Department of Psychiatry, Harvard Medical School; and Psychosocial and Personality Research, McLean Hospital, Belmont, Massachusetts 02478, USA
Address for correspondence: Dr. John G. Gunderson, Director, Psychosocial and Personality Research, McLean Hospital, 115 Mill Street, Belmont, MA 02478. Voice: 617-855-2293; fax: 617-855-3522.
gleasop{at}mcleanpo.mclean.org
Epidemiological and neurobiological perspectives about suicidality
in borderline patients are described, highlighting how self-destructive
and seemingly suicidal acts are their "behavioral specialty."
Principles for management, including the need for a primary
clinician to oversee safety, and the pros and cons of both "contracting
for safety" and hospitalization are presented. Clinical material
is used to illustrate an approach that involves minimal initiative
to rescue by therapists, a readiness to comply with patients'
wishes for protection (the principle of false submission), and
very active interpretation. This approach is contrasted with
those advocated by Linehan and Kernberg.
