Self-destructive borderline disorder: definition, causes, symptoms, and treatments

The self-destructive borderline disorder is a type of borderline personality disorder indicated by thoughts and tendencies relating to self-harm and self-destructive behaviors. People with this disorder tend to hate themselves and are often feeling bitter.

The main causes of self-destructive borderline disorder are childhood trauma, neurobiological factors, environmental factors, and genetics. A combination of different causes is likely the main culprit for this mental illness.

Symptoms associated with the self-destructive borderline disorder include self-harm, depression, suicidal thoughts and behaviors, excessive self-criticism, and abusing alcohol and drugs.

Treatments for self-destructive borderline disorder revolve around psychotherapy and medications. Patients may also need to be hospitalized. With proper treatment, it is possible to manage this mental illness and reduce the severity of symptoms to have a better quality of life.

What is self-destructive borderline disorder?

The self-destructive borderline disorder is a type of borderline personality disorder (BPD) indicated by displaying self-harming and abusive behaviors. Generally speaking, a borderline personality disorder is a mental illness wherein a person experiences difficulties regulating emotion.

In the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a borderline personality disorder is recognized as one of several personality disorders. There is no special chapter for the self-destructive type because it falls under BPD. Healthcare professionals refer to four types of BPD to better describe specific features of the condition in each patient. Other types of BPD are petulant, impulsive, and discouraged.

Not much is known about the history of self-destructive BPD. What we do know is that an American psychoanalyst Adolph Stern was the first to introduce the term borderline personality in 1938. The interesting thing here is that BPD was introduced and described in the United States whereas other personality disorders were described in Europe first, according to the Borderline Personality Disorder: Treatment and Management published on the website of the National Library of Medicine. Stern used the term borderline to describe patients whose symptoms were neither psychotic nor psychoneurotic. Instead, their symptoms were bordered on other conditions.

In 1975, Otto Kernberg, an Austrian-American psychoanalyst introduced the term borderline personality organization to describe a consistent pattern of behavior and functioning indicated by instability and impairments in psychological self-organization.

Three years later, in 1978, psychiatrists Gunderson and Kolb published a paper called Discriminating features of borderline patients in the American Journal of Psychiatry. In that paper, two psychiatrists discussed how borderline patients were discriminated against and misdiagnosed. They also described distinctive characteristics that could be used for diagnosing borderline personalities. These characteristics are still used today, and they served as a description of different types of BPD, including self-destructive.

For clarification, characteristics of BPD include an unstable self-concept, difficulty managing painful emotions, self-harm, and suicidal tendencies, difficulties in interpersonal relationships, impulsivity, and risk-taking behaviors.

Borderline personality disorder became a diagnosable mental condition with the release of DSM-3 in 1980. Different types of BPD, such as self-destructive borderline personality, serve to get a deeper insight into the patient’s condition and help avoid misdiagnosing or confusing this mental illness for other conditions such as depression.

How common is self-destructive borderline disorder?

It’s not clear how common self-destructive borderline disorder is, but BPD in general is not a rare condition. According to information by Dr. Jennifer Chapman et al. on the website of the National Library of Medicine, the prevalence of BPD in the general population is 1.6%, with a lifetime prevalence of 5.9%. Around 11% of the outpatient and 20% of the inpatient psychiatric population have BPD as well. At this point, it is unknown how many of these cases account for self-destructive borderline disorder.

In terms of gender, there is no significant difference in the prevalence of BPD among males and females in the general population. In a clinical setting, the condition is more prevalent in women with a ratio of 3:1.

Most patients with this disorder are adults, but it can be accurately diagnosed in patients as young as 11 years of age. The prevalence of BPD in adolescents is estimated at 3%, a review from J.M. Guile et al. in the November 2018 issue of Adolescent Health, Medicine and Therapeutics showed. In the clinical elderly population, the prevalence of BPD is between 18% and 42.7%, according to a paper that F. Rexand-Galais et al. published in the March 2021 issue of the Frontiers in Psychology.

