The risk of someone self-harming or having suicidal ideation is much higher in BPD than the general population – up to 10% of people living with BPD will attempt to take their own lives. Many people with BPD report frequent suicidal thoughts and self-harm.

Self-harm

Self-harm manifests in various ways and poses a significant threat to individuals with BPD. Moreover, it can serve as a precursor to the emergence of suicidal ideation or even actual suicide attempts. Self-harm can include:

• cutting or burning the skin
• hitting and punching oneself
• poisoning oneself with high but non-lethal doses of tablets or substances
• misusing alcohol and drugs
• starving yourself (anorexia), bingeing or bulimia

Any behaviour that causes injury or harm to someone as a way of dealing with difficult or intense emotions can be seen as self-harm.

The Self-Harm Cycle

Self-harm usually starts as a way of dealing with intense or distressing thoughts and feelings, as a way to relive the pressure or intensity. This gives the person temporary relief from emotional pain or distress, but the underlying reasons still remain undealt with. The person then feels guilt or shame for the harm, leading to more distress and the cycle continues.

Because it is a temporary reprieve from distress, self-harm can become the normal way to deal with difficulties and emotional distress.

Suicidal thoughts

Living with emotional pain and distress, along with any life difficulties that may also be present (abuse, neglect, domestic violence, ill health, abandonment, financial worries) can lead to suicidal thoughts. Some people may feel it the only way to find relief from their pain, distress and worry.

There are two types of suicidal thoughts:

• passive: a person has thoughts about suicide but doesn’t intend to plan or take their own life. They may have thoughts such as ‘not wanting to be alive’ or ‘not wanting to wake up tomorrow’.
• active: a person thinks about suicide but intends to make a plan and take their own life.

Not everyone with suicidal ideation will act on it. It is not possible to predict someone taking their own life but there are some signs to look for:

• giving away personal possessions
• extreme mood swings
• appearing frequently anxious or agitated
• posts on social media about wanting to die
• making plans such as researching methods of suicide and purchasing needed items
• avoidance of social interactions
• reckless and impulsive behavious
• talks about feeling hopeless and having no reason to live
• tells family and friends they would be better off without them in their lives