Conditions for Further Study 805
Functional Consequences of  Nonsuicidal Self-Injury
The act of cutting might be performed with shared implements, raising the possibility of
blood-borne disease transmission.
Differential Diagnosis
Borderline personality disorder. As indicated, nonsuicidal se lf-injury has long been re-
garded as a “symptom” of borderline pers onality disorder, even though comprehensive
clinical evaluations have found that most individuals with nonsuicidal self-injury have
symptoms that also meet criteria for other di agnoses, with eating disorders and substance
use disorders being especially common. Histor ically, nonsuicidal self-injury was regarded
as pathognomonic of borderline personality d isorder. Both conditions are associated with
several other diagnoses. Although frequently  associated, borderline personality disorder
is not invariably found in individuals with no nsuicidal self-injury. The two conditions dif-
fer in several ways. Individuals with borderline personality disorder often manifest dis-
turbed aggressive and hostile behaviors, whereas nonsuicidal self-injury is more often
associated with phases of closeness, collaborati ve behaviors, and positive relationships. At
a more fundamental level, there are difference s in the involvement of different neurotrans-
mitter systems, but these will not be apparent on clinical examination. 
Suicidal behavior disorder. The differentiation between nonsuicidal self-injury and sui-
cidal behavior disorder is base d either on the stated goal of  the behavior being a wish to
die (suicidal behavior disorder) or, in nonsuicidal self-injury, to experience relief as de-
scribed in the criteria. Depending on the ci rcumstances, individuals may provide reports
of convenience, and several studies report high  rates of false intent declaration. Individu-