Anxiety and OCD Exposed

How and Why Do Those With Borderline Personality Disorder Hurt Themselves?

By Charles H. Elliott, Ph.D.
September 26, 2009

People with Borderline Personality Disorder sometimes engage in acts of self harm. These acts of self harm are wide ranging; they’re also dramatic and startling in many cases. These behaviors include:

  • Blunt force trauma: This type of self harm includes banging one’s head on a hard surface, punching oneself, and using a hammer or other tool to inflict damage and pain to the body.
  • Cutting: This is one of the most common and widely known types of self harm that those with BPD engage in. Cutters use a variety of tools such as scissors, razor blades, knives, needles, and broken glass. Scars often result and many people who cut try to cover up their injuries while some people actually try to put them on display.
  • Burning: People resorting to this tactic use cigarettes, matches, lighters, and hot objects to burn themselves. They usually only burn a small area each time, but the resulting scars can often occur over a large part of the body.
  • Intentional accidents: Folks who set themselves up for accidents may not look like they’re trying to hurt themselves, but their failure to take even the most basic, reasonable precautions tips you off to their true motives. These people often end up in far more than their share of mishaps and investigation often reveals that they set ladders on obviously unstable ground or fail to use essential safety equipment.
  • Miscellaneous self injurious behaviors: These include swallowing harmful objects, inserting objects into body cavities, hair pulling, consuming harmful chemicals, pushing one’s eyeballs, or biting one’s body.

You’re probably wondering what the motivation is for these various acts of self harm that seemingly would result in no gains for the person who does them. The answer to your question is that there is no single motivation for self harm. Both mental health professionals and those with BPD have suggested a variety of possible motivations including:

  • To distract from emotional pain: You can’t underestimate the unbearable nature of inner pain experienced by those with BPD. Although the pain from self injurious acts rarely matches the internal, emotional pain, it does pull one’s attention away from the overwhelming emotions for a little while.
  • To meet other needs: In most cases, it’s not so much a need for attention as it is a need for basic nurturance and support from others. In some cases, it appears that people engage in self harming acts in order to obtain care and concern when they lack the skills or knowledge for obtaining those needs in healthier ways.
  • To punish themselves: Sometimes people with BPD appear to harm themselves out of a profound feeling or belief that they deserve punishment and abuse. Sometimes this belief appears to be related to the fact that they were abused as children and believed they deserved the abuse. Thus, they continue the pattern of abuse on themselves, thereby reenacting the abuse over and over again.
  • To get back at someone: Many people with BPD have trouble expressing anger in healthy ways. Thus, they will hurt themselves to make other people feel badly for something they did or said.
  • To feel better: When the body is injured, the brain releases a type of pain killer known as endorphins. Endorphins are similar to morphine and reduce pain and distress. Thus paradoxically, one may engage in self harm in order to regulate emotions and feel better. If that motivation sounds bizarre, consider the fact that many of us in New Mexico report loving to consume hot to really hot chili peppers in abundance. Why? It seems chili peppers causes a release of endorphins.
  • To feel almost anything other than numbness and emptiness: Many of those with BPD say that they have a constant feeling of “unrealness.” They say they feel out of it and/or dissociate. Pain feels “real” and allows them to connect to the world for a while.

Again, motivations vary from person to person and some people no doubt have several motivations from the above list. Still others may have motives we have not covered. Fortunately, there are treatments for self harm that appear to work for many people. These take time and professional help. Although it’s interesting and often productive to sort out a person’s motivations for self harm, it may not be necessary in all cases to fully understand the motivations for the behavior in order to change it.


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32 Comments to
“How and Why Do Those With Borderline Personality Disorder Hurt Themselves?”

“To distract from emotional pain: You can’t underestimate the unbearable nature of inner pain experienced by those with BPD”

Recently the captain of an airplane that nearly crashed in Melbourne, Australia this year, where pilot error was at fault, reported that “One of my friends almost admitted me to hospital I was so stressed,” he said. “If you have a near-death experience your body reacts in a particular way.”

For a person with Borderline Personality Disorder, simple things like posting a letter, going to work, pulling up weeds or crossing the road can cause the brain to produce toxic chemicals that lends to emotions that feel like a near-death experience where your body reacts in a particular way to certain conditions. In the past, for me just doing housework can cause a horribly overwhelming, all consuming brain reaction. With therapy and mindfulness I have overcome this to a greater extent. Different situation (plane crash -v- housework) but somehow manages to evoke same feelings.

