Borderline Personality Low Grade Self Mutilation: Stress Relief?

Self mutilation, as a symptom of BPD, is generally a common occurrence. Doctors meet many BPD patients for the first time during a crisis, which might include some form of cutting, burning, or other self imposed physical abuse as a means to either manipulate those around them, or to ease the pain they are feeling inside. Suffice to say, in all but the most serious of BPD cases, self mutilation recedes with treatment. It would be impossible for a BPD sufferer to cut themselves every day and still expect to walk around without restraints. Therefore, if you’ve witnessed someone with BPD in the midst of a self abusive act, take some solace in the fact that it is an uncommon event,that is, if the BPD gets some sort of treatment.

Left untreated, BPD self mutilation will continue, and might even approach suicide attempts. For the purposes of this blog, however, we’re going to assume that a BPD sufferer is “caught” in time and does not further escalate their self harming acts. Instead, it is important to discuss low-grade self mutilation.

During the initial years of my diagnosis, I was prone to cutting or searing my body with a small flame. This was mostly a private act meant to assuage the pain I was feeling, and the worst of it occurred before I was in formal treatment. After receiving medication and general psychotherapy, my urge to outwardly self mutilate fell away. I realized that hurting myself was extremely detrimental to my recovery and appearance. What’s more, I didn’t want to go to the next extreme, which from time to time crossed my mind. I have a couple faint scars on my arm left from when I was cutting, which are ironically hidden by diabetic glucose lancet pricks that leave my arm with plenty of small dots to distract the eyes from getting a closer look.

To say that I have completely stopped self mutilating would be a lie. Now, I practice low-grade self mutilation, characterized by spontaneous, random moments where I feel the need to touch my body in a potentially harmful way. In some cases, these acts take on the form of stress relief, allowing me to vent anger or frustration. Other times, I poke at myself because I feel very depressed and helpless. For some reason, being able to release the pressure behind the “pain valve” takes the form of agitating my body, no matter what state of mind I’m in.

Here are a few examples of my low grade self mutilation:

  • Mutilating Acne Lesions – This is relatively common among people without mental illness, but it takes on different proportions when the sufferer has BPD. If I am feeling upset, I will often focus all my energy on an acne lesion, squeezing it, poking it with sharp objects, or even trying to suffocate the lumpy appearance on my skin by inserting a diabetic syringe and sucking the pus out. I know, this is absolutely disgusting. For some reason, however, during the brief moments where I succeed in removing the lesion, I feel like I’m in control, that I was able to feel the pain and express it. Unfortunately, this quick fix for mental anguish comes at the expense of my skin. The result has produced scars where lesions used to be, and in most cases aggravating the acne only results in more breakouts. It’s a vicious cycle that continues even though I’m well beyond my adolescent years when acne is particularly severe.
  • Head Picking – I started this habit during early adolescence. Initially, I had a neurotic obsession with making sure wood ticks where not on my body. Sometimes, after playing outside or walking through the woods, I would spend several minutes running my fingers through my hair at all angles, hoping to catch a tick and remove it. One time, I actually did find a tick, and when I pulled it out, I felt a rush of relief come over me. Although it makes sense to be happy about not having ticks, the act ultimately gave me a horrible habit of picking at my head whenever I felt stressed or anxious. During particularly frustrating moments, I used to dig my nails deep into my scalp and yank out as much skin and hair as possible. It comes as no surprise to say that I developed a noticeable callous and scar. I was only able to drop this habit about a year ago. Now, instead of picking my head, I simply rub it profusely, which has allowed my small wound to heal.
  • Poking at My Ears – It seems the moment I dropped head picking, I picked up ear poking. This is a potentially dangerous substitute, because I risk losing my hearing. Still, in stressful moments, I will have the urge to insert unraveled paper clips into my ear, especially if I feel an itch that can’t be soothed from the outside. Sometimes I will play around with my inner ear by moving the paper clip in all directions, which for some reason just makes me feel better. Last year, however, I was doing this so much that I gave myself 2 outer ear canal infections that required a trip to the doctor, antibiotics, and ear drops. As recently as two months ago I felt another infection coming on, and was somehow able to reel in this awful habit long enough for my ear to heal. Don’t ask me how I got the idea for this. I can only tell you that it soothes me AND that I know it a bad thing to do. I’m slowly trying to get rid of this habit.
  • Prodding at Tonsils – By now you must be thinking, “This guy is a maniac! Who plays with their tonsils?”. The answer: I do. About 3 years ago I realized that I would develop tonsil stones from time to time. For the uninitiated, tonsil stones are small clumps of mucus, dead skin, debris, and bacteria that lodge themselves into the tonsillar crypts. If allowed to fester, they engorge themselves and eventually become the most foul smelling things you have ever experienced. After I realized I had this problem, I obviously became super self conscious about my breath, since these pungent balls of waste were lining the back of my mouth. To mitigate their effect, I slowly worked my way into a routine of poking, pushing, pulling, and even prodding my tonsils with metal objects in order to remove the stones. In fact, it is part of my nightly oral hygiene regimen: after floss, I grab a flashlight and begin playing with my tonsils to get rid of any semblance of tonsil stones. The only benefit to this habit is that I’ve managed to delay my gag reflex long enough to get rid of them. Other than that, in stressful moments when I think there are stones in my mouth, I’ve actually made my tonsils bleed after poking them with small pointed objects like toothpicks. This has only left me with a sore throat and minor infections. It’s a strange habit that I justify to myself by seeking fresher breath. In reality, that’s really just a cover story.

