Mental health disorder is a critical challenge that not only affects individuals but also presents serious issues to families and communities across the world. In the context of Australia, the common mental disorder associated with Non-Suicidal Self-Injury (NSSI), is borderline personality disorder (BPD) (Buelens, et al., 2020). Its symptoms appear commonly in early to late teens or early adulthood. As such, it is crucial to understand the approach to the assessment and management of mental health, especially for individuals susceptible to BPD. It is worth mentioning that examining the complex issue surrounding BPD and NSSI needs an all-inclusive strategy that involves both the community and inpatient mental health settings. Individuals with BPD typically choose NSSI as a leeway to deal with devastating feelings and pressure. The behaviour, although not planned to commit suicide, presents critical challenges for patients and their caregivers (Buelens et al., 2020). To support people with BPD and NSSI, developing a strategic approach to assess and manage it is essential. Therefore, this essay discusses how BPD is linked to NSSI and how it influences self-injury behaviours and appraises the process of effective assessment and management of patients in the community and or inpatient mental health settings in Australia.
Borderline Personality Disorder (BPD) is a critical mental disorder commonly characterised by four key features including affective instability, identity problems, negative or unstable interpersonal relationships, and impulsivity or recurrent self-harm.” (Reichl & Kaess, 2021; Buelens et al., 2020). Although a significant rate of symptomatic reduction characterises the course of BPD throughout life expectancy, it is evident that a substantial number of individuals never recover completely when it comes to psychological functioning (Videler et al., 2019). According to the Australian BPD Foundation, “Personality Disorder impacts up to 6% of the Australian population with about 50% estimated in psychiatric patients,” with the occurrence of BPD being the same in both women and men. (Australian BPD Foundation, 2023).
Relationship between BPD and NSSI
Self-harm, specifically non-suicidal self-injury, is a common mental health problem among psychiatric individuals; however, it is particularly relevant in the context of BPD. This behaviour can be considered the expressive sign of underlying impulse control challenges, interpersonal relationships, and emotion regulation x. In this case, people diagnosed with BPD have a high risk of engaging in NSSI and even premature death (Buelens et al., 2020). The connection between NSSI and BPD is not just accidental. It reveals the deep struggle and desperation that always accompany the fight to manage devastating emotions. Notably, BPD is associated with profound and quick changes in emotions (emotional dysregulation), thus making it difficult for individuals to control how they feel (Lurigio et al., 2024). As such, self-injury gives short-term emotional pain alleviation and provides a noticeable way to express and deal with internal turmoil.
Additionally, the uneven emotion of self-inherent in BPD can cause an individual to have a feeling of emptiness and identity disturbance or confusion. As a result, an individual may use NSSI to ground themselves or redeem a sense of self-control over their emotions and body. The behaviour of self-injury can be used to ease the prevalent emotional state of emptiness that BPD individuals experience (Fulham et al., 2023). Furthermore, people with BPD often grapple with impulsivity and poor decision-making, which are the main issues that lead to NSSI. The spontaneous nature of self-harm can be a direct expression of impulsivity, which is a common characteristic seen in BPD, where people react to extreme emotions without taking into consideration the consequences.
The interpersonal difficulties related to BPD, such as strong and unstable relationships, individual fright of rejection, and challenges to establish a harmless sense of attachment, contribute to the risk of NSS (Fulham et al., 2023). As such, self-injury may be an approach for people with BPD to vent out their dissatisfaction or seek attention and support from others in society. It is, therefore, crucial for mental health providers to understand the complex link between BPD and the characteristics and function of NSSI as an adaptive mechanism during the process of assessing and managing people grappling with these critical mental challenges.
Assessment of Persons with BPD and NSSI
Diagnostic Assessment
During the evaluation of people struggling with BPD engaging in the behaviour of NSSI, an inclusive investigative assessment is a crucial preliminary step. Mental health practitioners utilise established standard models and tools to guarantee accuracy in BPD diagnosis. These tools are significant in ensuring the identification of prevalent patterns and symptoms that characterise BPD, including emotional instability, impulsive behaviour, and intense but unstable relationships with others. Moreover, mental health professionals dig into the specifics of NSSI by examining its rate of recurrence and severity and recognizing causes or triggers (O’Dwyer et al., 2020). This inclusive diagnostic method warrants a subtle understanding of the mental health status of a person.
In Australia, mental health professionals usually follow the diagnostic standards established, like those specified in the “Diagnostic and Statistical Manual of Mental Disorders,” commonly known as (DSM-5), to assess signs and symptoms connected to BPD. Utilising established standard tools assists in accomplishing a regular and consistent diagnosis, sets the basis for tailored interventions.
Assessing Frequency, Severity, and Triggers of NSSI
Apart from BPD assessment through diagnosis, it is essential to evaluate the exact characteristics of NSSI. Knowing the frequency and severity of self-harming behaviours enables mental health practitioners to determine the immediate risk to the person. Furthermore, detecting triggers for NSSI gives an understanding of the primary psychological and physical aspects contributing to the behaviours.
A comprehensive assessment of risk is a vital factor in controlling individuals with BPD and NSSI. Mental health caregivers should examine the severity of self-harm and its probable consequences on the general well-being of the person involved. First, it is crucial to evaluate the seriousness of self-injury. It consists of measuring the physical injury caused, identifying the intent behind the self-injury behaviour, and assessing the level of risk for intensification (Hepp et al., 2021). This assessment provides guidelines for the establishment of intervention strategies that address the immediate impacts of self-harm and avoid further incidences.
