How Are Self-Harm And Personality Disorders Connected?

According to the National Alliance on Mental Illness (NAMI), self-harm can describe any attempt a person makes to physically hurt themselves. Self-harm can involve cutting or burning oneself, pulling out hair, picking at wounds, or causing self-injury in some other way. Being self-injurious doesn't always overlap with being suicidal, and self-harm usually isn't a suicide attempt. Instead, self-injurious behavior is often an unhealthy way of coping with intense negative emotions.

While self-harm and personality disorders can overlap, not everyone who engages in self-harm has a personality disorder. About 17% of adolescents and 6% of adults engage in self-harm, while a much smaller percentage of each have a personality disorder. Self-harm is a behavior that can also be associated with anxiety, depression, eating disorders, and other mental health concerns. Individuals who engage in self-harm often benefit from working with a licensed mental health professional who can help them implement healthier coping skills.

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Personality disorders and self-harm

Self-harm tends to be more prevalent among people with personality disorders. Specifically, people with borderline personality disorder are usually the most likely to engage in self-harm. However, not everyone who engages in self-harm has borderline personality disorder.

Borderline personality disorder typically involves a variety of symptoms beyond self-harm. A person with this disorder is likely to experience emotion dysregulation, frequent mood changes, troubled relationships, and negatively affected cognition. The mood changes and emotions experienced by people with borderline personality disorder can be overwhelming and intense. Often, a person may sense they are lost in their own feelings. They may perceive that they are mentally and emotionally out of control and no longer know who they are.

Why do people self-harm?

Most people who self-harm do so as a coping mechanism. Causing physical harm to themselves can be an unhealthy way of responding to overwhelming distress, anger, sadness, or other emotional pain. Self-harm may be tempting to some because the physical pain can be a welcome distraction from severe emotional pain. Sometimes, people self-harm because they experience a lack of emotion or are overwhelmingly numb and would rather feel physical pain than nothing at all.

In people with borderline personality disorder specifically, self-harm may stem from a desire to be in control. People with borderline personality disorder may experience an altered sense of their body or their own agency, especially when they experience the symptom of dissociation. Dissociation generally arises during stressful moments and involves a sense of disconnection from a person's body, self, or surroundings. For some, self-harm may be an unhealthy form of grounding, or overcoming dissociation and bringing themselves back to physical reality.

Studies show that people who have experienced assault, childhood abuse, or other trauma are usually more likely to engage in self-harm. It may be that these experiences led them to believe they had no control over their body. They may have also dissociated during the moment of trauma as a way of coping. Recurring self-harm years later may be a way of managing intense emotions that can arise surrounding these unresolved traumatic events. Not everyone who has experienced past trauma engages in self-harm, though, and more research may be needed to understand the connection between them.

In general, personality disorders do not directly cause a person to want to engage in self-harm. However, certain personality disorders may lead to intense, overwhelming emotions. For some people, engaging in self-harm is an attempt to manage these emotions. It's an unhealthy strategy, though, and can lead to increasingly negative consequences over time.

Self-harm can also become a bad habit, meaning that if a person does it once and finds that it relieves their intense emotions in the moment, they may do it again in a similar future situation. Drinking alcohol or using substances can make self-harm more likely because a person who is tempted to self-harm may be less inhibited and more likely to give into those temptations while under the influence.

Self-harm and suicide

People with personality disorders that involve a higher risk of self-harm usually also face a higher risk of becoming suicidal. For example, one study found that 75% of people with borderline personality disorder had attempted suicide at some point, and that 9% would die by suicide. Another found that about 5% of people with antisocial personality disorder would die by suicide. A review of 24 studies found that having any type of personality disorder generally puts a person at a higher risk of suicide.

Although self-harm isn't necessarily a suicidal behavior, it should be taken seriously and treated. Self-harm often precedes suicidal thoughts or suicide attempts. The same overwhelming emotions that can lead a person with a personality disorder to engage in self-harm may lead them to become suicidal in the future, especially if the habit of self-harm loses its ability to provide relief over time. 

Research has found that treatments like dialectical behavior therapy and mentalization-based therapy can help people with borderline personality disorder and other mental illnesses learn positive ways to cope with overwhelming emotions. This may empower them to stop engaging in self-harm and reduce their risk of suicide.

Remote therapy for self-harm

Even though the purpose of self-harm is not suicide, treating self-harm can be important. The behavior can become a difficult habit to break and may act as a precursor to suicidal ideation and suicide attempts in some people. 

Remote therapy may be one treatment option for self-harm. People who engage in self-harm might find remote therapy especially attractive, since it doesn't require them to visit anyone in-person, where they and any scars they may have from self-harm might be seen by others. Instead, remote therapy can be attended from the comfort of home or any safe space of a person's choosing that has an internet connection. BetterHelp is a remote therapy platform that can connect people with the best therapist for their needs.

Researchers haven't directly studied remote therapy and self-harm. However, they have studied the effect of therapy in general on self-harm. While the research is limited and more studies are needed, the existing evidence suggests that cognitive behavioral therapy may result in a reduction of self-harm behaviors. Other types of therapy, like dialectical behavior therapy, may also help a person engage in less self-harm behavior.

In addition, research shows that online therapy typically produces the same results as in-person therapy, which may mean that online treatment can be just as effective as in-person treatment for addressing self-harm.