What are the causes of self-destructive borderline disorder?

The causes of the self-destructive borderline disorder are biological, psychological, and environmental. A combination of different causes contributes to the development of self-destructive BPD. That happens because multiple factors influence a person’s psychological well-being and attitudes toward oneself. The biggest causes of the self-destructive borderline disorder are listed below:

• Childhood trauma
• Neurobiological factors
• Environmental factors
• Genetics

1. Childhood trauma

Childhood trauma is defined as a dangerous, scary, or life-threatening event that happens to a child or adolescent. Traumatic experiences from childhood have a deep impact on a person’s mental health and may pave the way to the development of illnesses such as self-destructive borderline disorder.

A paper by N. Cattane et al. from the June 2017 issue of BMC Psychiatry confirms that childhood trauma contributes to the onset of this disorder through changes in brain functioning. In fact, people with borderline personality disorder are 13 times more likely to report a history of childhood trauma than persons without mental problems, according to The University of Manchester research led by Dr. Filippo Varese whose findings were published in November 2019. The relationship between traumatic experiences in childhood and self-destructive BPD is complex. During childhood and adolescence, the brain is still developing and finding strategies to cope with everyday life challenges, including the negative feelings they may produce. However, in certain people with childhood trauma, these responses don’t form in the same manner. As a result, they become more sensitive to “normal” stress in daily life. A person with childhood trauma may not be able to cope with intense negative feelings and thoughts. This may lead to unhelpful or dangerous measures that help them feel better. One of these measures is self-harm or self-destructive behaviors.

Dr. Mark Travers in his August 18, 2021 post on Psychology Today explained that the relationship between childhood trauma and types of BPD could be due to Pace-Of-Life Syndrome, where persons grow faster and exhibit higher metabolism, which is why they are more susceptible to early bodily decline and death. This leads to elevated allostatic loads in adulthood. The term allostatic load refers to the cumulative burden of chronic stress and life events.

The January 2022 article by journalist Diana Kwon in Scientific American explains that traumatic events have long-term consequences on people and affect their ability to trust others, control their emotions, and how they cope. This also explains why experiencing trauma in young years can contribute to the development of the self-destructive borderline disorder.

2. Neurobiological factors

Neurological factors are defined as factors relating to the functioning of the brain, spine, and nerves. Changes and abnormalities in the function and structure of the brain and levels of neurotransmitters may contribute to the development of the self-destructive borderline disorder.

Multiple mechanisms explain why neurobiological factors can cause self-destructive borderline disorder, and decreased gray matter is one of them. A paper by P. Soloff et al. from the December 2008 issue of Psychiatry Research explained that people with BPD had reduced gray matter volume in the medial temporal cortex, including the hippocampus, amygdala, parahippocampal gyrus, and uncus. These brain regions are involved in declarative memory, learning, encoding and consolidation of memory, spatial navigation, and processing fearful and threatening stimuli, and emotions. Abnormalities affecting these regions lead to difficulties processing emotions and controlling behaviors, thereby contributing to the development of self-destructive BPD.

Amygdala is particularly significant here because it is the center for emotion regulation and modulation of the fear response. A review by Dr. Jack B. Ding from University of Adelaide and Dr. Kevin Hu at Lyell McEwin Hospital in Adelaide, in the July 2021 issue of Cureus explained that the degree of volume loss in the amygdala is associated with the severity of symptoms in patients with this disorder.

In addition to structural and functional abnormalities in several brain regions, neurological factors in the development of self-destructive BPD also include imbalances in neurotransmitters. Neurotransmitters carry signals from one brain cell to another. By carrying information, neurotransmitters help regulate our thoughts, emotions, behaviors, and overall functioning. A review by I.G. Gurvits et al. in the March 2000 issue of Psychiatric Clinics of North America reported that neurotransmitter system dysfunction can contribute to BPD, especially to symptoms such as aggressiveness and affective instability.

