Correlates of self-harm behaviour in patients with borderline personality disorder

Objective: The clinical phenomenon of self-harm is frequently recognized as a behaviour attributed to patients with borderline personality disorder (BPD). Self-harm has been found to occur in anywhere from 50 to 80% of BPD patients. This study used an attachment trauma perspective to compare BPD patients who self-harm with those who do not on a range of factors to determine if there is a possible profile for BPD patients who self-harm. Such a finding could assist towards understanding the role of self-harm in BPD patients and aid in developing the appropriate approach to treatment. Method: Study 1 (quantitative, N=69) investigated 58 BPD patients who self-harm compared with 11 BPD patients who do not self-harm. The measures investigated attachment/interpersonal problems, co-morbidity, trauma history, dissociation and impulsivity. Study 2 (qualitative, N=2 BPD self-harm patients) explored the function of self-harm behaviours through an in-depth interview analysed using interpretative phenomenological analysis. Results: Study 1 found that BPD patients who self-harmed were more likely to have a fearful attachment style, fear abandonment and have higher levels of dissociation. Increased frequency of self-harm behaviours was found in those with numerous interpersonal problems, a generalized anxiety disorder (GAD) diagnosis, higher global assessment of relational functioning (GARF) score and an intrusive or domineering interpersonal style. Unlike other studies, no link was found between self-harm in BPD patients and co-morbidity, childhood sexual abuse history and impulsivity. Study 1 findings matched the results in Study 2. Seven themes found in Study 2 provided insight into some of the functions of self-harm for BPD patients. Conclusion: The results of this current study imply that insecure-fearful attachment, fears of abandonment, dissociation and interpersonal functioning may be important aspects to assess and concentrate on in the treatment of BPD patients who self-harm. While an interpersonal component is important to include in the treatment for all BPD patients, particularly addressing interpersonal anxieties and emotional functioning for BPD patients who self-harm appears essential