental health concerns such as borderline personality disorder, dissociative symptoms, and the urge to engage in self-harm.

At our center in Southern California, clients benefit from a multifaceted approach that incorporates medication, therapy, adjunct services, education, and wraparound support services. We offer a safe and welcoming environment where clients can receive personalized clinical services while improving their ability to function within a supportive community.

To learn more about our programs and services, or for help determining if Crownview is the right place for someone that you care about, please contact us directly at your earliest convenience.