Even though I do not have borderline personality disorder, I do hurt myself, and I wish I could find the treatment that works for me. I have medication, I have a great therapist, I have a great pastor, and I have this horrible, helpful compuslion to hurt myself. But after 15+ years, I wonder if I will ever be free of it. Everyone tells me I will do it as long as I need it, but I wish that day would come sooner rather than later. Thanks for the informative article.

@Sonia: Thanks for sharing your thoughts and experiences!

@Catherine: You still may find the ideas in Borderline Personality Disorder For Dummies (you can get it used on Amazon) useful even though you don’t have the diagnosis. See if your therapist is willing to work with you on some of the techniques suggested.

Hi again. I’ve done pretty much all of these, for all of the reasons you gave. Also, one of my reasons used to be in order to stop myself from hurting someone else. Another reason was to prove to myself and to others that my distress was real or significant, because as a child and teen I was frequently distressed, and generally told that I was just making it up.

It used to be out of control, and frequent. Now I don’t get that distressed very often anymore, but when I do want to hurt myself, I honestly can’t see what’s the matter with doing it. I know lots of techniques for stopping it. I know that I’m concerned about other people who hurt themselves and I don’t want them to. But when it comes to me being distressed and wanting to hurt myself, no reasons seem compelling enough for me to actually care about preventing it. I know I’m not going to take it too far, and I can hide it (although I don’t always care about that either), and afterwards I’ll be able to cope better. Why does it matter?

Why is it that one must have BPD to be doing these things? I mean, the feelings and reasons you describe seem to be true for human beings of all sorts and not just limited to BPD. Like, someone with dissociative disorder may do it, or someone who is afraid to hurt someone else, or someone who just knows it works, the endorphin process.

I don’t even think many people feel any pain at all doing it, and it is not only less than the emotional pain and numbness, but literally ‘nothing’ compared to the emotional distress present.

It’s very much like a drug addiction?

@Katrin, I do not have a diagnosis of BPD but I self harm. What I have been diagnosed with is Post Traumatic Stress Disorder. I mean I guess it is possible I have BPD but it is undiagnosed but from what I have read on it, it does not fit except for the chronic feelings of emptyness and the self-injury. I cannot say if others feel pain when they hurt themselves, however, I do. It is when I stop feeling pain that I know I am in trouble and have gone too far. But most of the time I feel physical pain during the act of self injuring.

@Rapunzel: While I can think of reasons it could matter, this is something for you and your therapist to sort out. Thanks for the comment.

@Katrin & Catherine: Thanks for your comments. You are correct; although people with BPD often injure themselves, they are not the only people who do it. And not everyone with BPD engages in self harm. Diagnosing is tricky business and the science behind it not always as clear-cut as we wish.

Thanks Catherine, I did read your posts. And thanks Dr. Elliott.

I thought about this some more, and I really don’t think I have BPD, and neither did my psychiatrist whom I was in intensive therapy with for many years. Neither has, or did anyone else. (it did though cross my psychiatrist’s mind for a while when I did self harm, but it never went any further than ‘crossing his mind’)

And, when I did it, and I know exactly why as we talked about this a lot, the doctor was really , really great in this regard and ‘it’ got cured. (This was many years ago when most people still assumed cutting, and in my case I never did it superficially but really had to be sewn up afterwards, was a suicidal gesture and they did not even understand otherwise)

I never did ’splitting’; I never had erratic relationships…I did though dissociate.
There was the punishing aspect and there was the aspect of wanting to ‘cut’ my need for, and dependency on the therapist. In short, to avoid being a pain in the butt, and to not be ‘Borderline’, and it helped a lot.

More than anything, it was an attempt to externalize my pain in a way an eating disorder cannot do, no matter how painful that is.

Again, the therapist was great, and we would ask to see the wound and then we talked about it. He also did not panic and freak out but stayed very calm.

Anyway, just some thoughts…

What I mean, the ‘cutting’ for me was a healing step in the right direction.

I have found a simple way of stopping the thought, similar to smoking control techniques, for cutters that I see in the ER. The rubber band on the wrist, snapped to break the initial thought and desire to self harm, much like Donald Meichenbaum’s work.

I used to cut and burn myself to distract myself from suicide. I wanted to slash, but restricted myself to cuts that would heal.

What a great article & even better responses…it is so important for those who do not do these behaviors to understand that there is a ‘real’ reason people do these things,and that people who do these things may not know why they do it,just that it makes them feel better.
The first step is recognition…if you disassociate, as I did, it is tremendously difficult to realize that others have a very different experience of reality. Existing in numbness,separate from connection to others tends to cause all emotion to be suspect. However, there is much joy and beauty in Life that can be experienced, even after decades of merely existing.

@ Katrin Thanks for sharing your experiences. Sounds like you worked hard and had excellent treatment. As a psychologist, I use the language of diagnosis, but realize that a diagnosis rarely captures the experience of a person.

