Find A Physician

Return to Preventing Suicide in Patients with Borderline Personality Disorder Overview

More on Preventing Suicide in Patients with Borderline Personality Disorder

Newsroom

Return to Preventing Suicide in Patients with Borderline Personality Disorder Overview

More on Preventing Suicide in Patients with Borderline Personality Disorder


Research and Clinical Trials

Return to Preventing Suicide in Patients with Borderline Personality Disorder Overview

More on Preventing Suicide in Patients with Borderline Personality Disorder

Clinical Services

Return to Preventing Suicide in Patients with Borderline Personality Disorder Overview

More on Preventing Suicide in Patients with Borderline Personality Disorder

Preventing Suicide in Patients with Borderline Personality Disorder

New York (Aug 21, 2009)

Unhappy looking young woman

Borderline Personality Disorder (BPD), a multi-faceted psychological syndrome, is characterized by extreme and rapid shifts from one intense emotion to another, very chaotic and stormy relationships, and dramatic impulsive behavior such as wrist cutting and overdoses. Suicide attempts are also very common among those diagnosed with BPD, according to NewYork-Presbyterian Hospital psychologist Dr. Barbara Stanley. She is studying strategies to prevent suicide in these patients, and has developed an approach called safety planning to help patients through their moments of deepest despair.

Between 60 to 70 percent of patients with BPD attempt suicide, and about 10 percent succeed. Those most at risk for suicide are patients with a history of multiple suicide attempts and significant, persistent substance use. Following a suicide attempt, "BPD patients are typically either hospitalized," said Dr. Stanley, "or we keep our fingers crossed and hope that they come back safe for their follow-up appointment with the therapist."

The Concept of Safety Planning

With Dr. Greg Brown at the University of Pennsylvania, Dr. Stanley developed the concept of safety planning, in which the patient and therapist together create a written document that includes a plan for what the patient should do when his or her suicidal urge becomes overwhelming. "The idea behind this is that suicidal urges ebb and flow, and the plan can help patients get through the peak of their urge. The plan also includes 'means restriction', an effort to remove means such as medication or a gun that people can use to kill themselves," she said. "This gives people time for their urges to subside."

Each plan is highly individualized. "Working together with the patient we figure out what they consider a strongly distracting activity that will take their mind off their urges for a time," noted Dr. Stanley. "For some people this will be surfing the web, for others listening to music, going for a run, or taking a shower. The patient and therapist also identify social places where the patient can go and be around other people such as a local coffee shop or church, and identify people who can take the patient's mind off of the urge and get outside themselves."

Developing an Individualized Emergency Plan

When patients recognize that they are in crisis they follow their emergency plan, step by step. If step 2 does not decrease the suicidal urge, they move on to step 3, and so forth. The basic components of the safety plan include:

  • Recognizing the warning signs of an impending suicidal crisis
  • Identifying and employing internal coping strategies
  • Connecting with other people in healthy social settings to distract themselves from suicidal thoughts
  • Contacting family members or friends who can help them resolve the crisis and with whom they can discuss their suicidal urges
  • Contacting mental health professionals or agencies

Drs. Stanley and Brown developed this approach for adolescent boys and girls, and it has also been adopted by the Veterans Health Administration and is now used by every veteran who is at risk for suicide, she said. Dr. Stanley said she was approached recently at a conference by a Veterans Administration psychologist who told her that one of his patients, a vet, was about to jump off a bridge but touched his pocket and pulled out his safety plan, and did not jump.

Keeping Patients Safe When They're Away From Medical Care

Dr. Stanley is testing other approaches to bridge the gap between the emergency room and the doctor's visit through a series of studies in the ER at NewYork-Presbyterian/Columbia University Medical Center. "Suicidal individuals often don't stay in treatment," she said. Almost 40 percent of people who attempt suicide and are hospitalized do not seek outpatient treatment after discharge, and more than 70 percent are not in treatment one year after their suicide attempt.

Through two pilot studies with Dana Lizardi, Ph.D., Assistant Professor in the School of Social Work, Dr. Stanley is researching ways to increase the likelihood that suicidal patients seen in the ER will engage in treatment in the following three months. In one study the researchers are assessing the effectiveness of a problem-solving interview and in the other of a brief motivational interview.

Faculty Contributing to this Article:

Barbara Stanley, PhD is a Clinical Psychologist and Research Scientist in the Department of Molecular Imaging and Neuropathology at the New York State Psychiatric Institute (an affiliate of NewYork-Presbyterian Hospital), and on the faculty of Columbia University College of Physicians and Surgeons.

  • Bookmark
  • Print

    Find a Doctor

Click the button above or call
1 877 NYP WELL


eNewsletters


Newsroom


Top of page