Ask Bon,  Borderline Personality Disorder,  Pain,  Self-Injury,  Substance Abuse

Ask Bon: Why does my loved one with BPD do such dangerous things? (like cutting, drugs, etc.)

People with BPD are in a great deal of emotional pain. Since emotions are immediate and primal, emotional pain is also immediate and primal. As I have said, emotions represent a land-bridge between the body and the mind. Emotional pain manifests itself in both mental and physical ways. If you have ever been depressed or “fraught with grief” over the loss of something or someone important to you, you will know what I am saying in this regard.

Depression and grief can be a trying experience for anyone. You feel pain in every area of your body and mind. Sometimes you will just want to retreat to your bedroom and go to sleep for hours, just to get some relief from the physical and mental anguish you feel. The sleep represents a distraction of both the mind and the body from the experience of complete pain. You might also use alcohol to relieve the pain by “turning off your mind.” Many people “drink themselves into a stupor” and, in doing so, extinguish the pain for a short period. Pain-killers, whether over-the-counter or prescription, can also remove pain by working on the pain at its source (in the brain where pain is actually felt). Once, when I was asked by one of my daughters about how the Tylenol knew to go to her foot (which was in pain), rather than to her head (because she’d taken it for headaches before), I explained that it acts in the brain where she feels the pain, not where the pain actually “is.” In the case of emotional pain, the pain seems to be both in the body and in the mind, but the pain-feeling area of the brain is where these drugs act. See below about substance abuse.

People with BPD are likely to feel emotional pain many times a day every day. Since these emotions are basic (like fear, sadness and anger) the reactions to them are both physical and mental. These emotional pain-states are powerful and have the ability to overpower rational thinking. When you are in pain, regardless of the source, the main reaction of the body and mind is to get out of or to relieve the pain as soon as possible and by whatever means necessary.  I used the example of someone who is literally on fire. This person will try to douse the flames in any way, without thinking about the people around her and what harm may come to others if the flames spread. This situation is analogous to a person in deep emotional pain. The person will do anything to stop the pain, which is why my Internet site and Internet list are called “anything to stop the pain” (ATSTP). This “anything” includes self-destructive and relationship-damaging behaviors.

Self-injury

Self-injury can come in many forms and includes cutting oneself with razors or knives, burning oneself with cigarettes or matches, pulling out clumps of hair and picking at oneself (especially the nails and/or cheek) until blood is produced. Self-injury is one of the most difficult behaviors for the loved one to understand. In the case of BPD, self-injury is done for the purpose of pain relief, not to “get attention” or to manipulate the loved one. Most self-injury is done in private and done without the knowledge of the loved one. Occasionally, the self-injury cannot be covered-up (i.e. the blood and/or scars are apparent or the hair is missing in large area of the head) and others notice the activities. The actions themselves are fraught with shame and may lead to even more shame for the person.

In the hospital, ER doctors take a dim view of those who injure themselves and a person who engages in self-injury often avoid hospitals to avoid the inevitable judgment and lack of compassion these doctors (and nurses) will exhibit toward her. What is important for a loved one to understand is that self-injury has a purpose and that purpose is usually pain relief, not self-punishment or attention-getting. The person who engages in this behavior may feel and describe a deep “itch” inside her body that she has to rid herself of immediately.

While self-injury can provide relief from pain (through the release of endorphins, or natural, pain-killing substances within the brain), it can have risks and negative consequences. These include embarrassment, scars, infection and, in some cases, death.

Substance Abuse

Addiction Treatment Center in Richmond | Virginia Center for Addiction Medicine reporting, that many people use alcohol and/or drugs to dampen the effects of emotional pain. With BPD, it is likely that alcohol and/or drugs will be used for this purpose. Drugs and alcohol CAN function to reduce pain. However, this pain reduction is temporary. What I have noticed from the ATSTP group is that people with severe BPD are likely to use large quantities of alcohol and/or drugs to deaden their pain. Some estimates of substance abuse by people with BPD are as high as 75%.

Many people with BPD use and abuse alcohol and drugs. Often, they will ingest large quantities (more than someone without BPD could handle) and not overdose or even pass out. They may take both prescription drugs with anti-anxiety medication, such as Xanax, Ativan and Klonopin (and others); painkillers, such as Oxycotin, Vicodin or Codeine (and others); or they may take illicit drugs, such as Marijuana, Cocaine, Heroin, or Methamphetamine (and others). The purpose, again, is to remove emotional pain. Unfortunately, these substances, especially in the quantities consumed, can have several negative effects and consequences, including overdose, driving violations and an increase in impulsivity or dyscontrol.  These periods of impulsivity and dyscontrol and the behaviors that result (such as “risk-taking behavior” below) may cause more shame and self-punishment when the BP sobers up.

Risk-taking Behavior

People with BPD also engage in risk-taking behaviors of various forms. These behaviors include risky sexual behaviors, reckless driving and thrill-seeking behaviors. Many of these activities could be considered life-threatening either in the short term (by having a car accident) or in the long term (by contracting HIV or another fatal sexually transmitted disease). The people with BPD will, at the time of the risk-taking behavior, most likely not consider the consequences to life and limb – either physical or legal. Again, the purpose is to halt and/or deaden the emotional pain. In other words: “it seemed like a good idea at the time.” Sexual activities can provide pleasure, dangerous driving can provide a thrill and other risky behaviors, like hanging out of windows or jumping off cliffs into lakes, can provide a rush of adrenaline that temporarily removes the emotional pain. The point is for you, the loved one, to understand that the motivation of these behaviors, however short-sighted and ill-conceived you think they are, is to remove pain.

One member of the ATSTP group reported that her husband had totaled four cars in a period of eight years. These behaviors are impulsive and therefore not “thought through.” They are another method to “put out the fire” within the person. Certainly, these behaviors can have significant consequences, physical, legal, financial and otherwise.

Eating Disorders

Another behavior that many people with BPD engage in (particularly females) is eating disorders. Whether it is starving oneself or binging-and-purging or overeating (especially secret overeating), the eating disorder is another tool someone with BPD can use to alleviate emotional pain.

Again, eating disorders can have negative consequences including starvation, ill-health, poor self-image and obesity.

Other Binge Behavior

Other binge behaviors (or indulgent/irresponsible behaviors) are binge shopping, obsessive plastic surgery and “running away” through binge travel. These behaviors provide temporary relief from emotional pain as well. And again, they can have negative consequences by damaging a relationship or financial consequences.

On a final note on dangerous behaviors: it is important to prioritize when you are trying to help the BP halt or alter their behavior. You will want to start with the most dangerous first. If your daughter with BPD is having unprotected sex and smoking marijuana, regardless of your feelings about drugs, the unprotected sex will have to come first. Also, you need to be practical about it. Giving her condoms and saying, “I can see how buying these or asking your boyfriend to wear one might be embarrassing to you” rather than insisting she no longer see the boy is probably more effective, again regardless of your feelings about premarital sex. Once the genie is out of the bottle, it is difficult to stuff it back in. You can, however, help make it safer and you do so by being effective. Of course, you also have to be brave in this situation. It can be very difficult for a parent to talk to a child about sex.

Adapted from When Hope is Not Enough

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