A 35-year-old woman, an academic professional, sought outpatient treatment for chronic dysphoria, a pattern of turbulent and unsuccessful interpersonal relationships, and a state of barely concealed rage that she attributed to the shortcomings and failures of others. She received a diagnosis of borderline personality disorder and began twice weekly psychotherapy. About 1 year into treatment, a stormy but long-term relationship with a man broke up, and the patient became angry and agitated. Although she blamed the man for the failed relationship and chronicled his many shortcomings, her mood shifted over several weeks and she reported feeling depressed and suicidal, hopeless about her future, and uninterested in work, friends, or family. How common and how serious is suicidal ideation and/or behavior in patients with borderline personality disorder? How should it be evaluated and managed? What is the appropriate role of hospitalization in such cases?
(Reprinted with permission from The American Journal of Psychiatry 2006; 163:20–26)