Risk factors for suicide in borderline personality disorder

Michele S. Berk, PhD
Assistant professor of psychiatry, David Geffen School of Medicine at UCLA, Harbor-UCLA Medical Center, Torrance, CA

Bernadette Grosjean, MD
Assistant professor of psychiatry, David Geffen School of Medicine at UCLA, Harbor-UCLA Medical Center, Torrance, CA

Heather D. Warnick, PsyD
Postdoctoral Fellow, Harbor-UCLA Medical Center, Torrance, CA

Manipulative, “just threats,” or suicide gestures are terms you may have heard or used to label suicidal thoughts and behavior in individuals with borderline personality disorder (BPD). These terms imply that the risk of injury or death is low, but evidence shows that BPD patients are at high risk for completed suicide—and clinicians who use these labels may underestimate this risk and respond inadequately.

Based on the literature and our clinical experience, this article offers recommendations for assessing and treating suicidal behavior in BPD patients. We review risk factors for suicide and suicide attempts and suggest strategies for safety management, psychotherapy, and pharmacotherapy. Because of the high-risk nature of this population, we recommend that all clinicians working with suicidal BPD patients obtain consultation and supervision as needed when using these strategies.

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