Key Takeaways
- Many people with BPD may engage in self-harm, like hitting, scratching, or burning their body. They do this behavior intentionally but without the desire to end their life.
- We don’t yet fully understand the link between BPD and self-harm. However, experts theorize that self-harm may be a response to the emotional instability, fears of abandonment, and perceived rejection frequently experienced by people with BPD.
- If you’re dealing with self-harm and symptoms of BPD, there are effective treatment options that can address the full picture of your mental health. This might include cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), or medication.
Borderline personality disorder (BPD) is a mental health condition characterized by emotional instability, impulsivity, fears of abandonment, mood swings, and unstable relationships. In addition to these symptoms, research shows that around 65% to 80% of people with BPD engage in nonsuicidal self-injury (NSSI), or self-harm.* Self-harm is the purposeful act of injuring yourself without the intention of taking your life.
Fortunately, it’s possible to manage both symptoms of BPD and self-harming behaviors with the right support. Therapy, skill building, and a strong support system can help you develop healthier ways to cope with intense emotions, build more stable relationships, and regain a sense of control over your well-being.
A note on safety: The 988 Suicide and Crisis Lifeline provides confidential, 24/7 support through trained crisis counselors for anyone experiencing emotional distress or engaging in self-harm. If you or someone you care about needs help, please call or text 988. For life-threatening emergencies, always call 911.
Why do people with BPD self-harm?
We don’t fully understand all the reasons why so many people with BPD self-harm. However, research suggests that self-harm may be a response to the profound emotional instability that often accompanies untreated BPD. In other words, a person with BPD may hit, cut, or burn themselves to release uncomfortable feelings. But this relief is usually short lived, and the distress often returns soon after.
In addition to providing some temporary emotional relief, people with BPD may engage in self-harm to:
- Punish themselves for feeling “bad” or unworthy: You might struggle with negative feelings about yourself, and self-harm can sometimes feel like a way to punish yourself for those feelings of guilt or shame.
- Feel tangible physical pain: When emotional pain becomes overwhelming, self-harm can provide a way to experience physical pain, which might feel easier to understand or control than your inner turmoil.
- Feel alive: If you’ve been feeling numb or disconnected from your emotions, self-harm may give you a way to feel something real again, helping you break through that emotional emptiness.
- Feel numb: Sometimes, when emotions feel too overwhelming or unmanageable, self-harm can help you temporarily escape from that emotional numbness and feel something, even if it’s pain.
- Express frustration: If you’re finding it difficult to express your feelings in other ways, self-harm might feel like an outlet for releasing all that built-up frustration or anger.
- Regulate anxiety or despair: In moments of deep anxiety or despair, self-harm can provide temporary relief, helping you distract from those overwhelming emotions and giving you a sense of control.
Many people with BPD also report interpersonal reasons for turning to self-harm. For example, “seeking attention” is frequently reported as a reason for self-harm among those with BPD.
However, it’s important to remember that attention-seeking behavior isn’t necessarily manipulative. It’s often a way of asking for help. So, if you or someone you care about is engaging in self-harm, don’t hesitate to talk to a professional who can help keep you safe.
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Potential reasons for self-injury in BPD
Deepening your understanding of the link between self-harm and BPD can help you keep yourself or someone else safe. But it’s important to remember that BPD can affect people in many different ways. What triggers an episode of self-harm in one person may not affect another person in the same way.
However, research shows that self-harm in people with BPD may follow some consistent patterns. It may be more likely to occur if a person experiences:
- Shame: BPD can cause a person to feel like there’s something wrong with them or like they can’t fit in in social settings. This experience may bring about feelings of shame that can lead to self-harm.
- Fear of abandonment: One of the most common BPD symptoms is an intense fear of abandonment. So, if a person with BPD senses that a friend, partner, or loved one may leave them, they may turn to self-harm in an attempt to cope.
- Rejection from a loved one or caregiver: If a person with BPD feels like they’ve disappointed someone they care about, they may believe that the person will reject them forever, even if that’s not the case. In response, they may harm themselves as a form of self-punishment.
One common misconception is that self-harm in BPD is always an attention-seeking behavior. In reality, though, it’s often a private coping mechanism for overwhelming emotions. At the end of the day, everyone's struggles are real, and support should come with understanding, not shame.
How to get help for BPD and self-harm
If you’re experiencing BPD symptoms and engaging in self-harm, know that you’re not alone and help is available. One of the first and most important steps in accessing care is to make an appointment with a mental health professional.
If you’re not already working with a therapist or psychiatric provider, you can ask your doctor or another healthcare provider for a referral. During your first few sessions, your provider will listen to your concerns, ask questions about your symptoms, and ensure that you receive an accurate diagnosis. From there, you can work together to determine the best next steps for your needs and goals.
Remember, while BPD is considered a long-term condition, you can manage your symptoms with the right support. If you’re living with BPD, the following therapies can help you adopt new coping strategies, reduce the urge to self-harm, and create a plan to navigate a relapse.
- Dialectical behavioral therapy (DBT): DBT was created specifically to treat BPD. It can help reduce the emotional instability and feelings of shame that often lead to self-harm.
- Cognitive behavioral therapy (CBT): CBT can help you identify and challenge unhelpful thought or behavior patterns. For example, if a person with BPD has a thought like, “I’m worthless, so I need to punish myself,” CBT can help them challenge that idea and develop new ways of responding to emotional distress.
- Medication: There are no approved medications for stand-alone BPD or self-harm. However, BPD frequently occurs alongside other mental health conditions, like depression, bipolar disorder, and anxiety disorders. Sometimes, medication can help manage the symptoms of these co-occurring conditions. You can speak to your provider about whether medication is right for your unique needs.
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While not a formally recognized symptom of the condition, self-harm frequently accompanies BPD. The reasons for this overlap aren’t completely clear. But it appears that the emotional instability, fears of abandonment, and feelings of shame brought on by BPD may contribute to the urge to self-harm. Fortunately, BPD is a treatable condition, and you can manage your symptoms with the right support. In working with a therapist who specializes in treating BPD, you can learn to safely express uncomfortable emotions, reduce harmful behaviors, and develop new coping skills.
At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best.
Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 15,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we’re here to help you make progress — wherever you are on your mental health journey.
About the author
Liz Talago
Liz Talago, M.ed. is a mental health professional turned content writer and strategist based in the Detroit metro area. As an independent consultant for mental health organizations, Liz creates meaningful connections between brands and their audiences through strategic storytelling. Liz is known for championing diverse perspectives within the mental health industry and translating bold ideas into inspiring, affirming digital experiences.
In her free time, you can find her hiking with her two German Shepherds, puttering around her dahlia garden, or spending time with her family.
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