Most people who have been diagnosed with BPD are completely unaware that it is the only personality disorder in the DSM-5 which contains any kind of self-injurious behaviour among its diagnostic criteria. Many, if not all, patients diagnosed with BPD will make at least one suicide attempt in their lifetime and people with BPD are very high risk for completion of suicide. In many cases their treating clinicians do not fully understand this and because they fail to act appropriately and/or quickly enough, the patient succeeds in committing suicide. Some studies say that people with BPD complete suicide at a rate of approximately 3.8% higher than the general population. People with BPD who have also been diagnosed with depression are at even greater risk for suicide. What tends to set the person with BPD apart from the general population when they attempt suicide is the lethality of the method they choose.

Clinicians should carefully assess their suicidal borderline patient by asking about their intent to actually die. Some people with BPD are chronically suicidal but that does not mean that they are actively planning. Many people with BPD practice self-injurious behaviour without suicidal ideation. Sometimes the person is just voicing a desire to punish themselves for something.There is a distinct difference between the two behaviours and it is important for the clinical to conduct a full assessment. It is important to realize that non-suicidal behaviour can sometimes lead a person to make an attempt if the behaviour is not recognized soon enough and an intervention performed.

What are the risks for suicidal behaviour?

One of the biggest risk factor for future suicidal behaviour is past suicidal behaviour. The other risk factors are significant impulsivity, unresolved anger issues, hopelessness and interpersonal problems.

Restrict access to tools

Family members who worry about their loved one committing suicide should first and foremost remove and/or restrict access to any tools the person might use to commit suicide. This includes, firearms, medication, ropes, belts and in cases where the person has threatened to use carbon monoxide, car keys. Taking these steps will help reduce the chances of a loved one acting on impulse and give them to step back and review their choices.

Talking about suicide with someone with BPD

Most people with BPD who deal with chronic depression think about suicide on a regular basis. Asking them if they are thinking about it at a specific time will NOT put the idea into their head if it is not already there. If they acknowledge that they are thinking about it, ask them if they have a plan. This is where critical assessment is so vitally important. If they tell you they have a plan, ask them to talk to you about it. If they are open to doing that, ask them for details about the plan. The last step is to ask them if they feel safe at the moment. If they say no, ask them if there is anything you can do to help them feel safe. Ask them if they think they need to call their doctor or go to the emergency room. Though family members and loved ones should take every precaution against becoming a “rescuer” of someone who is suicidal, the last thing you want to do is leave an actively suicidal person alone with their thoughts, plan and tools.

If the city in which you live has a place where there are “safe beds” and if your loved one agrees, contact them and see if you can arrange an overnight stay for your loved one. It just might save their life.