Self-Mutilation and Borderline Personality Disorder

Self-mutilation is very difficult to understand if you have never experienced the urge to engage in this behavior yourself. If you have a friend or family member with borderline personality disorder (BPD) who self-mutilates, it can be scary, confusing, and frustrating. By understanding why self-mutilation occurs, you can help your loved one cope with these urges and act as a support network for that individual.

What Is Self-Mutilation?

Self-mutilation involves the direct and deliberate destruction or alteration of the body. Examples of these behaviors include cutting, burning, sticking oneself with needles, and severe scratching. The research frequently uses the term nonsuicidal self-injury (NSSI).

Self-mutilation is usually very different than other self-harming behaviors. Research has shown that individuals who engage in self-harm are usually not trying to kill themselves when they engage in the behavior, although some may report that they have mixed feelings about the intent of the act.

This is not to say that people who engage in self-mutilation are not suicidal; many people who self-mutilate also have suicidal thoughts or even make suicide attempts. In addition, in cases of very severe self-mutilation, people have died from their injuries.

Why People Engage in Self-Mutilation

Many believe that people engage in self-mutilation to get attention. This is a myth. Most people who self-harm do it in private and make sure that the marks or scars are hidden.

Self-harmers often will wear long sleeves to cover these signs. They are likely ashamed of the behavior and keep it a secret. Particularly for those with BPD who have rejection sensitivity, they worry continuously about people finding out about their secrets.

Research suggests that people with borderline personality disorder may engage in self-injury as a way to increase their sense of personal agency. BPD can cause people to experience dissociative episodes and an altered sense of body awareness. Self-mutilation, therefore, acts as a maladaptive coping strategy for people with BPD who are struggling struggling with dissociation and feelings of agency. 

Who Engages in Self-Mutilation?

Unfortunately, self-mutilation is a common behavior, particularly among those with BPD. One study found that risk factors for deliberate self-harm included suicidal ideation, abuse and neglect during childhood, and comorbid mental health conditions.

Past research suggested that self-mutilation was more common in women and girls. However, there is variability in the findings, and some research indicates it may occur at equal or higher rates in men and boys.

People who have experienced maltreatment during their childhood, such as through sexual abuse or neglect, or who were separated from a caregiver in childhood, are at greater risk for self-mutilation than the general population.

Risk Factors for Self-Mutilation

Factors that can increase the risk for self-mutilation include:

• Age: Self-mutilation may be more common in adolescents and young adults
• Gender identity and sexual orientation: Self-injurious behavior occurs more frequently among LGBTQIA+ people, often due to higher rates of bullying, abuse, and discrimination
• Trauma: People who have experienced child abuse and trauma have a higher risk of engaging in self-mutilation
• Bullying and isolation: People who are bullied or rejected by their peers are more likely to engage in non-suicidal self-injury
  

Related Conditions

People with BPD have a higher risk for self-mutilation, but it can also occur in other conditions, including:

• Anxiety
• Bipolar disorder
• Conduct disorder
• Depression
• Eating disorders
• Gender dysphoria
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Substance-use disorders

Treatment for Self-Mutilation

Because self-mutilation is often an attempt to manage intense feelings, cognitive-behavioral treatments for self-mutilation focus on helping the person find new, healthier ways of managing emotions and thoughts.

For example, one cognitive-behavioral treatment for borderline personality disorder, dialectical behavior therapy, addresses unhealthy attempts at coping by helping the patient learn and practice a new set of coping skills.

In some cases, a doctor may prescribe medications to help regulate emotions and feelings and decrease the urge to self-harm.

When a Friend or Loved One Self-Mutilates

If you are going to talk to your friend or loved one about self-mutilation, it's important to do it in a non-judgmental fashion. Approaching them calmly and with care can make the person feel heard and understood.

Before talking with a loved one, it may be a good idea to consult with a therapist who specializes in treating BPD and self-mutilation. He can give you professional advice on the best way to approach the situation without frightening or upsetting your loved one.

Resources

If you or someone you know is struggling with self-mutilation, there are a variety of treatment resources available including finding a therapist to talk to. 

If you or someone you know is self-harming or having suicidal thoughts, call 988 to talk to a trained counselor. If you or a loved one are in immediate danger, call 911.

You can also contact the Crisis Text Line by texting 741741 to speak to a trained crisis counselor via text message.

LGBTQ+ youth who are coping with self-harm can contact the Trevor Project's Lifeline at 1-866-488-7386.