A mixed methods study of the relationships between self-harm, suicidal behaviour, and disordered eating in BPD: the role of psychological factors

Co-occurring borderline personality disorder and eating disorders confer a greater risk for self-harm and suicide attempts than either diagnosis alone. The nature of, and possible reasons for, the relationships between disordered eating, borderline personality disorder, and self-harm behaviour remains unclear. This study used a cross-sectional mixed methods approach to examine the prevalence of self-harm, suicide attempts, and eating disorder symptoms in borderline personality disorder; investigate the effect of psychological factors on these relationships; and to explore lived experiences of self-harm, suicidal behaviour, and disordered eating in borderline personality disorder. 52 individuals with borderline personality disorder in NHS Highland completed questionnaires assessing various psychological factors. A subset of these (n=7) took part in semi-structured interviews exploring experiences of self-harm/suicide attempts, and disordered eating, analysed using interpretative phenomenological analysis. Results demonstrated that self-harm and/or suicide attempts were reported by all participants, and the mean scores on the EDE-Q were high. Social perfectionism, emotional dysregulation, depression, and low resilience were associated with eating disorder severity; social perfectionism uniquely so. Three superordinate themes describing participants’ experiences of self-harm, suicide attempts and disordered eating emerged from the analysis: ‘self as defective’; ‘need for control’; and self-harm as ‘friend and foe’. These findings highlight that high rates of self-harm, suicide attempts, and disordered eating are reported by individuals with borderline personality disorder. Social perfectionism in particular appears to be a risk factor in those with co-occurring borderline personality disorder and disordered eating, alongside emotion dysregulation, depression, and low resilience. More attention needs to be given to assessing and treating eating disorder symptomatology and self-harm/suicide attempts in individuals with borderline personality disorder