Suicidal ideation is a frequent concern in people who suffer from Borderline Personality Disorder (BPD). The emotional dysregulation of those with BPD involves extreme, sudden mood swings, intense anxiety and fear of abandonment, and poor impulse control. During periods of intense feelings, the emotional centers in the BPD brain temporarily overpower the logical centers, meaning that the person may react to strong emotions without consideration of the consequences. Those who suffer from Borderline Personality Disorder often become involved in particularly intense, turbulent relationships involving alternating periods of high regard for, then heavy disappointment in family members and romantic partners. This polarized way of viewing others, paired with the intensity of emotions experienced by individuals with BPD, can lead to thoughts of suicide in response to real or perceived relationship conflicts.
Lack of impulse control creates a real danger that someone with Borderline Personality Disorder may act on these thoughts of suicide without thinking through their actions. Instances of suicidal ideation in the general population are much fewer than actual suicide attempts or completed suicide. But research shows that more than 60 percent of people with BPD will attempt to take their own lives at least once, and some will make multiple suicide attempts. Also, those with BPD are far more likely to succeed in suicide attempts than other suicidal individuals. The rate of completed suicide in individuals who suffer BPD is 50 times higher than in the general population. It is estimated that nearly 10 percent of people with Borderline Personality Disorder will commit suicide.
Although it is difficult to prevent Borderline Personalities from engaging in suicidal thoughts, friends and family members of people with BPD can help to decrease the probability of attempts or completed suicides. There are “safety planning” strategies to help BPD patients through moments of extreme despair. The first important step in preventing suicide in BPD individuals is to remove drugs and alcohol from the home. A large number of completed suicides occur in conjunction with substance abuse, and many involve drug overdose. Removing these substances, as well as obvious “tools” for suicide (such as guns) may provide enough time between suicidal ideation and completion to distract the despairing person from their suicidal course.
Safety planning also involves communication and written agreements between suicidal individuals, therapists, and family or friends. The patient and the therapist together create an individualized plan of action in case of overwhelming suicidal urges. This plan helps the suicidal person to recognize the warning signs of an impending emotional crisis, gives him or her some internal coping strategies (rehearsed in therapy) as a first step, and then provides a series of methods for getting past the crisis point of suicidal thoughts. The BPD individual comes up with some strongly distracting action that can derail suicidal thoughts long enough to get past the most dangerous peak of the urge. This action may be as simple as working on a puzzle, surfing social media, or taking a shower, and must be readily available to engage in at short notice. The plan also identifies places for the patient to go for social interaction, such as nearby coffee shops, book stores, or churches; and people to call who can temporarily take the individual's mind off the immediate suicidal urge.
When BPD patients realize they are experiencing suicidal ideation, they follow the steps of their written plan. Because those with Borderline Personality Disorder experience such a drastic ebb and flow of emotions, having a step-by-step plan to follow in cases of emotional crisis may give an individual enough “wait time” during the peak of their suicidal thoughts to get beyond the danger of impulsive suicide attempts or completion.
For an updated, more in-depth look at this topic, see How Therapists and Patients Perceive DBT.