Oh, and a second thought. As an empath, I discovered that over 80% of the pain I was experiencing on a daily basis was not my own. I joined a pyschic development group, and discovered that for those who have psychic ability and don’t know it, there are several common factors:

–unexplainable ’sensitivity’ or emotional distress out of proportion to events (the psychic is reacting to psychic information/ emotions/sensations that others do not realize);

–addiction to stimulants to function daily, such as caffiene, and thus to downers like sleeping pills as the unrealized psychic has not been given appropriate tools to screen out unwanted psychic disturbances;

–history of mental/physical/sexual abuse, as these things tend to trigger the ‘need to know’ and the ‘need to have power’ in the abusive situation;

–history of low self esteem, as many psychics have been disbelieved by family or friends, causing them to doubt their own sanity or judgements.

I am giving this information because I had felt very alone,believing that there must be something very wrong with me that I could not function as others did.

When I began to see that I was having a common experience, it lifted me out of my self blame and I was able to use appropriate tools to decrease my pain & open myself to greater wisdom, which resulted in much greater functionality.

I can think of no higher blessing than to be able to function on a daily basis.

Nissa
You have an intersting point. Sometimes just being able to put one foot in front of the other seems like a blessing. There are days that feel like you are rock climbing and others like you are sailing. This has been an interesting discussion.

I don’t have BPD but I used to self-injure. I was diagnosed with atypical schizophrenia. I’ve not self-injured in almost ten years since my psychiatrist put me on 12mg of Gabitril for anxiety. (Not to control my SIB.) It was a happy side effect.

My self-injury was connected to my delusions and paranoia. My anxiety fueled both. Controlling anxiety and stress is critical to controlling my symptoms.

@schizkitty: Thanks for sharing your experience! Glad to hear it’s had a good outcome.

I am involved in a Dialectical Behavioral Therapy group/class that is mostly consisted of people dxed w/borderline. My therapist had that as an “exploratory” dx for me. I already have been dxed w/bipolar 1 disorder.

I actually asked my therapist take any mention of borderline off my records or receipts that I submit to ins. as I know about the stigma against people w/borderline. It is incredible. Being bipolar is a walk in the park compared to being dxed w/borderline. There is so much stigma to having borderline. These people are suffering.

But EVERYONE who has a dx of borderline in the group does self-harming behavior. Cutting is the most common. One even to the point of stabbing herself in the stomach when she found out the baby she was carrying had died. She has been involuntarily committed to a mental hospital.

I guess I “self-harm” in that I don’t make very good eating decisions. I did quit smoking once I got on bipolar meds & started feeling better. I never “self-harm”, but have had many suicide attempts…

Very complicated. My mother did commit suicide when I was 15 (bipolar, as well).

I’ve been dxed with more conditions than I care to write. Bi-Polar II being the biggest and for the longest time 17yrs.
Because I receive Medicaid and seem to move a lot, relationship problems ect, how can I find out if all the dxes are correct? I now live in OH see a doc but since I moved from MO I have yet to find one I trust or even like some of the time. And how can I go to join a group ect when I also have agoraphobia and hardly ever leave the house?

Thanks for the good article, many people do not know WHY some may do the things they do.

@Cathi: Try going to http://www.abct.org for a referral to someone trained in assessment and diagnosis as well as agoraphobia. That person can take you through gradual steps to overcome your agoraphobia and eventually may employ group therapy too–just not right away. Good luck!

@Others: Thanks for your comments!

I’ve been on countless websites, and have read all the symptoms of Borderline Personality Disorder, and I’m concerned that I might have it. What should I do?

@Cakey: The only way you can know is to make an appointment with a licensed mental health practitioner who is familiar with the problem. You should also know that if you have BPD, treatment has been found to help!

My parents won’t get me an appointment, because they don’t believe me. I mean, I’m not saying that I HAVE it, I’m just saying that to me it seems very possible. But obviously they don’t.

@Cakey: Try seeing your school counselor.

What do I say? “Hi, I think I have a psychological disorder”? Ha.

@Cakey: Just tell the counselor you’ve been worried about yourself because of some things you’ve read. They’ll take it from there…

Okay, I see. Thank you for all your help.

hey…my aunt thinks i am BPD!!! How do i find out if i am or not??

@Sarah: You can learn a lot about BPD from our book Borderline Personality Disorder For Dummies. But to know if you have it, you should really consult a licensed mental health professional.

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Laura L. Smith, Ph.D. and Charles H. Elliott, Ph.D. are authors of many books, including Borderline Personality Disorder for Dummies. Pick up the book today!

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