Dysfunction in dopaminergic and serotonergic neurotransmitter systems is involved in the development of this disorder, according to a paper by P.R. Joyce et al. in the January 2014 issue of Frontiers of Genetics. That means imbalances of dopamine and serotonin, or reduced expression of their receptors, can cause this mental illness. As a reminder, dopamine plays a role in memory, movement, motivation, and reward. Serotonin affects emotions, mood, appetite, and functions such as digestion and sexual desire.

3. Environmental factors

Environmental factors are family, social, and environmental influences that affect a person’s mental health and well-being. A person’s social life and family dynamics can contribute to the development of mental illnesses. The self-destructive borderline disorder isn’t an exception.

According to the UK’s NHS, environmental factors that contribute to the onset of self-destructive BPD include exposure to long-term fear or distress as a child, being neglected by one or both parents, and growing up with a family member with a serious mental illness, such as bipolar disorder. People with this disorder have also been found to be exposed to invalidating, unstable relationships or conflicts.

It’s unclear how environmental factors cause self-destructive BPD, but a potential mechanism is that they may affect processes in the brain. By influencing functioning in the brain, these factors could impair the way a person regulates emotions and behaviors, which may lead to the onset of this disorder. Similar to trauma, the inability to handle or cope with abandonment, unhealthy relationships, and family dynamics could lead to self-destructive BPD. When a person is unable to cope with a negative development, they struggle to control their reactions, behaviors, and emotions.

4. Genetics

Genetics refers to the presence of mutations in genes and genome sequences that may contribute to the development of an illness or a mental disorder. People can have a genetic predisposition to develop the self-destructive borderline disorder.

Genetics causes self-destructive BPD because people may inherit genes from their parents that make them more vulnerable to this mental illness.

A review by A. Amad et al. from the March 2014 issue of Neuroscience and Behavioral Reviews showed familial, and twin studies support the potential role of genetic vulnerability in the development of BPD. In fact, the estimated genetic vulnerability of this disorder is around 40%. At the same time, a study by S.H. Witt et al. from the June 2017 issue of Translational Psychiatry revealed that genes DPYD and PKP4 could increase the risk of developing several mental illnesses such as depression, schizophrenia, bipolar disorder, and BPD.

The most significant piece of evidence that confirms inheriting certain genes can lead to self-destructive BPD comes from twin studies. One Swedish study by C. Skoglund et al, from the June 2019 issue of Molecular Psychiatry, found that identical twins were more likely to develop this disorder than fraternal twins. The same study revealed that clusters of borderline personality disorder types in families have genetic causes and aren’t caused by shared environmental factors. That means that even if those identical twins were raised in different environments, their likelihood of developing BPD would be the same due to the genes they share.

While genetics is a significant cause of self-destructive BPD, it is not the only factor that induces the symptoms. Genetics usually works in combination with other causes.

What are the symptoms of self-destructive borderline disorder?

The symptoms of the self-destructive borderline disorder are intense self-hatred, feelings of bitterness and depression, and unstable emotions. In other words, they are quite similar to symptoms of BPD, but the tendency for self-harm and self-destructive behaviors is emphasized in people with this type of BPD. The most significant symptoms of the self-destructive borderline disorder are listed below:

• Self-harm
• Depression
• Suicidal thoughts and behavior
• Excessive self-criticism
• Abusing alcohol or drugs

1. Self-harm

Self-harm is defined as the act of deliberately inflicting damage or pain on oneself. It is important to clarify that self-harm and suicidal behavior are not the same, even though people may use these terms interchangeably. The biggest difference between self-harm and suicidal behavior is the intent. The main intent of self-harm is to experience a sense of mental or emotional relief primarily because a person is unable to cope with their emotions in a healthier manner.

Physical effects of self-harm include burns, cuts, bruises, and scratches caused by attempts to inflict pain. Other physical effects of self-harm may include alcohol poisoning or drug overdose, as people may deliberately take large amounts in order to induce pain. Sexual-transmitted diseases (STDs) are also among the physical effects in people who want to inflict emotional pain through sexual activities.

