borderline-personality-disorder.com
Borderline personality disorder (BPD) is a potentially severe form of mental illness that seriously destabilizes affected individuals’ ability to maintain a sense of well-being, control mood fluctuations, act in socially appropriate ways and/or cultivate strong social bonds with others. Unfortunately, suicidal thought and conduct are quite common among people affected by this illness. In an extensive study review published in November 2014 in the journal Borderline Personality Disorder and Emotional Dysregulation, researchers from a dozen U.S. institutions assessed the effectiveness of five treatments for suicidal people diagnosed with BPD. The researchers also looked at the core underlying factors that contribute to treatment effectiveness.
Roughly 38,000 people die annually in America as a result of suicide, the National Institute of Mental Health reports. A much larger number of people think about suicide, make actual plans to commit suicide and/or don’t die after actively making a suicide attempt. Known risks for committing suicide include having other family members who committed suicide, having a family history of substance problems, having a family history of mental illness, growing up in a violent household, having a personal history of previous suicidal behavior, having a personal history of serious substance problems, being male, having American Indian/Alaska Native racial/ethnic ancestry and being a teenager, young adult or adult over the age of 84. In addition, people with a personal history of borderline personality disorder or certain other mental illnesses have increased chances of making a suicide attempt.
As many as four out of every five people affected by BPD think about suicide, make plans to kill themselves and/or follow through on suicidal plans. Depending on the source used for reference, the actual rate of suicide among people dealing with borderline personality disorder may be as low as 4 percent or as high as 9 percent.
Five forms of psychotherapy have at least some demonstrated usefulness for suicidal individuals affected by borderline personality disorder: schema therapy, dialectical behavior therapy, mentalization-based therapy, transference-focused psychotherapy and a therapy known as good psychiatric management. Some of these therapies employ a traditional psychoanalytic, “talking” approach to treatment, while others employ a more active approach that aims to modify the real-world behaviors of BPD patients in highly stressful situations that present peak suicide risks. One of the therapies, good psychiatric management, combines psychoanalytic talking techniques with active behavioral techniques. A sixth psychotherapeutic approach for suicidal BPD patients, known as alliance-based intervention for suicide, has not been thoroughly studied by large numbers of researchers.
In the study review published in Borderline Personality Disorder and Emotional Dysregulation, researchers from Yale University, Columbia University Medical Center, Cornell University and nine other U.S. institutions analyzed the results of 29 previous studies designed to explore the effectiveness of current psychotherapeutic approaches to helping suicidal people coping with borderline personality disorder. Specifically, the researchers examined the effectiveness of schema therapy, dialectical behavior therapy, mentalization-based therapy, transference-focused psychotherapy and good psychiatric management. They also sought to articulate the underlying principles that make psychotherapy a valid approach to treating suicide-related symptoms in BPD patients.
After completing their analysis, the researchers confirmed the general usefulness of the five therapeutic approaches under consideration as treatments for BPD-related suicidal thoughts and actions. They also identified six factors that contribute to the usefulness of these approaches. These factors are clear agreement between the therapist/counselor and client/patient on the ground rules of treatment; emphasis on the client/patient taking responsibility for his or her treatment outcomes; the ability of the therapist/counselor to clearly understand the methods of the psychotherapeutic approach in use; reliance on the bond between therapist/counselor and client/patient to forge an honest discussion about suicide; a commitment to rapidly deal with all suicide-related issues; and the use of outside professional resources to support the therapist/counselor conducting the therapy.
The study review’s authors believe that all effective psychotherapeutic treatments for suicidal people with borderline personality disorder share the same six core principles, regardless of the details of any given treatment’s methods or techniques. For this reason, they believe that two other psychotherapeutic approaches, alliance-based intervention for suicide and a treatment called cognitive behavioral therapy, may also prove useful for helping suicidal BPD patients. Both of these approaches share similar core principles with the five treatments that already have a proven track record.