Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- 1 Treatability in severe personality disorders: how far do the science and art of psychotherapy carry us?
- 2 The treatment of choice: what method fits whom?
- 3 Countertransference: recent developments and technical implications for the treatment of patients with severe personality disorders
- 4 Beyond management to cure: enhancing the positive dimensions of personality
- 5 Personality disorders from the perspective of child and adolescent psychiatry
- 6 Disruptions in the course of psychotherapy and psychoanalysis
- 7 Managing suicidal crises in patients with severe personality disorders
- 8 Borderline personality disorder, day hospitals, and mentalization
- 9 Pharmacotherapy of severe personality disorders: a critical review
- 10 Severe cases: management of the refractory borderline patient
- 11 Dangerous cases: when treatment is not an option
- 12 Stalking of therapists
- 13 Common elements of effective treatments
- Index
- References
7 - Managing suicidal crises in patients with severe personality disorders
Published online by Cambridge University Press: 14 August 2009
- Frontmatter
- Contents
- List of contributors
- Preface
- 1 Treatability in severe personality disorders: how far do the science and art of psychotherapy carry us?
- 2 The treatment of choice: what method fits whom?
- 3 Countertransference: recent developments and technical implications for the treatment of patients with severe personality disorders
- 4 Beyond management to cure: enhancing the positive dimensions of personality
- 5 Personality disorders from the perspective of child and adolescent psychiatry
- 6 Disruptions in the course of psychotherapy and psychoanalysis
- 7 Managing suicidal crises in patients with severe personality disorders
- 8 Borderline personality disorder, day hospitals, and mentalization
- 9 Pharmacotherapy of severe personality disorders: a critical review
- 10 Severe cases: management of the refractory borderline patient
- 11 Dangerous cases: when treatment is not an option
- 12 Stalking of therapists
- 13 Common elements of effective treatments
- Index
- References
Summary
The treatment of patients with severe personality disorders, particularly those who meet criteria for the category of borderline personality (BPD), is well known to be difficult and marked by multiple crises. This chapter will focus on the most common scenario, which occurs when patients threaten to kill themselves or make a suicide attempt.
Suicidal crises and suicide prevention
Patients with severe personality disorders make multiple suicide attempts, gestures, and threats (Soloff et al., 2000). These behaviors are often brought on by a breach in an intimate relationship (Gunderson, 2001). The most common scenario is an impulsive but non-lethal overdose, carried out in circumstances in which rescue is likely.
Self-mutilation, particularly wrist-cutting, is also common in severe personality disorders (Gerson and Stanley, 2002). But this pattern should not always be considered as suicidal behavior. This behavior might have a different purpose from an overdose: instead of providing escape from a difficult situation, cutting functions as a means of regulating dysphoric affects (Brown et al., 2002; Leibenluft et al., 1987), and can take on some of the characteristics of an addiction (Linehan, 1993).
Suicide attempts obviously require attention from therapists. However, it has never been shown that we can prevent patients with severe personality disorders from killing themselves. Moreover, it is very difficult to predict who is most at risk. In a population characterized by repeated suicide attempts, it is important to note that patients who make repeated attempts are statistically more at risk for completion (Zahl and Hawton, 2004).
- Type
- Chapter
- Information
- Severe Personality Disorders , pp. 109 - 117Publisher: Cambridge University PressPrint publication year: 2007
References
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