Behavioral effects of self-harm include actions or behaviors such as burning, cutting, scratching, consuming toxic amounts of alcohol, and engaging in risky sexual activities. Other behavioral effects may include wearing long-sleeved, baggy clothes that cover the skin, cuts, and signs of self-harm. Additionally, people may avoid socializing because they don’t feel comfortable spending time with friends or family.

2. Depression

Depression is a serious mood disorder characterized by persistent feelings of sadness, low self-worth, and loss of interest and motivation. According to a paper that J. Kohling et al. published in the April 2015 issue of Clinical Psychology Review, 41% to 83% of people with BPD report a history of major depression. Depression as a symptom of self-destructive BPD may occur due to intense boredom, restlessness, and desperation as well as interpersonal losses that people experience.

Physical effects of depression include a weakened immune system, constricted blood vessels, higher risk of cardiovascular diseases, appetite changes, weight gain, increased risk of type 2 diabetes, and abdominal cramps. Other physical effects of depression may include high blood pressure, high cholesterol, and hormonal imbalances.

Behavioral effects of depression include losing interest in activities once enjoyed, withdrawing from social relationships, acting in frustration, drinking too much alcohol or using drugs, difficulty functioning in teams at work or school due to low productivity and lack of interest, and suicidal thoughts and tendencies. Lack of self-care and personal hygiene is also a behavioral effect of depression.

3. Suicidal thoughts and behavior

Suicidal thoughts and behavior are ideas, actions, and thought patterns about the possibility of ending one’s life. The main intent behind suicidal thoughts and tendencies is to escape from unbearable psychological pain.

Physical effects of suicidal thoughts and behavior are injuries on the body and internal organs in cases of failed suicidal attempts.

Behavioral effects of suicidal thoughts and behaviors include social isolation, neglecting hygiene and self-care, engaging in risky activities, excessive or insufficient sleep, talking about the desire to die, making threats about killing oneself, and making preparations. The latter refers to giving personal possessions away, sudden visits to friends and family, and searching for suicide-related ideas online.

4. Excessive self-criticism

Self-criticism is a tendency for negative self-evaluation and self-depreciation, resulting in feelings of worthlessness, shame, guilt, and hopelessness. Excessive self-criticism in people with BPD, including this type, is associated with a lack of self-compassion, according to a study by F. Donald et al. from the February 2019 issue of Australasian Psychiatry. People with the self-destructive borderline disorder are prone to feeling irreversibly bad, flawed, and repulsive. This makes them criticize, loathe, and hate themselves.

Physical effects of excessive self-criticism include weight gain or weight loss, increased stress levels, and its consequences such as poor sleep quality, headaches, hormonal imbalances, muscle tension and pain, and nausea and/or vomiting.

Behavioral effects of excessive self-criticism include changing eating patterns (eating too much or not enough), social withdrawal, acting in anger and frustration, arguing with others, difficulty maintaining personal relationships, constantly evaluating oneself, and criticizing own appearance, behaviors, and performance.

5. Abusing alcohol or drugs

Abusing alcohol or drugs is the act of excessively consuming alcohol or taking illicit drugs and misusing prescription medications. People with mental illnesses often abuse drugs and alcohol. A paper by N.G. Toftdahl et al. from the January 2016 issue of Social Psychiatry and Psychiatric Epidemiology found that the prevalence of substance abuse or physical addiction in people with personality disorders is 46%. People with self-destructive borderline disorder have feelings of emptiness, disconnect, and depression. They may start abusing drugs or drinking too much alcohol to cope with those feelings. They may resort to substance abuse to inflict internal pain and damage as a form of self-harm.

Physical effects of abusing alcohol or drugs include heart or lung disease, cancer, stroke, kidney and liver damage, weight loss, brain damage, tooth decay, and pale skin. Substance abuse can also increase the risk of heart attack, affect hormonal balance, and lead to sleep problems.

