Borderline Personality Disorder: Suicidality and Self-Mutilation

~Epidemiological and neurobiological perspectives about suicidality in borderline patients are described, highlighting how self-destructive and seemingly suicidal acts are their “behavioral specialty.” Principles for management, including the need for a primary clinician to oversee safety, and the pros and cons of both “contracting for safety” and hospitalization are presented. Clinical material is used to illustrate an approach that involves minimal initiative to rescue by therapists, a readiness to comply with patients’ wishes for protection (the principle of false submission), and very active interpretation. This approach is contrasted with those advocated by Linehan and Kernberg.