Borderline personality disorder: self-harm and suicidal ideation

TRIGGER WARNING – Due to the nature of this blog’s topic please proceed with caution if you are easily upset by discussion of self-harm and/or suicide. 

This is my fifth post in a nine part blog series on the criteria for borderline personality disorder (BPD). In this post I am looking at the fifth point of criteria:

‘Recurrent suicidal behaviour, gestures, or threats, or self-harming behaviour’

Although this criteria specifies suicidal behavioural first (reflecting the tendency of services to prioritise BPD patients based on the perceived risk of suicide), I would like to begin by talking about self-harm.

What is self harm?

Self-harm means different things to many people. Although an enormous part of my life (almost half) has been tainted with self-harming behaviours and at times near-constant thoughts about physically hurting myself, this is something I feel distant from at the moment. I see the scars on my skin and I feel uncomfortable. This was never who I was supposed to be. And although I don’t really evaluate this in any particularly positive way deep down, I feel like I have stepped over some kind of threshold in which I don’t need that anymore. I hope, so anyway. It’s taken more than just my skin and my blood.

Self-harm comes in many forms. If you’re physically hurting yourself with the intention of hurting yourself, it’s self-harm. Self-harm isn’t just the thick red and purple marks on skin. It’s more than cutting. It’s a monster that comes in all shapes and sizes. And people who struggle with self-harm will often go to extremes to keep it hidden. Others will go to extremes for other people just to bloody notice. I don’t think either should be judged and I don’t think the latter should be shunned as ‘attention seeking’ in a horrific way in which they are then denied the help they really need on the basis of being somewhat less valid.

I wish that there had been better invention for me before my self-harm escalated from superficial to severe and frequent self-harm. At the end of the day, I now have to live with them. I cannot undo what I did. There have been moments where these horrible scars have brought me together with other people. In McDonald’s at the end of a night out and another girl with scars who I’d never met before just gives me a hug. At Pride in 2016 when one kind woman stopped me and said that she just wanted to let me know that I’m really brave and that I shouldn’t give up. But mostly it has been pain which has only led to more pain. To angry and confused faces. To broken relationships. To my parents crying and my younger siblings seeing things they really, really never should have.

Why do people with BPD self-harm?

In relation to borderline personality disorder, I think I have struggled with self-harm for multiple reasons. These reasons may not apply to everyone else who has this disorder, and is especially complicated because I am also diagnosed with clinical depression which also often leads to self-harm. But here are some of the reasons why I believe I have struggled with self-harm:

  • As a way to cope with really painful memories.
  • As a form of self-punishment.
  • In order to make myself feel ‘real’ during times of chronic emptiness.
  • As a way of coping with anger so intense I’ve felt like it was about to destroy me.
  • In order to make myself look as horrible as I felt inside.
  • As a way of appeasing suicidal thoughts.

And with the last point, I now want to articulate some thoughts about BPD and suicidal ideation. 

First of all, I find the term suicidal ‘threats and gestures’ to be problematic. It’s unsympathetic. I would like to point out a few things:

  • You can be actively suicidal, yet part of you still want to be alive. I believe this is the case for almost everyone. I would like to believe that, whether we acknowledge it or not, we all have some hope even if it is tiny and it’s deep down. But what I’m trying to say is that what services may interpret as a suicidal ‘gesture’ is genuinely sincere. And despite that part fighting, there is always the real risk that the desire to die is going to win. Suicidal behaviours should always be taken seriously.
  • A lot of people with BPD struggle with passive suicidal ideation which can quickly become active. This is certainly true for me. Although I am not currently actively suicidal, that passive desire to die has never left me and I doubt it ever will. It’s something that I’ve had to live with. For this reason, people with BPD often need long-term help from services. We can switch so easily.
  • Suicide attempts can be difficult to define. I have previously been in the emergency department receiving treatment for an OD and been honestly told ‘Well, if you really wanted to die you would have taken x or x amount then’. Perhaps I didn’t really want to die. Perhaps I just longed for the pain. Or the unknowing of whether I would pull through. But the intention felt real to me, and those comments have never left me.
  • Suicidal thoughts/urges can cloud normal judgement. Sometimes sufferers of BPD can seem incredibly problematic. For me and for many others, this is particularly true when we are struggling with severe suicidal ideation. It consumes you and it takes all your strength away. It can make you seem like a selfish person. ‘Aren’t you thinking about your family?’. Well yes I am, but I am in so much pain and I am so aware of what a pain I’m being to everyone else that it feels like they’d be better off without me as well. Please be kind.

If you are struggling with thoughts of self-harm or suicide, please reach out for help. Please visit your GP or look for counselling charities in your area. Talk to your parents and your friends. If you are unsafe, please call 111 or take yourself to the nearest emergency room. And remember that Samaritans are here to talk 24/7 on 116 123 (UK). Take care.

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