I Hate You--Don't Leave Me - Jerold J. Kreisman [23]
Self-Destruction
Criterion 5. Recurrent suicidal threats, gestures, or behavior, or self-mutilating behaviors.
Suicidal threats and gestures—reflecting both the borderline’s propensity for overwhelming depression and hopelessness and his knack for manipulating others—are prominent features of BPD.
As many as 75 percent of borderlines have a history of self-mutilation, and the vast majority of those have made at least one suicide attempt.28 Often, the frequent threats or halfhearted suicide attempts are not a wish to die but rather a way to communicate pain and a plea for others to intervene. Unfortunately, when habitually repeated, these suicidal gestures often lead to just the opposite scenario—others get fed up and stop responding, which may result in progressively more serious attempts. Suicidal behavior is one of the most difficult BPD symptoms for family and therapists to cope with: addressing it can result in endless unproductive confrontations; ignoring it can result in death (see chapters 6-8). Although many of the defining criteria for BPD diminish over time, the risk of suicide persists throughout the life cycle.29 Borderlines with a childhood history of sexual abuse are ten times more likely to attempt suicide.30
Self-mutilation—except when clearly associated with psychosis—is the hallmark of BPD. This behavior, more closely connected to BPD than any other psychiatric malady, may take the form of self-inflicted wounds to the genitals, limbs, or torso. For these borderlines, the body becomes a road map highlighted with a lifetime tour of self-inflicted scars. Razors, scissors, fingernails, and lit cigarettes are some of the more common instruments used; excessive use of drugs, alcohol, or food can also inflict the damage.
Often, self-mutilation begins as an impulsive, self-punishing action, but over time it may become a studied, ritualistic procedure. In such instances the borderline may carefully scar body areas that are covered by clothing—which illustrates the borderline’s intense ambivalence: he feels compelled to flamboyantly self-punish, yet he carefully conceals the evidence of his tribulation. Though many people get tattoos for decorative reasons, on a societal level the increasing fascination with tattoos and piercings over the past two decades may be less a fashion trend than a reflection of borderline tendencies in society (see chapter 4).
Jennifer (see chapter 1) would fulfill her need to self-inflict pain by scratching her wrists, abdomen, and waist, leaving deep fingernail marks that could easily be covered.
Sometimes the self-punishment is more indirect. The borderline may often be the victim of recurrent “quasi accidents.” He may provoke frequent fights. In these incidents, the borderline feels less directly responsible; circumstances or others provide the violence for him.
When Harry, for example, broke up with his girlfriend, he blamed his parents. They had not been supportive enough or friendly enough, he thought, and when she ended the affair after six years, he was forlorn. At twenty-eight he continued to live in an apartment paid for by his parents and worked sporadically in his father’s office. Earlier in his life he had attempted suicide but decided he wouldn’t give his parents “the satisfaction” of killing himself. Instead, he engaged in increasingly dangerous behaviors. He had numerous automobile accidents, some while intoxicated, and continued to drive despite the revocation of his driver’s license. He frequented bars where he sometimes picked fights with much bigger men. Harry recognized the destructiveness of his behavior and sometimes wished that “one of these times I would just die.”
These dramatic self-destructive behaviors and threats may be explained in several ways. The self-inflicted pain may reflect the borderline’s need to feel, to escape an encapsulating numbness. Borderlines form a kind of insulating bubble that not only protects them from emotional hurt but also serves as