Suicidality versus self-harm

CrossCurrents

Suicidality in individuals with BPD presents a complex clinical picture, not only because it is chronic, but because it is often accompanied by self-harming behaviours. Many mental health experts distinguish suicidal from self-harming behaviours in terms of underlying motivation: Suicidal behaviours are motivated by the intent to die, whereas self-harming behaviours are not. Some experts, however, such as Dr. Marsha Linehan at the University of Washington, do not make such a clear distinction. She has postulated that all deliberate self-harm ought to be considered on a continuum of lethality, regardless of its underlying intent.

Similarly, not all experts mean exactly the same thing when talking about self-harm. Traditional definitions have focused on physically self-injurious behaviours, such as superficial cutting, slashing or burning of the skin. Self harm, however, is also widely used to refer to other deliberate, potentially dangerous behaviours, such as substance abuse and high-risk sexual activity, and can encompass any self-damaging behaviour, be it physical, emotional or social.

People with BPD who cut themselves often report that the behaviour offers relief from acute feelings of anxiety, sadness or anger, and that it has an analgesic effect. And they can feel the urge to cut themselves in the same way that someone with alcohol dependency craves a drink.

Because self-harming behaviours are often chronic, therapists can mistakenly view them as willful, manipulative or ultimately non-life threatening. Various studies, however, have found that the presence of self-harming behaviours in a given client doubles that client’s risk of dying by suicide.