Dilemmas in the management of suicidal behavior in individuals with borderline personality disorder

Article Abstract:

The moral and ethical issues that are involved in determining the responsibility of the psychotherapist when confronted with a patient expressing suicidal behavior are complex. From a therapeutic standpoint, it is necessary to distinguish between cases of acute suicidal behavior, when the patient clearly presents a picture of impending self-destruction and requires immediate elimination of suicidal risk, and chronic suicidal behavior, when an individual with a borderline personality and self-destructive notions is best treated with less dramatic interventions. Traditional management of suicidal behavior focuses upon treating the behavior as an acute crisis, immediately determining the likelihood of the patient carrying out his threat, and assessing the most appropriate setting and approach for managing the crisis. However, a second state, termed 'chronic suicide,' that is common among borderline patients, may actually be aggravated by traditional therapy. Unfortunately, current ethical and legal attention to the problem of suicidal behavior does not acknowledge the clinical difference between the two states. Management of the chronic suicide generally requires less coercion and more focus upon the interpersonal context. It is concluded that more research is needed to determine the relative effectiveness of different therapeutic approaches to chronic suicidal states. A seven-step plan for identifying and managing chronic suicidal crises is presented. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Borderline personality disorder

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Familial and intrapsychic splits in suicidal adolescents

Article Abstract:

A theory is presented regarding the underlying mechanisms that may be at work which cause adolescents to engage in suicidal behavior. Suicidal behavior in some adolescents is a response to a split arising between the child and the parents. In some cases, the child is used by one parent against the other, creating a familial split. An intrapsychic split may then develop in the child as a way of coping with the difficulty imposed by such an untenable position. The child may be on the one hand unwanted, yet at the same time needed to maintain the split relationship between the parents within the family. As a consequence, conflicts arise within the psyche of the adolescent, who develops both positive and negative attitudes toward life and death, pain, and self-image. A frequent characteristic of this split is a feeling of being trapped. This leads the suicidal adolescent to instigate others to fail him, thereby exacerbating his frustration. The self-entrapment process is an attempt to clarify inner confusion, by pushing things to an extreme, a resolution is sought, perhaps by means of intervention. Case studies are presented to illustrate the nature of the splits within families that may lead to suicidal behavior. Both family and individual therapies are required to heal both the intrafamilial and intrapsychic splits. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Case studies, Causes of, Abused children, Adolescent psychology, Adolescent anxiety, Anxiety in teenagers

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Dialectical behavior therapy: a new treatment approach for suicidal adolescents

Article Abstract:

An evaluation is provided on the use of dialectical behavior therapy, or balancing change and acceptance, to treat teenagers with borderline personality disorder and emotional dysregulation. Components include nurturing the patient's capabilities, enhancing the patient's desire to change, and structuring the environment to foster these outcomes.

United States, Usage, Teenagers, Youth, Suicidal behavior, Dialectic

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