Borderline Personality Disorder

"People with borderline [Borderline Personality Disorder -- BPD] have a very fragile existence. Often they have volatile relationships, with impulsivity and a fear of real or imagined abandonment. They are difficult patients. They have very difficult lives. Suicide cies to the mind as a solution because life is constantly breaking into a thousand pieces. They [BPD patients] are always skating on thin ice."
"They create chaos. It's hard for them not to. One of the things to do [for BPD patients] is to accept the unacceptable. This is what you have to do."
"Suicide is a public health epidemic. But very little is being done. Hospitals in the '90s had more services available than there are now. It's all bare bones now."
Dr. Antoon Leenaars, psychologist, suicide researcher, former president, Canadian Association for Suicide Prevention

"The scientific question is whether we know enough to predict and prevent such events. Unfortunately we don't. And that is why I have suggested working with suicidal patients in outpatient therapy rather than hospitalizing them. Most experts on BPD agree with me on this point."
"This is understandable [feelings of familial guilt], but fails to take into account that some patients have such a strong wish to die that they come to believe this is the only way to relieve their pain. And we don't know whether we could reduce the suicide rate with a better mental-health system. Suicide prevention remains a hope rather than a proven thing."
"One cannot compare different studies to show that we are succeeding in prevention suicide in BPD. I would like to believe that this is the case, given all the effort we have put into helping clinicians and their families identify this disorder. But I see no way to prove it. We do not have good data on how many BPD patients in Canada die by suicide. Again, you cannot generalize from following a clinical sample, and we have no population data."
"Our group in Montreal has shown that the vast majority of patients we treated over the past 15 years went on to recovery. BPD is a disorder that usually gets better with time and responds positively to well-designed psychotherapy."
Dr. Joel Paris, psychiatrist, expert in BPD, professor emeritus, McGill University

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Each day in Canada an estimated eleven people die by suicide, according to the Canadian Association for Suicide Prevention; another 200 Canadians make a suicide attempt daily -- this number considered an underestimate. The Canadian Community Health Survey states that 14.7 percent of Canadians think about suicide while 3.5 percent have attempted suicide during their lifetime, making suicide ranked as the ninth-leading cause of death in the country; the second-leading cause of death, after accidents for people between 15 and 34 years of age.

The Ottawa Hospital emergency rooms of the General and Civic campuses alone in one city yearly see about six thousand people seeking help for a mental-heath crisis. Roughly half of these people have suicidal thoughts. Borderline personality disorder, a condition characterized by fraught relationships, impulsiveness, extreme emotions and occasionally recurrent suicidal behaviour has as its hallmark instability, described as an unsteady sense of self and one's emotions. Depression, eating disorders and substance abuse also mark some people with BPD.

Patients with BPD are frequently dismissed as merely needy drama queens relating to the constant roller-coaster of emotions they can suffer from. Even some  health professionals consider them to be attention-seekers. One to two percent of the population is affected by BPD, but between five and ten percent of people who have BPD end up dying by suicide. And when most suicides are diagnosed, the cause is either depression or BPD, according to Dr. Leenaars. Patients describe the emotional pain that assails them as intolerable.

When a suicide is successful, guilt is the most common reaction from family members and friends. They wonder what else they could possibly have done to prevent the unthinkable from happening. Yet youth suicide in Canada has decreased in recent decades "But we really have no idea why", comments Dr. Paris, once chair of the department of psychiatry at McGill University. Although no research is available to show that organizing safety networks of supportive friends and family is beneficial, Dr. Paris believes they do make a difference in death by suicide.

Still, for people with BPD suicide is not inevitable. Some people move forward in their lives to eventually acquire happiness and stability, and manage well. Once they're in that situation they may look back and wonder at the intensity of the negative emotions that assailed them to the point where they once wanted to die. According to Dr. Paris these changes take place and they're common where patients eventually arrive at a highly improved state. He cites less impulsivity after age 30, linking it to brain maturation where people learn to avoid situations difficult to face.

In addition to which, patients who have been through therapy learn to apply effective skills taught there.

Warning Signs:

• Ideation: thinking about suicide;
• Substance use: problems with drugs or alcohol;
• Purposelessness: feeling like there is no purpose in life or reason for living;
• Anxiety: feeling intense anxiety or feeling overwhelmed and unable to cope;
• Trapped: feeling trapped or feeling like there is no way out of a situation
• Hopelessness or helplessness: feeling no hope for the future, feeling like things will never get better;
• Withdrawal: avoiding family, friends or activities;
• Anger: feeling unreasonable anger;
• Recklessness: engaging in risky or harmful activities otherwise normally avoided;
• Mood change: a significant change in mood

Source: Canadian Mental Health Association