The Reinforcement Model Of Suicidality: Understanding And Psychotherapy Of Chronic Suicidality In Borderline Personality Disorder

In spite of great advancements in evidence-based therapies, chronic suicidal patients with borderline personality disorder (BPD) still challenge our mental health system. BPD is afflicted with a high suicide risk of 5-10% and a high risk for self-mutilation (up to 80%). Therapists as well as relatives feel often stunned and helpless when confronted with suicidality resulting in interruption of therapies, repeated presentations to emergency rooms and referrals to hospitals. Reinforcement mechanisms turned out to play an important role in the maintenance of repeated non-suicidal self-injury (NSSI). While individual motives for NSSI and suicidal behavior including suicidal ideations can differ, the principal mechanisms appear to be transferrable. This article aims to give a better idea of what is behind and what are the differences between non-suicidal self-injury, suicidal ideations and suicide attempts. It further integrates recent developments of behavioral science in a reinforcement model of suicidality that can provide therapists a practical armamentarium in their work with chronic suicidal clients. (C) 2021 The Author(s) Published by S. Karger AG, Basel