Behavioral effects of abusing alcohol or drugs lead to social withdrawal, conflicts with family and friends, difficulty maintaining relationships and jobs, engaging in risky activities, neglecting hygiene, and getting into legal and financial troubles. Other behavioral effects include being secretive, lying about substance use, mood changes, and going to extra lengths just to keep using drugs or drinking alcohol.

Who is affected by self-destructive borderline disorder?

Persons in their early adulthood are usually affected by the self-destructive borderline disorder. This disorder can affect adolescents as well. Women may be more affected by self-destructive BPD than males. This mental condition tends to affect persons who have experienced trauma and haven’t found a way to process it in a healthy manner, so they hold a great deal of hatred toward themselves.

What are the risk factors for self-destructive borderline disorder?

Risk factors for the self-destructive borderline disorder are related to genetics, environment, and biological aspects. While certain factors increase the risk of this mental disorder, they don’t make it inevitable that someone will develop it. In fact, it’s possible for a person to develop self-destructive BPD even if none of the risk factors are present. That being said, the most significant risk factors for the self-destructive borderline disorder are listed below:

• Major stress or trauma in childhood including physical neglect or abuse, emotional abuse and neglect, and sexual abuse
• Family or personal history of personality disorders and other mental illnesses including depression and bipolar disorder
• Disrupted family life
• Poor communication among family members
• Low family socioeconomic status
• Having poor emotional control
• Being impulsive and aggressive
• Negative emotionality and affective instability

How is self-destructive borderline disorder diagnosed?

The self-destructive borderline disorder is diagnosed after a medical or physical exam and psychiatric evaluation. It is important to mention that personality disorders are generally difficult to diagnose because the affected persons tend to lack insight into their disruptive thought patterns and behaviors. Even when they seek professional help, they usually do it for other reasons, such as depression.

A doctor will first perform a physical exam and order blood tests, urine tests, or imaging tests such as MRIs. A medical exam is necessary to determine the presence of substance abuse and whether the symptoms arise due to some health condition. If these tests show nothing specific, a doctor refers a patient to a psychiatrist. Psychiatric evaluation is a simple yet important process that allows a psychiatrist to understand a patient’s thoughts, moods, emotions, and behaviors. They ask questions about symptoms with an emphasis on self-harm tendencies. Patients may need to complete a questionnaire and answer questions about personal and family medical and mental health history. To get more information about the patient’s condition, a psychiatrist may also interview family members.

For diagnostic purposes, a psychiatrist will use DSM-5 and diagnose borderline personality disorder when a patient meets the criteria described there. To further elaborate on their condition they will determine the type based on the most dominant symptoms and behaviors.

Speaking of diagnostic criteria in DSM-5, a patient is diagnosed with this disorder when they experience intense difficulties in interpersonal relationships, difficulty managing painful emotions, and when they have unstable self-concept or disinhibition, impulsivity, and exhibit risk-taking behaviors. These characteristics need to be present in multiple contexts such as home and work and cause significant impairment in functioning in order to meet diagnostic criteria from DSM-5, according to a post by Dr. Neff, a late-in-life diagnosed autistic-ADHD psychologist, on her website Neurodivergent Insights.

The disorder is usually diagnosed in young adults, but psychiatrists can also diagnose it in adolescents. The criteria here is that the abovementioned characteristics are present for at least one year, reported J.M. Guile et al. in the November 2018 issue of Adolescent Health, Medicine and Therapeutics.

The process of diagnosing this disorder can be complex, but it is necessary to perform thorough evaluations since BPD is largely misdiagnosed. It is commonly misdiagnosed as bipolar disorder type 2. Inaccurate diagnosis prevents a patient from getting the right treatment.

How to prevent self-destructive borderline disorder?

