Borderline personality disorder (BDP) is a mental disease characterized by a continuous pattern of varying moods, behavior, and self-image. The symptoms usually lead to impulsive actions and issues with relationships. Patients with borderline personality disorder might also show intense episodes of depression, anger, and anxiety that could last up to several days. Many people with the borderline disorder engage in actions that are potentially self-injurious that might include burning, cutting, and small drug overdoses. 9% of the people suffering from the disorder commit suicide as shown by research. Understanding the etiology of the borderline personality disorder and its implication in self-harm requires a critical analysis of personality theories applicable.
Summary
The characteristics of the BDP include cognitive, behavioral, and emotional dysregulation. Some of the common implications of the disease on an individual include impulsivity, emotion dysregulation, problems with relationships, identity crisis, and self-injurious behavior. One of the characteristics of this disease that could result in self-harm is the feeling of emptiness inside. Other than the common injuries a person might inflict to themselves including pulling their hair, opening wounds, burning, and scratching their skin, there are chances that these people will engage in suicidality. The risk factors for the developing the disorder include family history, brain factors, social, environmental, and cultural factors. One of the theories that could vividly explain the etiological model of BPD is the Linehan’s Biosocial Theory.
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Linehan’s Biosocial Theory
The theory attempts to explain the etiology of the BDP. Crowell, Beauchaine and Linehan (2009) asserted that Linehan asserts that the disorder is characterized by emotional dysregulation that comes as a result of the interaction between biological vulnerabilities and specific environmental factors. As such the patient has increased emotional sensitivity, inability to control excessive emotional responses, and a gradual return to emotional normalcy. Linehan gives a broad definition of emotion and emotional dysfunction to include other factors such as physiology, biochemistry, cognitive processes, facial and muscle reactions among others. Because the patient's emotion is not regulated correctly, the person depicts poor responses when fronted with a situation or events that challenge their emotion. Linehan further asserted that the BPD is likely to occur in an invalidating environment which is an environment where the thoughts or feelings of an individual are not tolerated ( Crowell, Beauchaine & Linehan, 2009). Therefore, the individuals grow up with a perception that their thoughts, actions, and feelings do not matter. As such, they might find it difficult to recognize their emotions hence causing them to distrust their emotions. The result seen in such individuals include emotional avoidance, interruption, and suppression.
The Linehan's biosocial theory can also be used to explain the cause of self-harm in an individual with BPD such as suicide. Linehan asserts that self-harm such as the suicidal behavior is a method learned to cope with the emotional suffering. Suicidal ideation and various forms of injury are common in patients suffering from BDP. One of the main importance of the biosocial model is that it explains emotion vulnerability which is a main cause of self-harm. Some characteristics of emotions seen in BPD patients include high sensitivity, high reactivity, and a slow return to the baseline. Together with the action of the environment and genetic disposition, the theory postulated by Linehan creates a close relationship between the disorder and the development of both suicidal and non-suicidal injurious behavior.
Development of Non-Suicidal Self-Harm
The harm is usually deliberately self-inflicted to body tissue without the intention of committing suicide and for reasons that are not socially sanctioned. It is most common among the adolescents with a prevalence of between 15 and 20% (Holly et al. 2017). Adults, on the other hand, report less with a prevalence of around 6%. Self-harm is mainly seen among patients who intensely and chronically critical about themselves. The biosocial theory attempts to explain that the self-mutilation seen in these patients is a way of gaining control of the excessive emotions and feelings. Emotional dysregulation is the chief cause of self-injurious activities among these individuals. As such, harming oneself is a strategy to regulate or rather gain control and influence over the emotional turbulence.
Researchers have since intimated that the certain risks are associated with self-harm in patients with this disorder. One of the factors that are responsible for the self-injurious tendency is a history of suicidal behavior or thinking. Secondly, continuous participation in impulsive behavior is also likely to increase a person's inclination towards engaging in self-harm. When a person has an inaccurate or unstable depiction of self or having a perpetual sense of meaninglessness, they are at a higher position of engaging in the appropriate behavior of harming themselves. The development of dissociation is common among BPD patients and researchers intimate that this is also a common cause of self-inflicting harm. With regards to gender, females are better poised to commit self-injury in comparison to their male counterparts. Racially, people with a European-American origin have a higher chance of engaging in harming themselves more than any other race. The most common incidents of self-harm include head-butting, cutting, skin scratching, and pinching among others.
