n clinical populations, the suicide rate of patients with borderline personality disorder (BPD) is estimated between 8% and 10%, a rate far greater than that in the general population. While suicidal tendencies in BPD patients is a multi-determined phenomenon, a key factor that leads to the higher than average mortality rate could be the impulsive trait common among BPD patients. Hence, a general consensus highlights that by reducing the impulsive personality characteristic, this will ultimately reduce the high risk nature of this disorder. In light of this, Dialectical Behavioural Treatment (DBT) – an adapted version of cognitive behavioural therapy – was developed to specifically reduce suicidality in BPD patients by applying behavioural techniques to control impulsivity. This essay reviewed previously conducted randomised controlled trials, to investigate the efficacy of DBT in treating suicidality in BPD patients through reducing impulsivity, as well as examined the limitations of this intervention. The findings indicated DBT to be more effective in several outcome measures, namely self-harm, parasuicidal behaviours and suicidal ideation, when comparing DBT with treatment as usual and community treatment by experts. Additionally, DBT’s mindfulness module was found to be a salient component in reducing impulsive self-injurious behaviour. While the efficacy of DBT is undisputed, this intervention is still an extensive and costly treatment. Hence, dismantling studies were conducted to identify the treatment component most significant to treat suicidality in BPD and findings revealed shortened variants of DBT are more cost-effective and are just as effective in yielding significant improvements.

INTRODUCTION

Suicide risk is a frequent companion in the treatment of Borderline Personality Disorder (BPD); a disorder that has a prevalence of 1-2% in the general population, and is present in 10% of psychiatric outpatients and 20% of inpatients (Lieb, et al., 2004). According to a study conducted by the Substance Abuse and Mental Health Services (SAMHSA) in 2014, nearly 80% of individuals with BPD report a history of suicide attempts and up to 10% do end up completing suicide – a rate that is almost 50 times higher than in the general public (Sack, 2015). In fact, self-harm and suicide attempts are so prevalent in BPD that it is the only personality disorder to have such behaviours included in its diagnostic criteria. For instance, the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) includes “recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour’’ as the fifth criterion for diagnosing BPD (Oldham, 2006, p. 20). Indeed, there is an increasingly important need to reduce the high mortality rates of this disorder and debunk the notion of BPD as “the suicidal personality disorder” (Pompili, et al., 2005, p. 319). Given the high risk nature of this disorder, it is important to discern wh