Managing suicidal crises in patients with severe personality disorders

doi:10.1017/CBO9780511544439.008

7 - Managing suicidal crises in patients with severe personality disorders

Published online by Cambridge University Press: 14 August 2009

Edited by

Salman Akhtar and

Joel Paris: Affiliation:
Professor of Psychiatry McGill University, Research Associate, SMBD-Jewish General Hospital, Montreal, Québec, Canada
Bert van Luyn: Affiliation:
Symfora Group, The Netherlands
Salman Akhtar: Affiliation:
Thomas Jefferson University, Philadelphia
W. John Livesley: Affiliation:
University of British Columbia, Vancouver

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Summary

The treatment of patients with severe personality disorders, particularly those who meet criteria for the category of borderline personality (BPD), is well known to be difficult and marked by multiple crises. This chapter will focus on the most common scenario, which occurs when patients threaten to kill themselves or make a suicide attempt.

Suicidal crises and suicide prevention

Patients with severe personality disorders make multiple suicide attempts, gestures, and threats (Soloff et al., 2000). These behaviors are often brought on by a breach in an intimate relationship (Gunderson, 2001). The most common scenario is an impulsive but non-lethal overdose, carried out in circumstances in which rescue is likely.

Self-mutilation, particularly wrist-cutting, is also common in severe personality disorders (Gerson and Stanley, 2002). But this pattern should not always be considered as suicidal behavior. This behavior might have a different purpose from an overdose: instead of providing escape from a difficult situation, cutting functions as a means of regulating dysphoric affects (Brown et al., 2002; Leibenluft et al., 1987), and can take on some of the characteristics of an addiction (Linehan, 1993).

Suicide attempts obviously require attention from therapists. However, it has never been shown that we can prevent patients with severe personality disorders from killing themselves. Moreover, it is very difficult to predict who is most at risk. In a population characterized by repeated suicide attempts, it is important to note that patients who make repeated attempts are statistically more at risk for completion (Zahl and Hawton, 2004).

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Type: Chapter
Information: Severe Personality Disorders , pp. 109 - 117

DOI: https://doi.org/10.1017/CBO9780511544439.008 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2007

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