Clinical features of auto-aggressive behavior in borderline personality disorder: a review of current research

Abstract

Borderline personality disorder (BPD) is a common psychiatric disorder characterized by severe auto-aggression (AA) in the form of suicide attempts (SA) and non-suicidal self-injury (NSSI). The purpose of this review was to describe the current knowledge about the clinical features of self-harming behavior in borderline personality disorder. Materials and methods: The eLibrary, PubMed, CNKI, and Google Scholar databases were searched for articles on the relevant search query for the last 11 years. As a result, 28 articles were selected and summarized (a total of 7,284 BPD patients and 134 controls were included). Results: Suicidal attempts occur in 75 % of BPD patients, and NSSIs — in 90 %. AA behavior varies with age: adolescents tend to NSSIs, while adults more often undertake SAs. Depending on the type of clinical dynamics, AA in BPD may be impulsive, demonstrative, associated with comorbid addiction, or occur in the context of depersonalization. Among BPD symptoms, feelings of chronic emptiness, avoidance of abandonment, emotional instability, and identity disturbance are most commonly associated with auto-aggression. Risk factors for self-harming behavior in BPD include traumatic childhood events, especially physical and sexual abuse, and stress caused by microsocial conflict. Men with BPD and AA more often have comorbid narcissistic, antisocial, paranoid, and schizotypal personality disorders, as well as substance use disorders. Women with borderline personality disorder and AA tend to suffer more from addictive and obsessive-compulsive personality disorders, as well as eating disorders, particularly bulimia nervosa. In conclusion, self-harming behavior in BPD has many clinical features and can manifest in different forms. It is always necessary to study the predominant clinical manifestations, risk factors, and comorbid disorders to be able to assess the severity of AA.