Self-Harming Threats and Behavior in BPD

Many individuals with symptoms of borderline personality disorder (BPD) either harm themselves or threaten to harm themselves. If you love someone who has BPD, this can be very frightening and disturbing. Knowing how to react to the threats and actions will decrease your sense of helplessness and give you the confidence to take appropriate actions in stressful circumstances.

Self-harm and threats of self-harm or suicide serve different functions to individuals suffering from symptoms of BPD. These different motives require different responses from you.

Self-Harm

Individuals with BPD often cut themselves, burn themselves, bite themselves, pull out their hair, or otherwise hurt themselves as an unhealthy way of modulating their emotions that are dysregulated by their disease. When self-harm is done for this purpose, it is usually done secretly and hidden. They choose parts of the body, like legs and upper arms, that are easily concealable by clothing. When people do see these lesions, they often lie and say that they come from an accident.

If you discover that your loved one is harming themselves secretly, you need to confront them. You should let them know that you are aware of their self-harming behavior and that you know that this means that they are in a lot of psychic pain. Encourage them to get help and if you are willing, offer to go with them to a clinic or mental health provider.

Threats of Self-Harm or Suicide

Individuals with symptoms of BPD often threaten suicide in order to get others to do what they want them to do. This is illustrated in the following exchange between Marcy, who has symptoms of BPD, and her father.

Marcy: Dad, I need a new car.

Dad: What happened to your car?

Marcy: It’s a piece of crap.

Dad: Did it break down?

Marcy: No, but it's disgusting inside and it's a loser car.

Dad: The car is only three years old.

Marcy: I look like a loser in that piece of crap!

Dad: Why don’t you clean the inside?

Marcy: Can you please just get me a new car?

Dad: No. There is nothing wrong with your car. I will pay for a car wash.

Marcy: I have to have a new car. I can’t stand being in that piece of garbage.

Dad: Do you want me to help you clean it?

Marcy: I will kill myself if you don’t get me a new car.

Threats of self-harm that are made for manipulative purposes need to be treated differently. If you give in to these threats, you will not be helping your loved one; in fact, you'll increase the chance that they will use threats in the future whenever they can’t get what they want. This is a form of enabling and it makes the situation worse in the long term

In this circumstance, you should tell your loved one that you cannot give in to their threats. You should offer alternative ways to find a compromise solution, if possible. In the above example, Marcy’s dad offered to pay for a car wash as an alternative solution. He might also have offered that he will split the cost of a new car with her if he was willing and able to do so.

In many instances, your loved one may reject the compromise offer when initially presented. They might test you to see if you are serious about saying no. This is particularly true if you have given in to them in the past. You need to hold your ground and keep the compromise offer on the table.

Sometimes, individuals with symptoms of BPD "test" by harming themselves or making a suicidal gesture. They may make non-lethal cuts or burns on themselves. They might take a non-lethal overdose of medication. In this circumstance, they will most likely do this in front of you, not secretly.

Non-lethal injuries and suicide attempts must be taken seriously. Sometimes efforts that are meant to be non-lethal can be very dangerous. If you find yourself in a situation where your loved one hurts themselves in front of you in an effort to manipulate you, you should insist that they get medical attention. If the injury is serious, you should call 911 if they refuse to seek medical care on their own.

After testing your resolve and finding out that you are not going to give in to their drama, they may go back to your compromise solution and take you up on it. In situations where the injury is not severe enough to warrant a 911 call, you can make it a condition to the compromise solution that they get help first.

You now have a strategy for dealing with your loved one with symptoms of BPD when they harm or threaten to harm themselves. This is a difficult, if not traumatic, situation for you and it will take a toll on you emotionally. If you find yourself in this position with your loved one, you should consider setting a boundary: that you cannot continue in this relationship if this behavior continues. If you do set this boundary, be prepared to act on it—because if you don’t, you will be enabling the illness and making it worse.