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NSSI, Borderline Personality Disorder, and Comorbidity

Below is an annotated bibliography of articles describing the prevalence of Borderline Personality Disorder (BPD), in contrast to other clinical disorders, among individuals who engage in NSSI. I have only included studies that use a standardized method of assessment for diagnostic variables, as chart review diagnoses are likely to be influenced by biases of clinicians who view NSSI as possible only in the context of BPD. As you can see from the below (non-exhaustive) sample of articles, that is not the case! Some articles compare the rates of BPD with the rates of other disorders, whereas other articles focus on highlighting the variability in BPD diagnosis rates among people with a history of NSSI.


Please note: this is not an exhaustive list, and I am not an author on these articles. For reprints, please contact the authors directly.



1) Andover, M. S., Schatten, H. T., Morris, B. W., Holman, C. S., & Miller, I. W. (2017). An intervention for nonsuicidal self-injury in young adults: A pilot randomized controlled trial. Journal of Consulting and Clinical Psychology, 85, 620–631.


Sample: Young adults participating in an RCT for NSSI treatment.

Diagnostic Measures: SCID-I (clinical disorders) and SCID-II (BPD and ASPD).

Results: 79% of participants had at least one Axis I (clinical) diagnosis, and 30% met criteria for BPD. Most common clinical diagnoses were MDD (42%), anxiety disorders (55%), and substance use disorders (30%).


2) Bjureberg, J., Sahlin, H., Hellner, C., Hedman-Lagerlöf, E., Gratz, K. L., Bjärehed, J., … Ljótsson, B. (2017). Emotion regulation individual therapy for adolescents with nonsuicidal self-injury disorder: a feasibility study. BMC Psychiatry, 17(1).

Sample: Adolescents with NSSI Disorder participating in a treatment trial.

Diagnostic Measures: MINI-KID (clinical disorders), SCID-II (BPD).

Results: 41% of participants met criteria for BPD. In contrast, 53% met criteria for ADHD, 41% for MDD, and 41% for Panic Disorder.

3) Bracken-Minor, K. L., & McDevitt-Murphy, M. E. (2014). Differences in features of non-suicidal self-injury according to borderline personality disorder screening status. Archives of Suicide Research, 18, 88–103.

Sample: Undergraduate students.

Diagnostic Measures: MSI-BPD (BPD).

Results: Of participants who met NSSI Disorder criteria (n = 62), less than half (47%) met threshold for BPD. Of participants who met threshold for BPD (n = 67), less than half (43%) met criteria for NSSI Disorder.

4) Chartrand, H., Sareen, J., Toews, M., & Bolton, J. M. (2012). Suicide attempts versus nonsuicidal self-injury among individuals with anxiety disorders in a nationally representative sample. Depression and Anxiety, 29, 172–179.


Sample: Collaborative Psychiatric Epidemiological Surveys (national sample of adults).

Diagnostic Measures: WMH-CIDI (anxiety, mood, substance use disorders).

Results: Among those with NSSI, prevalence for various disorders was as follows: any mood disorder (68%), any substance use disorder (45%), Social Phobia (40%), PTSD (38%), GAD (24%), Panic Disorder (20%), and Agoraphobia (10%).


5) Esposito-Smythers, C., Goldstein, T., Birmaher, B., Goldstein, B., Hunt, J., Ryan, N., … Keller, M. (2010). Clinical and psychosocial correlates of non-suicidal self-injury within a sample of children and adolescents with bipolar disorder. Journal of Affective Disorders, 125, 89–97.

Sample: Adolescents with a diagnosis of bipolar disorder.

Diagnostic Measures: K-SADS-PL (clinical disorders).

Results: Among youth with bipolar disorder, approximately 34% of children and 37% of adolescents reported a history of NSSI. NSSI was associated with higher odds of experiencing psychotic symptoms, higher severity of depressive and manic symptoms, and elevated (but not significantly different) rates of anxiety disorder diagnoses.

6) Glenn, C. R., & Klonsky, E. D. (2013). Nonsuicidal self-injury disorder: an empirical investigation in adolescent psychiatric patients. Journal of Clinical Child and Adolescent Psychology, 42, 496–507.


