Self-Mutilation and Borderline Personality Disorder

Depressed teen
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The content of this article may be very triggering if you engage in self-mutilation. Please consider this carefully before reading on.

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 her.

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.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

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 has shown that most people self-mutilate in order to help regulate internal experiences such as intense emotions, thoughts, memories, and physical sensations.

Who Engages in Self-Mutilation?

Unfortunately, self-mutilation is a common behavior, particularly among those with BPD. One study found that, among college students (not necessarily with BPD), attachment issues (insecure attachment, childhood separation, and emotional neglect) along with sexual abuse and dissociation, were significant risk factors for self-injury, and that the risk factors were gender-specific.

Evidence suggests that significant gender differences exist in prevalence, method, and where on the body the self-harm is inflicted. Females reported higher numbers of the behavior overall, more cutting and scratching, and more damage to arms and legs than males. Males reported more burning and self-hitting, and more damage to the chest, face, or genitals.

In another study of youth in the third, sixth, and ninth grades in one community, ninth-grade girls were most at risk, with a similar injury pattern of more cutting and scratching, and engaging in self-harm three times as much as 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.

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. 

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