When is inpatient care indicated for the treatment of borderline personality disorder (BPD)?

Updated: Nov 05, 2018
  • Author: Roy H Lubit, MD, PhD; Chief Editor: Caroly Pataki, MD  more...
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Answer

Inpatient care is generally not indicated, unless the goals of treatment are well defined. However, some individuals with BPD need to be hospitalized as a result of suicidal or other self-injurious behavior. The hospital stay should be as short as possible; all but the briefest hospitalizations are likely to lead to regression.

Many individuals have chronic suicidal ideation. In such cases, therapists are placed in a difficult position. They must weigh the following factors:

  • The intensity of the individual’s thoughts

  • The risk that the individual will do something impulsive

  • The safety net the person has in the community

  • The likelihood that the patient will call before doing anything

  • The likelihood that the suicide attempt will prove fatal if the patient does take action to hurt himself or herself

The therapist’s willingness to be constantly available by phone and to make frequent calls to monitor the patient and provide support can affect the level of safety. Some therapists find it necessary to hospitalize their BPD patients when they go on vacation because the risk of self-injurious behavior is so high. Major depressive disorder and poor social adjustment increase the risk of a suicide attempt.


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