There is no foolproof way to prevent self-destructive borderline disorder or any type of BPD for that matter. Genetic predisposition is deeply rooted in the development of this mental illness. There is nothing a person can do to change their genes.

That being said, finding a healthy way to process trauma (especially from childhood) could help protect a person’s mental health and reduce the risk or prevent complications of self-destructive BPD. It is also possible to prevent the extreme effects of self-destructive BPD, such as suicidal tendencies, by going to therapy regularly and seeing a doctor for difficulties regulating emotions.

What are the treatments for self-destructive borderline disorder?

Treatments for the self-destructive borderline disorder are listed below:

• Psychotherapy: the first-line treatment for personality disorders. The main purpose of therapy is to help people with self-destructive BPD uncover fears and motivations linked to their thoughts and behaviors. That way, they can learn to relate to others in a more positive manner. The exact therapy approach depends on the severity of the condition and the symptoms that people experience. The most significant types of therapy for the treatment of self-destructive BPD are dialectical behavior therapy (DBT) and cognitive-behavioral therapy (CBT). Dialectical behavior therapy was specifically developed for patients with borderline personality disorder and its main objective is to help patients accept reality and empower them to learn to change unhelpful behaviors. During DBT sessions, patients learn skills to control emotions, improve relationships, and reduce self-destructive tendencies. A growing body of evidence, including a study by C. Gillespie et al in the March 2022 issue of Borderline Personality Disorder and Emotion Dysregulation, confirms the effectiveness of DBT in patients with this condition. The study explored the follow-up experiences of people with BPD who participated in DBT sessions. Results showed DBT exhibited a positive influence on subjects’ lives in the years after the completion of the program, thereby enabling their further development. Additionally, DBT gave them control over their lives and empowered them to overcome challenging situations. Dialectical behavior therapy also helped improve the quality of life and relationships. There is no set duration of DBT for patients with self-destructive borderline disorder. A full course of therapy usually takes six months, includes four modules, and requires weekly one-on-one sessions lasting 45 to 60 minutes. In addition to DBT, cognitive-behavioral therapy is helpful for patients with this disorder. During CBT sessions, patients learn to identify negative thoughts and replace them with more realistic alternatives in order to correct unhealthy emotions and behaviors. The main point is to understand how thoughts affect actions. Patients also learn skills necessary for daily functioning, such as communication skills to improve relationships. A paper that A.K. Matusiewicz et al. published in the September 2010 issue of Psychiatric Clinics of North America confirmed that CBT is helpful for patients with personality disorders. The specific number of CBT sessions depends on the severity of self-destructive BPD. Patients generally need between six and 20 sessions, but some people may need more than that. Sessions last 30 to 60 minutes once or twice a week.
• Medications: at this point, there are no FDA-approved medications for patients with self-destructive BPD, but a healthcare provider may prescribe certain drugs to reduce the severity of symptoms. These include antidepressants, antipsychotics, and mood-stabilizing medications. It’s useful to mention that medications are never the main treatment for the self-destructive borderline disorder. They are only prescribed in combination with therapy.
• Hospitalization: the more intense treatment provided in a psychiatric hospital or clinic. Not all people with the self-destructive borderline disorder need hospitalization. A doctor may recommend it only when a patient experiences severe symptoms and the risk of self-harm is high.

Does self-destructive borderline disorder have a cure?

No, self-destructive borderline disorder doesn’t have a cure, but it can be effectively monitored and managed. Successful management requires adherence to the doctor-recommended treatment plan. Thanks to a well-structured treatment, patients with self-destructive BPD can reduce the intensity of symptoms and significantly improve their quality of life.

Management of self-destructive BPD also requires a proactive approach regarding comorbidities. This disorder can occur with other psychiatric conditions, which makes it more challenging for a person to cope with their symptoms. These conditions include depression, bipolar disorder, antisocial personality disorder, narcissistic personality disorder, eating disorders, and substance abuse. By managing these mental illnesses, it becomes easier to manage the self-destructive borderline disorder, too.