Self-harm and suicidal thoughts are a troubling part of many mental illnesses, but for those struggling with borderline personality disorder (BPD), the risk is extreme.
In fact, self-harm and suicide attempts are so prevalent in BPD that it is the only mental disorder that includes such behaviors as part of its diagnostic criteria. Almost 80% of those with BPD report a history of suicide attempts, and suicide deaths range between 8-10%. This rate is 50 times greater than that found in the general population, according to a 2014 analysis of BPD research by the Substance Abuse and Mental Health Services Administration (SAMHSA).
Then there is self-destructive behavior—cutting, burning, hitting, hair-pulling, head-banging, and skin-picking. More than three-quarters of those with BPD engage in at least one of these actions, with a 2008 study putting the number closer to 90%. The reasons vary and can overlap but most commonly include:
- An attempt to shift the pain from the mental to the physical;
- To feel something or “more real”;
- To express anger or frustration or, conversely, to keep emotions in check;
- As self-punishment;
- As a plea for attention or help.
Such self-harm classifies as nonsuicidal self-injury and doesn’t usually involve an intent to die. Instead, it becomes an attempt to use pain to deal with pain.
Living Life at Extremes
A look at the realities of BPD sheds light on its ability to fuel such destructive reactions. Characterizing this complex illness are an intense fear of abandonment, impulsivity, risk-taking, an unstable sense of self, angry outbursts and overreactions (especially to criticism), and emotions that move from one extreme to another. This can set the stage for volatile personal relationships in which the people in their lives (including themselves) are on pedestals at one moment and then off in the next.
BPD can also bring feelings of emptiness and detachment, as well as paranoia, especially in times of stress.
Estimates on the prevalence of BPD vary, but we now know it to be more common than we once realized. Some researchers put the number at almost 6% of the population. It often, but not always, comes with a history of childhood trauma such as early neglect or physical or sexual abuse.
Though women more often receive diagnoses than men, research now suggests it occurs in the male and female populations in equal measure. The past tendency to view BPD as a women’s issue is likely due to the fact that it seems to hit women harder, with higher levels of mental and physical disability, and to come with different co-occurring conditions. For example, research shows that women with BPD more often have eating disorders, anxiety, major depression and post-traumatic stress disorder. Men with BPD, on the other hand, have higher instances of drug and alcohol addiction and antisocial personality disorder, and are more likely to show explosive anger and have higher levels of risk seeking. These traits—along with gender bias—may have led to a mischaracterization of such males as having personality problems other than BPD.
It’s because BPD shares such links and commonalities with other issues that people often misunderstand it, making it important to turn to a licensed mental health professional for a diagnosis.