Understanding self-harm in Borderline Personality Disorder

Self harming and treatment - CALDA Clinic
Author: Claudia M. Elsig, MD

Approximately 2%-6% of the general population1 and 20% of psychiatric inpatients are estimated to suffer from Borderline Personality Disorder (BPD).2 A staggering 65-80% of these individuals engage in some form of non-suicidal self-injury (NSSI).3 This blog explains more about what it is like to live with this condition and examines why self-harming features so significantly in this complex disorder.

What is Borderline Personality Disorder?

Everyone has a personality. But for some people, patterns of behaviour develop which are rigid, inflexible, or maladjusted. Borderline Personality Disorder – also known as emotionally unstable personality disorder (EUPD) – is a mental disorder that affects how a person thinks, feels, behaves, and interacts with other people. People with BPD lack the ability to learn from their own mistakes (which is essential for ‘normal’ psychological development).

Symptoms of BPD include emotional instability, hypersensitivity to rejection, and impulsive and self-destructive behaviours. People with BPD can have extreme mood swings over a short space of time, and they often experience intense but unstable relationships with others.4

A person with BPD often feels intense and sudden rage, sorrow, shame, panic, and terror, and commonly experiences feelings of emptiness or loneliness. For someone living with BPD, everything feels unstable. Things like self-image, goals, and even likes or dislikes can feel confusing and unclear. People with BPD have a “rigid and unhealthy level of thinking.”2

BPD often occurs with multiple comorbidities, such as mood, anxiety, obsessive-compulsive, eating, dissociative, addictive, psychotic, and somatoform disorders.5

How BPD affects a person’s life

Living with BPD poses many challenges, particularly around relationships with other people. A person with BPD feels strong emotions and is unable to modulate intense feelings. They can feel angry or upset a lot of the time. They are often rash, impulsive and possess a strong readiness for conflict.

The UK’s leading mental health charity, MIND, describes BPD as having a very big impact on daily life. A person with BPD may:

  • Fear being abandoned
  • Experience intense emotions that can last from a few hours to a few days
  • Have a poor sense of self that can change according to who they are with
  • Find it hard to make and keep stable relationships
  • Experience strong feelings of emptiness
  • Act impulsively, such as binge eating, using drugs or driving dangerously
  • Self-harm
  • Have intense feelings of anger that are difficult to control
  • Experience paranoia or dissociation6

What causes BPD?

BPD is complex and there are many different reasons people develop the condition, but there is commonly an experience of childhood trauma. Studies show that trauma during childhood, parental mental illness, and exposure to poverty in early stages of life are strong precursors to BPD.5 People who have been sexually, physically, or emotionally abused, or neglected or mistreated in childhood are at higher risk. Separation from parents during childhood also raises the risk. That doesn’t mean that everyone who has these experiences will develop BPD, but it does tip the scales to make it more likely.

Genetic disposition can also be a factor. BPD often runs in families. “A growing body of evidence is emerging about interaction between genes (e.g. FKBP5 polymorphisms and CRHR2 variants) and environment (physical and sexual abuse, emotional neglect).”7

Dysregulation of chemicals in the brain – in particular, the neurotransmitter, Serotonin – is also associated with several psychopathological conditions, including BPD.

Serotonin is one of the most important neurotransmitters affecting mental health and its optimum regulation defines normal personality and acts as a mood stabilizer.7 Research confirms that altered serotonergic activity is associated with various mood disorders.8

BPD is most likely to develop because of a combination of these – childhood trauma, genetics, and differences in brain chemicals.

Why do people with BPD self-harm?

Self-harm is considered a pervasive problem in several mental health conditions but is especially prevalent in Borderline Personality Disorder. Research shows that individuals with BPD report more frequent, severe and versatile NSSI compared to self-injurers without BPD.9 People with BPD also report higher rates of suicidal ideation.

So, why do people with BPD self-harm?

Self-harming behaviours are often used to regulate emotions or reduce dissociation. The main functions of self-harm in all cases (not just BPD) include “affect-regulation, anti-dissociation, self-punishment, interpersonal influence, anti-suicide, interpersonal boundaries, and sensation-seeking.”9

In BPD, the inability to regulate emotions is the most likely association with self-harming behaviors.9 A person with BPD uses self-harming behaviors to ascertain some form of control.

Self-harming in BPD serves several functions such as, regulation of dysphoric mood (profound dissatisfaction and unhappiness), communication of distress, a means of expressing emotions, and a way of coping with dissociative states.9

Treatment at CALDA

Personality disorders, especially BPD, are deep-rooted conditions that require expert treatment. Conventional treatments often involve various psychotherapeutic procedures as well as the use of medication. Such treatment is lengthy and often unsuccessful or fraught with relapses.

The holistically orientated therapy program offered at the CALDA Clinic is highly successful in the treatment of personality disorders. One-on-one therapy is specially tailored to your needs in line with the CALDA Concept. We use scientifically founded methods from classical medicine and hypnotherapy and combine these with particularly proven healing methods from complementary medicine, traditional Chinese medicine (TCM) and orthomolecular medicine. In our experience, quite amazing results can be achieved within a short period of time – and usually without the use of medication!

Get in touch to find out more about our treatment programs. All our clients are self-payers and discretion is of the utmost importance to us, so you can be assured of complete confidentiality.


  1. Brickman, L.J. et al. (2014). The relationship between non-suicidal self-injury and borderline personality disorder symptoms in a college sample. Bord personal disord emot dysregul 1, 14.
  2. Chapman J. et al. (Jan 2022). Borderline Personality Disorder. [Updated 2022 Jan 25]. In: StatPearls [Internet].
  3. Brickman, L.J., Ammerman, B.A., Look, A.E. et al. (2014). The relationship between non-suicidal self-injury and borderline personality disorder symptoms in a college sample. Bord personal disord emot dysregul 1, 14.
  4. NHS Website. Symptoms – Borderline Personality Disorder [accessed 11th April, 2022].
  5. Bozzatello, P. et al. (Sept 2021). The Role of Trauma in Early Onset Borderline Personality Disorder: A Biopsychosocial Perspective. Frontiers in Psychiatry. V12.
  6. MIND Website. Borderline Personality Disorder. [accessed 11th April, 2022].
  7. Hansenne, Michel & Pitchot, William & Ansseau, M. (2002). Serotonin, personality and borderline personality disorder. Acta Neuropsychiatrica. 14. 66 – 70.
  8. Lin, S. H., Lee, L. T., & Yang, Y. K. (2014). Serotonin and mental disorders: a concise review on molecular neuroimaging evidence. Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology, 12(3), 196–202.
  9. Colle, L. et al. (May 2020). Self-Harming and Sense of Agency in Patients With Borderline Personality Disorder. Frontiers in Psychiatry. V11.