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Another study of suicidal self-injury in Borderline Personalities attempts to clarify
certain differences between potentially lethal behavior in people suffering Major
Depression and those with Borderline Disorders (Gerson & Stanley, 2004). Seriously
depressed patients usually seem to be suicidal out of a deep sense of despair or self-
disdain and seek the nothingness or peace of death. If their suicidal efforts fail,
depressed patients may become even more depressed, hopeless, guilt-ridden,
withdrawn and lethargic. Gradually, if treated with medication and psychotherapy,
they usually become less suicidal in time. In contrast, the Borderline patient (70%
have self-injured) becomes suicidal more quickly in response to changing
circumstances or relationships and they report feeling better soon after the self-
injury. This is more in keeping with their impatient, impulsive personalities. Starting
in late adolescence, they often cling to others but have problems with dependency
and anger control, so their relationships may become highly emotional and unstable.
A major problem here is that Borderline personalities, who often self-injure in
order to regulate their strong, rapidly changing emotions, run a serious risk of
unintentionally dying because they underestimate the risk of death in self-injury.
Their therapists may also underestimate the risk, believing (correctly) their
Borderline patients do not intend to kill themselves. Research has documented that
single acts of self-injury are rarely lethal but when repeated over and over self-
injuries can become a serious risk. Be aware. About 10% of Borderline patients
eventually die by suicide (Paris, et al, 1987). A cognitive-behavioral therapy,
Dialectical Behavior Therapy, has been developed specifically for Borderline
Personality Disorders (Linehan, 1993).
The creation of paradoxical behavior
Most of us hate pain and do all we can to avoid hurting ourselves—our bodies
have powerful reflexes and natural mechanisms to avoid injury and pain--the sight of
our own blood flowing out of a cut is alarming to most of us. Some of the
consequences of self-injury to some people are not what you would expect, namely,
it can be an escape or venting mechanism, it may release built up emotions of anger,
self-hatred, badness (blood letting can be seen as “letting the badness flow out of
me”). Also, a dramatic self-injury can stop the downward spiral of depressive
thoughts. Other people discover that the process of inflicting self-injury and pain
takes their attention away from the most disturbing thoughts. So, some people
simply learn they can produce pain or a shocking injury that distracts them from
depression, guilt, anger, and worrisome obsessions. As a result, some might start to
self-injure repeatedly, ironically, to feel better (to come out of a terrible emotional
slump). This may seem odd, but it will not be surprising to people familiar with the
concept of negative reinforcement (see chapter 4) in which the payoff or powerful
reinforcement following some behavior is escape from an unpleasant situation.
Reinforced self-injury can become a compelling habit.
Here is how one girl described her self-cutting from 13 to 16: “I was bullied and
teased about my weight for two years and I couldn’t stand it any more. I became so
angry with my body that I tried to commit suicide just to punish myself. I wanted to
cut my wrists but couldn’t do that, so I cut my arms instead. I was calm as I did it. It
felt I was finally in control of my life. It was a relief. The pain was intense but I
focused all my attention on it. It proved I was still human and had feelings. From
that first time, cutting became my preferred way to release feelings. When I got
upset or angry, I’d just go to my room and cut with a razor or a sharp knife, then