So, even though I’m no longer cutting my arm or searing my stomach with a lighter, I still practice small acts of self mutilation. The bottom line is this: If I can’t get the pain out of me, I MAKE it come out. I will poke and prod at my body, even to the point that blood comes up, until I have gotten rid of whatever I am chasing and get the mental relief I am seeking.

The real question to consider is how one can stop such habits, particularly when they are interwoven with BPD symptoms. I don’t have an answer for that right now, but I can tell you that the only thing that has worked for me is “downgrading” my poking to rubbing or pushing. Instead of making the acne bleed, I push it and then clean up with a tissue. Instead of picking at my head incessantly, I rub it round and round until my stress is alleviated. Instead of jamming things in my ear, I try tugging on my ear lobes if I feel an inner ear itch (much like a toddler might do).

I still have no answer for the tonsils, but I’m working on it. 🙂 Until then, don’t try to go cold turkey on your low grade self mutilation, because it is high mountain to pass in one leap. Try bringing your habits down notch by notch, and eventually you will not pose a threat to your own body anymore.

Further Evidence that BPD has a Physiological Component

The following video is commentary from a doctor regarding the inner workings of the brain in BPD patients. Although the commentary starts out slowly, he eventually concludes that a part of the brain responsible for social interactions is not functioning correctly. Further, he proves this detailing the results of a study between a control group (normal people 🙂 ) and a group of BPDs regarding levels of trust established in a mock monetary investment experiment.

The general idea is that although there is strong evidence that BPD results from behavioral and environmental conditions, there is equally plenty of evidence that points towards faulty brain functioning.

Does Social Exclusion Come Before or After BPD?

First off, what is social exclusion? Broadly defined, social exclusion is the condition in which some group or sub-culture is not allowed to be apart of the mainstream due to the socio-economic standards, value systems, or interpersonal interactions of the majority population. Social exclusion can be described in many ways, including the struggle which smaller ethnic groups face as they assimilate into a larger society; the existence of a glass ceiling for women in the work place; or even as simply as the lone kid on the playground who doesn’t seem to fit in. For the purposes of this blog, we’ll consider social exclusion on a micro scale and how it might contribute to – or result from – Borderline Personality Disorder.

Chief among the causes of BPD is a constant fear of abandonment and rejection. In most cases, Boderlines experience some sort of rejection early on in life. This could take the form of being “different” than the rest of the crowd, being raised by an abusive parent, or feeling an overwhelming sense of dejection from what would otherwise be considered a “normal” course of social maturation.

In some cases, social exclusion is merely bad luck. For example, a guy approaches a girl for a date, only to learn that she is coming out of another relationship and needs time to herself. She’s not outwardly rejecting him, but instead making his romantic overtures null and void. Likewise, a child in middle school might be ostracized due to a socially embarrassing incident in which a bully pulls his pants down in the middle of a cafeteria. The victim was not necessarily a planned target, just at the wrong place at the wrong time. As a result, he might be labeled with a degrading nickname for the rest of his grammar school years.

There are also more serious forms of social exclusion. A child who experiences the death of a parent at an early age could feel extremely abandoned, worthless, and unwanted. What would otherwise be a happy childhood is destroyed by a loss which most children can’t even fathom. Similarly, a child with a handicap (mental or physical) might experience a constant distance and rejection from his or her peers. Despite all good intentions and efforts, the handicapped child can never seem to fit in with others, and this results in an underlying feeling of sadness, angst, and general frustration with other people. When a child finally becomes fully aware of the negative stigma he or she has, all sense of self esteem and self worth are devastated.

This is where BPD comes in. By definition, Borderlines are not “normal” like everyone else. They are burdened with damaged emotional cores and a view of the world that is skewed towards the negative. They can’t related well to others, and take any form of social rejection personally and severely.

Slowly but surely, this gives rise to pent up anger and sadness, which they either take out on themselves or others. A BPD “rage” episode is often the result of feeling an oncoming rejection, such as being dumped in a relationship, or not allowed to hang out with the popular crowd at school. The Borderline Personality may not “crack” on a day to day basis, but instead feel a longstanding sense of worthlessness that is continually deepened any time another sort of rejection is experienced. Borderlines don’t get over rejection, they simply sweep it under their emotional rugs and save it for a random moment when they suddenly explode.

So does social exclusion come before or after BPD? The answer is found in the middle of the road: it happens during both points of the gradual climb towards full blown Borderline Personality. Without a doubt, BPDs feel excluded from the get go, and once they start acting out and displaying their true colors, they are further excluded. Society doesn’t want angry, emotional ballistic missiles set to go off at any given moment. Furthermore, society doesn’t want social outcasts or constant “losers” who are incapable of dealing with rejection. Such behaviors are just unacceptable to the normal spectrum of people around the BPD.

All of this begs the question: what can be done about someone with BPD who was or continues to be excluded? Unfortunately, the answer to that question lies in the person with BPD and the support system around them. The “rest” of the world passes sufferers of BPD by almost instantaneously. As a result, in order to mitigate a perpetual feeling of rejection and abandonment, BPDs must be taught healthy coping skills and counseled by skilled mental health professionals.

Personally, I’d love to tell everyone else to go f*ck themselves; and to be truthful I have in my blinding moments of rage. Sadly, these moments don’t help me become anymore “well adjusted” or socially accepted. Instead, I am the one who has to do the work and find a way back towards the center.

This is, in essence, a large part of the treatment cycle for those with Borderline Personality Disorder. If someone with BPD can learn to adapt despite strong feelings of social exclusion, they are much better off. Further, if someone with BPD can find ways to diffuse the sense of anger and loss they harbor, they will be much happier, productive individuals. They will learn to find value in themselves, and in so doing, will once again find value in the world around them.