Secondly, risk assessment can be done by evaluating suicidal ideation and general well-being (Hepp et al., 2021). Rather than the immediate harm caused by NSSI, mental health nurses measure the manifestation of suicidal ideation and personal mental health well-being. This extensive viewpoint assists in creating an all-inclusive treatment strategy that can help to address not only the signs and symptoms of BPD but also the related dangers of self-injury. It enables mental health clinicians to create interventions to the specific individual’s needs, enhancing an inclusive and effective strategy for mental health care. Lastly, the awareness of diagnosis and risk assessments is vital in establishing safety approaches and crisis intervention strategies. Safety plans are tailored methods that a person can use during times of emotional distress to evade involvement in NSSI, while crisis intervention strategies are hands-on actions designed to address immediate pressures on the safety of an individual (O’Dwyer et al., 2020). These strategies are dynamic and flexible based on the mental status of an individual and also work as a proactive mechanism for both the patient and their supporting system.
Management of Individuals with BPD and NSSI
Dialectical Behaviour Therapy (DBT)
Since patients diagnosed with BPD are susceptible to engaging in self-injury behaviour, it is essential to create and establish evidence-based interventions in mental healthcare, which can help to decrease the most persistent problems. One of the best evidence-based interventions for people with BPD engaging in NSSI is Dialectical Behaviour Therapy (DBT). DBT is specific structured cognitive behavioural therapy (Kresznerits et al., 2023). It was initially designed to provide therapy to individuals with self-injury behaviours and emotional dysregulation, mostly seen in people with BPD (Prada et al., 2018). It is centred on a “biosocial theory of emotion dysregulation,” emphasising the balance between acceptance and change. Core strategies in DBT consist of several modules, including mindfulness, tolerance of distress, emotion regulation and interpersonal effectiveness. All these together address the complex difficulties experienced by the individual grabbling with BPD and NSSI. The efficacy of this evidence-based therapy is supported by several research papers, showing drops in NSSI and continuous improvement in general well-being among people with BPD (Kothgassner et al. 2021; Kresznerits et al., 2023; Prada et al., 2018).
The first primary component of DBT is the emphasis on establishing skills to encourage emotion control and enduring distress. People with BPD usually struggle with deep and rapidly fluctuating emotions, leading to the possibility of committing to NSSI. DBT enables them to obtain practical skills to recognize, understand and control their feelings effectively Kothgassner et al. 2021). Skills training involves understanding mindfulness practices to remain present and active, embracing distress tolerance techniques to cope and manage devastating emotions without engaging in self-injury activities and establishing practical skills in interpersonal relationships to interact with others adaptively. In the Australian mental health setting, incorporating these skills supports a hands-on strategy to manage NSSI in patients with BPD.
Collaborative Care Approach
It is important to note that the collaborative care approach is an essential method for managing people struggling with BPD and NSSI. This approach ensures that different healthcare specialists come together to offer inclusive and integrated mental healthcare. Collaborative care involves all relevant mental health professionals, including psychiatrists, mental health nurses, and social workers, in treating patients with NSSI and PBD (Timberlake et al., 2020). This interdisciplinary practice guarantees that the specific needs of each individual are addressed from different viewpoints, encouraging a more wide-ranging understanding of their circumstances. In the Australian mental health setting, collaborative care aligns with the “National Health and Medical Research Council guidelines” (NHMRC, 2023), enhancing a collaborative approach to the treatment of mental problems. This coordinated management enables the involvement and input of skills, insights, and opinions, leading to a more subtle understanding of the dynamics influencing NSSI in patients with BPD.
Furthermore, collaborative care extends further than the outdated silos of mental healthcare, identifying the coordination of psychological, physical and social issues influencing people with NSSI and BPD (Timberlake et al., 2020). This inclusive understanding enables healthcare practitioners to modify intervention strategies to address both signs and symptoms of BPD and the primary factors contributing to it. The mental health setting in Australia emphasises a person-centred method, and the collaborative care approach supports this approach by highlighting an individual’s experiences and unique needs. This method is the best in managing NSSI, especially when there is no one-size-fit strategy because of different circumstances and presentations in which self-injury behaviour occurs.
Crisis Intervention and Safety Planning
Managing patients with BPD needs to focus on the impulsive nature related to NSSI. As such, crisis intervention and planning for safety offer a tailored approach to managing immediate danger and assisting individuals in establishing other response mechanisms. To achieve this, several things need to be done. First, it is vital to address the impulsive nature of NSSI. Being hasty in nature, NSSI is guided by deep emotions or disturbing circumstances. The Australian mental health sector should focus on these behaviours on time. Crisis intervention comprises prompt response mechanisms to avoid and guarantee the patient’s safety. This may focus on applying grounding systems, using distraction techniques, and ensuring the availability of secure and supportive surroundings BPD (Timberlake et al., 2020).
Additionally, crisis intervention plans comprise a hands-on activity to handle critical incidents of NSSI. Mental health practitioners may jointly create a crisis plan with patients, highlighting particular procedures to take during times of crisis. It may involve providing emergency contacts, coping responses, and access to crisis helplines. Such strategies in Australia are in line with the “National suicide prevention strategy for Australia’s health system” (Australian Government, 2023), emphasizing a hands-on and collaborative method to manage NSSI.
In conclusion, this essay has explored the connection between NSSI and BPD, highlighting the issues encountered by mental health practitioners in Australia. Based on the discussion above, the assessment and management of people struggling with BPD engaging in NSSI needs a multidimensional strategic approach involving diagnostic assessment, risk evaluation, and evidence-based interventions such as DBT. Collaborative care and crisis intervention approaches advance the effectiveness of mental health provision in addressing NSSI in people with BPD in Australia. As the understanding of mental health continues to advance, research and innovation are vital to improve assessment and management techniques, eventually enhancing mental health outcomes for those grappling with NSSI and BPD.
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