Many people with borderline disorder engage in self-injurious behaviors such as cutting, burning and small drug overdoses. Cutting is by far the most common act of this type of behavior. About 9 percent of people with the disorder commit suicide. The most frequent means is by drug overdose. Both types of behavior may occur in the same individual. Cutting behaviors double the risk of suicide in people with borderline disorder.
Self-Injurious Behaviors
In addition to cutting and burning themselves, and taking small drug overdoses, people with borderline disorder hit themselves, pull out their hair, scratch their skin to the point they open wounds, and injure themselves in other ways. Most people with the disorder who injure themselves report that they do so mainly to decrease the intense emotional pain they experience. Feeling empty inside may also lead to self injurious behaviors. Remarkably,it is often reported that the first time cutting and other self injurious behaviors occurred, the idea just came to the indivdual. Finally, they report that these acts usually do result in brief emotional relief.
It is important that family and other loved ones understand that this is the main motive of self injurious behaviors, not primarily to manipulate the situation or the people around them, though this is often a secondary motive.
Risk Factors for Suicidality
There are a number of factors that increase the risk that a person with borderline disorder will commit suicide. Although nothing can be done to reverse some of these factors, others are highly treatable, and deserve immediate attention.
- co-occurring disorders
- antisocial personality disorder (higher in males)
- major depression
- substance abuse*
- personality characteristics
- impulsive aggression
- poor emotional control
- hopelessness
- history and severity of childhood sexual abuse
- age over 30 years
- number of prior self-injurious behaviors and suicide attempts
- no prior treatment, or extensive and unsuccessful treatment history
Prevalence Across the Life Cycle:
Self-injurious behaviors do not appear to decrease or “burn out” with increasing age in people with borderline disorder, as do other aggressive and impulsive behaviors.
Management of Self-Injurious Behaviors and Suicidality
General Treatment Interventions for Self-Injurious Behaviors and Suicidality:
- careful evaluation
- determine the level of intent and risk of self-injurious behaviors and suicide – overt and unstated
- directly involve the patient and family in the process of treatment
- treat at the least restrictive level of care for the shortest period of time indicated
- aggressively treat all co-occurring disorders
- modify the treatment to accommodate the significant increase in severity of borderline disorder symptoms
- highly structure the environment
- identify and promptly address precipitating events
- assure involvement and coordination of the entire treatment team, including the family
- continue to balance risk vs. reward
Specific Treatment Interventions: Medications
Purposes
- reduce or eliminate co-occurring disorders, such as major depressive episodes, substance abuse, ADHD and anxiety disorders
- reduce core symptoms of borderline disorder: e.g., emotional dysregulation; aggressive-impulsivity; and cognitive-perceptual impairment
Specific Treatment Interventions: Medications-often as needed (PRN) dose of the antipsychotic agent being used; and crisis sessions of Psychotherapy
Purposes
- reduce self-injurious behaviors and suicidality
- decrease the frequency of hospitalizations
* Note: If you have borderline disorder and have a tendency to abuse alcohol or drugs, it is essential that you obtain help to abstain completely from doing so.