Sample: Adolescents receiving inpatient or partial hospitalization psychiatric care.

Diagnostic Measures: SCID-II (BPD), MINI-Kid (clinical disorders).

Results: Adolescents who met criteria for NSSI Disorder were more likely to meet criteria for BPD (52%) than the adolescents in the clinical comparison group (15%). Adolescents in the NSSI group were more likely to have a diagnosis of an anxiety disorder (74%), ADHD/disruptive behavior disorder (73%), and mood disorder (66%) than to meet criteria for BPD.


7) Groschwitz, R. C., Plener, P. L., Kaess, M., Schumacher, T., Stoehr, R., & Boege, I. (2015). The situation of former adolescent self-injurers as young adults: a follow-up study. BMC Psychiatry, 15, 160.

Sample: Adolescents receiving outpatient NSSI treatment, followed-up as young adults.

Diagnostic Measures: Mini-DIPS (clinical disorders), SCID-II (BPD).

Results: As adolescents, the most common diagnoses were MDD (60%), "adaptive disorder" (32%), eating disorder (17%), and anxiety disorder (15%). As adults, 46% of participants met criteria for BPD, 39% met criteria for MDD, 39% met criteria for an anxiety disorder, and 32% met criteria for a somatoform disorder.

8) Kleiman, E. M., Ammerman, B., Look, A. E., Berman, M. E., & McCloskey, M. S. (2014). The role of emotion reactivity and gender in the relationship between psychopathology and self-injurious behavior. Personality and Individual Differences, 69, 150–155.

Sample: Undergraduate students.

Diagnostic Measures: MSI-BPD (BPD), QIDS (dimensional depression score).

Results: Depression symptoms were significantly correlated with a history of NSSI for both men and women (rs = .22 to .30). BPD status was significantly associated with NSSI history for women (r = .29) but not for men (r = .07).

9) Koenig, J., Rinnewitz, L., Warth, M., Hillecke, T. K., Brunner, R., Resch, F., & Kaess, M. (2017). Psychobiological response to pain in female adolescents with nonsuicidal self-injury. Journal of Psychiatry & Neuroscience, 42, 189–199.

Sample: Adolescents receiving outpatient treatment for NSSI and/or risk-taking behaviors.

Diagnostic Measures: MINI-KID (clinical disorders), SCID-II (BPD).

Results: 60% of self-injuring youth met diagnostic criteria for BPD. 93% of self-injuring youth had a primary diagnosis of MDD (current, past, or recurrent).

10) Nock, M. K., Joiner, T. E., Gordon, K. H., Lloyd-Richardson, E., & Prinstein, M. J. (2006). Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts. Psychiatry Research, 144, 65–72.


Sample: Adolescent females receiving inpatient psychiatric care with a past year history of NSSI.

Diagnostic Measures: DISC (clinical disorders), DIPD-IV (personality disorders).

Results: 88% of participants met diagnostic criteria for at least one clinical (formerly Axis I) disorder, and 67% met criteria for at least one personality disorder (formerly Axis II). 52% of participants met criteria for BPD; 31% for avoidant PD, and 21% for paranoid PD. Common clinical diagnoses were substance use disorders (60%), conduct disorder (49%), ODD (45%), MDD (42%), and PTSD (24%).

11) Weismoore, J. T., & Esposito-Smythers, C. (2010). The role of cognitive distortion in the relationship between abuse, assault, and non-suicidal self-injury. Journal of Youth and Adolescence, 39, 281–290.


Sample: Adolescents receiving inpatient psychiatric care.

Diagnostic Measures: K-SADS-PL (clinical disorders).

Results: One-hundred sixteen adolescents (63%) reported a history of past year NSSI. The NSSI group had significantly higher prevalence of MDD (71%), GAD (31%), and PTSD (35%) than the clinical control group. High, but not statistically different, prevalence rates were found for Social Phobia (30%), ADHD (36%), ODD (15%), Alcohol Use Disorder (22%), and Substance Use Disorder (29%).

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