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Assessing Suicide Risk in Patients With Borderline Personality Disorder

(PSYCHIATRIC TIMES) - "Anita" was a 24-year-old single female referred to our crisis intervention team by her family doctor for a suicide risk assessment. Prior to being seen, the emergency department staff noted that she had been previously diagnosed with borderline personality disorder (BPD). Upon being assessed, Anita stated, "My doctor doesn't know what to do with me, and I think he's fed up with me," and said that she only came to our crisis service because she promised her doctor she would. She felt that there was no hope that things could be better and did not believe there was a future for her.

Treatment History

Two days prior to the assessment, Anita discharged herself from our inpatient service after a brief admission following an episode of self-injury. She acknowledged that her self-injury had become more frequent and severe over the past six months and suicide attempts had increased to once a month. Anita also reported increased abuse of alcohol and marijuana. In addition, she felt like a failure with respect to her suicide attempts, as she stated, "See, I'm such a loser, I can't even kill myself right."

Anita had made several previous suicide attempts, which she believed were different from her self-injury, which she described as "easing the tension" and helping her "feel calmer." She stated, "The more overwhelmed I feel, the deeper I need to cut to calm myself." Suicide attempts occurred after a series of severe self-injuries that required medical attention. She had been hurting herself since age 5 and suffered from "crazy-making, rollercoaster" moods that fluctuated dramatically within hours. Her most common suicide attempt method was by overdosing on her medications. She had had several admissions, three in which she was admitted to an intensive care unit (ICU) because of an overdose-induced coma and most other admissions lasting three to five days. Sometimes a hospital admission was helpful for Anita because it gave her a sense of safety and containment. She felt infuriated when she was automatically discharged if she self-injured while being an inpatient. She attempted suicide twice on an inpatient unit, using bed sheets to try to hang herself. Anita has not asked for help when she has been in distress or feeling suicidal, and she stated, "I'm bad and deserve to die." Anita gave a history of using alcohol and marijuana to sleep, stating, "It helps me get away from everything." She reported drinking excessively when she was really stressed and had been drinking heavily for a few weeks prior to this assessment.

For full article, please visit:
http://www.psychiatrictimes.com/dissociative-disorders/article/1016...

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