Can Self-Harm Reduce Suicidal Thoughts in People with Borderline Personality Disorder?

What you need to know

• Non-suicidal self-injury (NSSI) is associated with short-term reductions in suicidal thoughts in people with borderline personality disorder.
• NSSI may be used as a coping strategy to manage suicidal thoughts, but it can increase long-term suicide risk.
• Early intervention for NSSI is crucial to prevent the reinforcing effects of self-injury and reduce long-term suicide risk.

Understanding Non-Suicidal Self-Injury and Suicidal Thoughts

Non-suicidal self-injury (NSSI) is when a person deliberately harms their body without intending to end their life. This behavior is different from a suicide attempt, but it’s still a serious concern. NSSI is common in people with borderline personality disorder (BPD), a mental health condition characterized by unstable moods, relationships, and self-image.

Many people who engage in NSSI report that it helps them cope with intense emotions or reduce suicidal thoughts. However, until now, there hasn’t been clear evidence to show whether NSSI actually leads to a decrease in suicidal thoughts in the short term.

The Study: Real-Time Monitoring of Self-Harm and Suicidal Thoughts

Researchers conducted a study to examine how NSSI affects suicidal thoughts in people with BPD. They used a method called ecological momentary assessment (EMA), which involves participants reporting their thoughts and behaviors in real-time using smartphones or other devices.

The study included 82 adults with BPD who had a history of suicidal thoughts and either NSSI or suicide attempts. Participants answered questions about their suicidal thoughts and self-harming behaviors six times a day for seven days.

Key Findings: NSSI and Suicidal Thoughts

The study revealed several important findings:

1. Increase in suicidal thoughts before NSSI: People were more likely to engage in NSSI when their suicidal thoughts had increased since the previous check-in.

2. Short-term reduction in suicidal thoughts after NSSI: On average, participants reported a decrease in suicidal thoughts after episodes of NSSI. This decrease was significantly different from the slight increase in suicidal thoughts observed after periods without NSSI.

3. No difference in overall suicidal thought intensity: The intensity of suicidal thoughts following NSSI was not significantly different from periods without NSSI. This suggests that NSSI may temporarily reduce suicidal thoughts but doesn’t necessarily lead to an overall lower level of suicidal thinking.

The Complex Relationship Between NSSI and Suicide Risk

These findings highlight the complex relationship between NSSI and suicide risk. While NSSI appears to provide short-term relief from suicidal thoughts, it’s important to understand that this doesn’t make it a safe or healthy coping strategy.

In fact, engaging in NSSI is one of the strongest risk factors for future suicide attempts. This may seem counterintuitive, but there are several reasons why NSSI can increase long-term suicide risk:

1. Habituation to self-harm: Repeated self-injury may reduce a person’s fear of physical pain or injury, which could make it easier to attempt suicide in the future.

2. Reinforcement of maladaptive coping: If NSSI effectively reduces suicidal thoughts in the short term, it may encourage people to continue using this harmful strategy instead of developing healthier coping mechanisms.

3. Escalation of self-harm: Over time, some individuals may find that they need to engage in more severe forms of self-harm to achieve the same emotional relief, potentially increasing the risk of accidental severe injury or death.

Implications for Suicide Prevention and Treatment

The study’s findings have important implications for how we approach suicide prevention and treatment, especially for people with BPD:

1. Early intervention is crucial: Identifying and addressing NSSI early on may help prevent it from becoming an established coping strategy for managing suicidal thoughts.

2. Addressing the function of NSSI: Treatment approaches should recognize that some individuals use NSSI as a way to cope with suicidal thoughts. It’s important to help people find alternative, healthier ways to manage these thoughts and urges.

3. Comprehensive risk assessment: For individuals with BPD who engage in NSSI, it’s essential to conduct thorough suicide risk assessments, even if they report that self-harm helps reduce their suicidal thoughts.

4. Developing alternative coping strategies: Treatment should focus on helping individuals develop healthier ways to regulate their emotions and cope with suicidal thoughts. This might include techniques like mindfulness, distress tolerance skills, and emotion regulation strategies.

5. Addressing underlying issues: It’s important to treat the underlying mental health conditions, such as BPD, that contribute to both NSSI and suicidal thoughts.

Understanding the Limitations

While this study provides valuable insights, it’s important to note some limitations:

1. The study focused specifically on people with BPD, so the findings may not apply to all individuals who engage in NSSI.

2. The real-time monitoring occurred every two hours, which means some changes in thoughts or behaviors between check-ins may have been missed.

3. The study didn’t explore the specific reasons why NSSI led to reduced suicidal thoughts (e.g., whether it was due to a general improvement in mood or a direct effect on suicidal thinking).

Conclusions

• Non-suicidal self-injury is associated with short-term reductions in suicidal thoughts in people with borderline personality disorder.
• While NSSI may temporarily alleviate suicidal thoughts, it significantly increases long-term suicide risk and should not be viewed as a safe coping strategy.
• Early intervention and treatment focused on developing healthier coping mechanisms are crucial for reducing both NSSI and suicide risk in individuals with BPD.

This research underscores the complexity of self-harm behaviors and suicidal thoughts. It highlights the need for compassionate, comprehensive care that addresses both immediate safety concerns and long-term mental health needs. If you or someone you know is struggling with self-harm or suicidal thoughts, it’s important to seek help from a mental health professional who can provide appropriate support and treatment.