Why do patients meeting criteria for borderline personality disorder deliberately harm themselves? Some hypothesised neurobiological correlates

The majority of patients meeting criteria for borderline personality disorder deliberately harm themselves at some time in their lives. This deliberate self-harm is nearly always subsequent to interpersonal loss. This paper postulates that the physiological arousal, which precedes deliberate self-harm, has a distinctive pattern specific to borderline personality disorder. The clinical manifestations are: baseline distress, followed by an environmental trigger factor (separation), which sets off an acute response of increasing distress, usually accompanied by ruminations.This develops into an intensely disagreeable subjective state, with simultaneous cutaneous anaesthesia or dissociative symptoms. It is this highly unpleasant state which is rapidly and very effectively relieved by soft tissue injury.