Borderline Personality Disorder Treatment: Suicidal Behaviors

Borderline Personality Disorder (BPD) has a suicide rate many times that of the general population, and even higher than that of any other mental illness.

Around 75 percent of those diagnosed with BPD will attempt suicide at least once. Tragically, one in 10 people diagnosed with Borderline Personality Disorder complete suicide.

What can be done to help prevent this unsettling statistic regarding BPD and suicidal behaviors?

The American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Borderline Personality Disorder provides an evidence-based combination of psychotherapy and medication for Borderline Personality Disorder treatment.

But, as Marsha Linehan, PhD, professor of psychology at the University of Washington, found herself unsatisfied with the effects of traditional psychotherapy and medication on high-risk suicidal women diagnosed with BPD, she began to look further.

“All treatments are not equal for such suicidal patients,” reported Linehan in an issue of Archives of General Psychiatry.

DBT to Treat Suicidal Behaviors

With the support of the National Institute of Mental Health (NIMH) over the past two decades, Linehan and her colleagues developed Dialectical Behavior Therapy (DBT) to help treat this population.

DBT is a form of psychotherapy that combines the tenets of Cognitive Behavioral Therapy (CBT) with the mindfulness practices found in Buddhism. DBT specifically targets suicidal behavior, behaviors that interfere with treatment, and risky social behaviors.

A study conducted by NIMH found that, when used in Borderline Personality Disorder treatment, DBT reduces suicide attempts by half when compared to other types of psychotherapy, reduces emergency room visits, and cuts therapy dropout rates in half.

While this is certainly a step in the right direction, it is not a failsafe. “Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior” is one of the nine diagnostic criteria for BPD. In someone diagnosed with Borderline Personality Disorder, all gestures must be taken seriously.

Keeping an Eye on Triggers

A case on the Agency for Healthcare and Research Quality website describes a young woman with Borderline Personality Disorder who was admitted into inpatient treatment after a suicide attempt. Despite the patient’s history of self-injurious behavior and a failed suicide attempt, after several days of appropriate behavior (as observed by her caregivers) the young woman left the treatment center for a visit home on her birthday. Once home, she set herself on fire, at which point she was returned to the hospital.

In his commentary on this particular case, John M. Oldham, MD, professor and executive vice chair of the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine in Houston, Texas, suggested that, “A common error in treatment of patients with BPD is to underestimate the importance of self-injurious behavior or to view suicidal ideation as only likely to lead to non-lethal suicide ‘gestures.’”

He also wrote that the trigger event in this case was unclear, but that emotional family events such as birthday get-togethers can be difficult for patients with BPD and can themselves trigger episodes.

Borderline Personality Disorder Treatment

When used in Borderline Personality Disorder treatment, Dialectical Behavior Therapy can help identify triggers or events that may lead to such instances of self-destructive or self-harming behavior. DBT can provide the tools needed to help patients regulate their emotions so they no longer feel the need to self-harm or make suicidal gestures.

Inpatient treatment at a Borderline Personality Disorder treatment center can provide a safe place to help a patient with BPD seek the help needed, away from triggers and volatile situations. As BPD often co-occurs with other issues such as substance abuse or an eating disorder, an inpatient BPD treatment center can be a place to get away from outside influences that may exacerbate the symptoms of BPD.

If you or someone you love is struggling with suicidal behaviors, make sure to get appropriate Borderline Personality Disorder treatment before the suicidal gestures turn into irreversible actions.