Ask About BPD
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Ask About BPD: Suicidal Ideation

Today’s question:

Hi. I’m struggling to help my partner who has a diagnosis of BPD. He’s expressing suicidal thoughts and he won’t allow me to be there for him, when that’s all I want to do. I was wondering if you could possibly give me any advice on how to help him? It would be greatly appreciated.

Thank you for your question. Perhaps one of the most confusing and frightening aspects of BPD is suicidal ideation. BPD is the only personality disorder to have suicidal ideation as a criterion for diagnosis. 70% of us will have at least one serious attempt on our live and 10% of us will be successful.

It is important to take all threats seriously, but sometime talk is just talk. A lot of times we really don’t want to die. We want someone to listen and understand. You can do this by validating the pain he is in, validating his thoughts, and reminding him that although all thoughts are valid not all thoughts are real.

The most common warning signs of suicidal ideation transferring from passive to active are:
1. Visiting or calling people to say goodbye.
2. Making arrangements; setting one’s affairs in order.
3. Giving things away, such as prized possessions.
4. Looking for means to kill oneself, such as searching online for methods or guns. Ensure your home is safe and that any weapons are locked away in a place your partner knows he cannot get to.

Why Suicide?
Every individual who has had a suicide attempt will have their own story and reasons behind their actions, but we can break most of those down into a few common categories.

1. Sense of control. If we cannot be in control of our lives, we can at least control of how or when we die. I’ve experienced this first hand. It’s like everything in the world is falling apart and no matter how hard you try to put it back together you keep messing up. Dropping pieces. The world is moving around you, yet you are immobile.

Discuss aspects of his daily life that make him feel out of control. Ask how you may be able to help him bring control into his life. Sit down and make a list of real world, easily attainable, solutions. No step is too small. Even small amounts of control can make a big difference.
Be consistent in your daily routine. Stability and predictability can give him a sense of control.

2. Escape from pain and suffering. When you live a life with BPD you live a life that is fraught with very intense negative emotional experiences. These experiences are so painful that we find ways to escape – this includes suicidal behavior. It is something that has to be dealt with from the inside out.

When he expresses negative thoughts combat them with positive ones. Remind him of how much you love him and that although he is experiencing pain now there were times he did not and there will be times in the futures that he will feel well.

3. Communicating distress. Individuals with BPD do not expect to be readily heard by others, and often feel the need to demonstrate the depth of our suffering in a concrete fashion. One way we can express the depths of our emotional pain is by expressing how much we want to die.

Do not confuse this with manipulation. The word manipulate can be defined as: to manage, control or influence in a subtle, devious, or underhand manner; control or influence (a person or situation) cleverly, unfairly, or unscrupulously; or to handle with mental or intellectual skill.
Suicide threats or attempts are certainly not subtle or devious. It is not an act to control you, but an effort to gain a sense of control of our own life. A way to be heard by others.

Active listening is the best way to validate his experience without sounding condescending. When he opens up to you do not interrupt. When you respond, start with a reflection of those thoughts and feelings. Validate his emotional reactions, his thoughts, and the pain he is experiencing. Acknowledge the situation and acknowledge the emotions behind it.

4. Impulsivity. In moments of overwhelming pain or hopelessness, a BPD mind often acts and reacts without thinking about consequences. I would describe it is as an extreme panic attack. Our bodies and mind scream for it to stop and sometimes the action we take is as an attempt on our lives.

The best way for us to combat impulsivity, and its consequences, is by engaging in a CBT/DBT program. You can help him by finding a provider close to your home and supporting him while me learns new skills for distress tolerance.

There is hope!

Remind him of what he has to live for by creating a hope kit. Fill a box with reminders of reasons to live. Include photos of loved ones, vacations, special events, quotes about life, positive compliments people have said. Include self-soothing items such as a relaxation tape, a coloring book, music. Keep the box visible and easily accessible and use it when he is feeling down about life.

Suicidal thoughts in BPD can be very difficult for both you and him. I understand you want to be there for him, and I know he wants you to the there for him too, even if he says otherwise. As his illness becomes more under control thoughts of suicide will decrease. Remind him that he has made it through all the days of his life and he can make it through more.

4 Comments

  1. Pingback: Ask About BPD: Suicidal Ideation | MAKE BPD STIGMA-FREE!

  2. I was feeling down about my dbt skills/learning/lack of skills today; this post really had some brilliant ways of framing ideas in an understandable way-and a hope kit?! omg-that is brilliant goodness that will be something tangible I can put together to keep my focus when things get (really really) hard. Thank you for this important post. Seriously.

    Like

    • Recovery takes time and there will be days when we feel better about our progress than others. A hope kit is a great way to remind us of this. I hope building yours will be a rewarding and encouraging experience.

      Liked by 1 person

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