Risk for Self-Harm in Borderline Personality Disorder Drops Off Over Time
Perhaps the most severe possible symptom of borderline personality disorder (BPD) is recurring involvement in suicidal threat-making or actual suicide attempts. In addition, people with the disorder may have recurring involvement in acts of non-suicidal self-injury. In a study review published in January 2015 in the journal Borderline Personality Disorder and Emotional Dysregulation, researchers from Germany’s University of Ulm sought to determine if the risks for self-harming behavior in individuals with BPD change substantially over time.
Borderline Personality Disorder and Suicide
All people affected by borderline personality disorder have a set of personality characteristics that interfere with their ability to regulate their moment-to-moment impulses, keep their thoughts and emotional processes under control and/or maintain friendships that don’t vary widely in tone and stability. Under terms established by the American Psychiatric Association, official diagnosis of the disorder requires the presence of at least five out of a maximum nine symptoms. Repeated involvement in suicidal threat-making, suicidal behavior and/or non-suicidal self-injury constitutes one of the potential indications of illness.
Up to four out of every five people with BPD consider killing themselves and go as far as the active planning stage of a suicide attempt, the National Institute of Mental Health reports. In addition, roughly 4 percent to 9 percent of all individuals affected by the disorder will die in a suicide attempt. In stark contrast, the suicide rate among the general U.S. population stands at approximately 0.013 percent, according to recently released figures from the Centers for Disease Control and Prevention. Mental health professionals have devised a form of psychotherapy, called dialectical behavior therapy or DBT, specifically to address suicide-related issues in individuals with borderline personality disorder.
BPD and Non-Suicidal Self-Injury
Unlike people affected by suicidal thoughts or behaviors, people affected by non-suicidal self-injury (NSSI) do not overtly consider killing themselves. Instead, they physically harm themselves in a non-suicide-oriented context. Specific activities that qualify as NSSI include burning yourself, cutting yourself, banging your head against hard objects, scratching yourself and taking steps to stop your body from healing any wounds you have sustained. In some cases, non-suicidal self-injury results in relatively mild or superficial forms of damage. However, at its extreme end, the behavior can result in damage severe enough to unintentionally lead to a lethal outcome. When diagnosing borderline personality disorder, doctors take all recurring episodes of NSSI with equal seriousness and don’t make a distinction between the types or severity of the injuries present in the individual.
Do the Risks Change Over Time?
In the study review published in Borderline Personality Disorder and Emotional Dysregulation, researchers used data from 32 previously conducted studies to help determine if the risks for suicidal behavior and/or non-suicidal self-injury change over time in a person with borderline personality disorder or any other mental health problem. Twenty-two of the studies under consideration explicitly focused on NSSI, while the remaining 10 focused more broadly on self-harming behavior that could also include suicidal actions. The researchers undertook their project, in part, because mental health professionals have relatively little information on the long-term impact of non-suicidal self-injury and suicidal behavior on the mental health status of affected individuals. The studies under review came largely from the U.S. and Europe.
After completing their analysis, the researchers found that some of the studies they looked at charted an increase in NSSI from adolescence to adulthood, while others charted a decrease. Overall, they concluded that, for most individuals with BPD or other illnesses, the rate of involvement in non-suicidal self-injury likely peaks in adolescence and falls off in early adulthood before dropping to near zero in later stages of adulthood. The researchers noted the same basic trajectory for the likelihood of suicidal behavior.
The study review’s authors also examined the factors that most frequently predict non-suicidal self-injury and/or suicidal behavior in a person with BPD or any other mental health problem. They identified three main predictors: having a previous history of involvement in NSSI, being female and having symptoms of major depression or any other condition classified as a depressive disorder. The authors believe that awareness of these indicators could help doctors significantly reduce the risks for self-harm in affected population groups.