Development of Suicidal Thoughts
Suicide is another common form of self-harm in people with Borderline Personality disorder. Holly et al . (2017) asserted that research has shown that 70% of people with the disorder have at one time attempted to commit suicide. It is also revealed that a majority of the patients will attempt the disorder for multiple times in their lifetime. It is also imperative to note that people with BPD are likely to complete suicide compared to any other people with a mental disorder. Around 9% of the individuals with the disorder will complete the suicide which is an alarming rate given that it is almost 50 times that of the general population. Questions can arise as to why suicidality is common in these patients. First, it is vital to note that BDP is associated with high negative emotional experiences. The experiences in most cases are painful, and the patients would want to find a way of escaping from them. Suicide is among the last resort methods that could be employed by these individuals in looking for a remedy.
As a chronic condition, BDP tends to last in a person for many years. Without treatment, it might not get better, and this tends to frustrate the patients leading to suicidal ideation. Research has also revealed that there is a high likelihood that BDP co-occurs with other mental disorders such as depression and bipolar disorder hence increasing the likelihood of suicide. Impulsivity is a major characteristic of BPD. People tend to act spontaneously without necessarily assessing the possible consequences that might come out. The risk further increases when an individual engages in drug and substance abuse. According to the Linehan’s biosocial theory, the dysfunctional behavior can be associated with suicidal thoughts. Some of the factors to be considered in the causation of suicide include emotions, cognition, overt behaviors, and environmental factors. Regarding emotions, the inability to overcome the excessive and impulsive feelings leads to the likelihood of harming oneself. Cognition in most cases control behavior, and if it cannot, then the problematic tendencies in a person will set in leading to overt behavior. Pearson et al. (2018) asserted the environmental factors implicated in suicidality include difficult childhood which can act to distort or dysfunction proper thought patterns leading to harmful behavior such as suicide. Other factors that can cause suicidal thoughts include shame and hopelessness, self-invalidation, and faulty emotional processing.
Preventing Self-Harm In BPD
It is important first to understand the cause of self-harm in BPD patients. As stated in the Linehan’s theory, self-harm is due to emotional dysfunction and the lack of pressure to contain thereof. Therefore, one way to deal with self-harm is by applying the cognitive behavioral therapy which can help an individual to recognize and appreciate the patterns of behavior and what can potentially trigger self-harm in a person. The treatment appreciates the fact that negative feelings that lead to self-injury occur out of a person’s level of consciousness. Psychodynamic therapy could also be used especially in cases where the injury is as a result of childhood experiences.
Conclusion
Linehan’s theory of biosocial theory is critical about the etiology of borderline personality disorder and its association with self-harm. Self-harm can either be non-suicidal or suicidal. One of the reasons for such injurious behavior is due to emotional dysregulation that comes as a combination of biological vulnerabilities and environmental factors. Therefore, the patients resort to inflicting themselves with harm hoping that they overcome their emotional turbulence. Harm might occur in the form of cutting, burning, head-butts, and suicide in extreme scenarios. Treatment and management can occur by first appreciating the cause of the disorder and then embarking on cognitive behavioral therapy and psychodynamic therapy where necessary.
References
Crowell, S. E., Beauchaine, T. P., & Linehan, M. M. (2009). A biosocial developmental model of borderline personality: Elaborating and extending Linehan’s theory. Psychological Bulletin , 135 (3), 495–510. http://doi.org/10.1037/a0015616
Andrewes, H. E., Hulbert, C., Cotton, S. M., Betts, J., & Chanen, A. M. (2017). Patterns of non-suicidal self-injury and their relationship with suicide attempts in youth with borderline personality disorder. Archives of suicide research, 1-14. http://dx.doi.org/10.1080/13811118.2017.1358226
Pearson, R., Campbell, A., Howard, L., Bornstein, M., O'Mahen, H., Mars, B., & Moran, P. (2018). Impact of dysfunctional maternal personality traits on risk of offspring depression, anxiety and self-harm at age 18 years: A population-based longitudinal study. Psychological Medicine, 48 (1), 50-60. Doi: 10.1017/S0033291717001246
