Assisted dying – psychiatric euthanasia: You okay with it? Part 2

Assisted dying – psychiatric euthanasia: You okay with it? Part 2

Crushing symptoms day after day for years. Is it any wonder some of us want a permanent out? Assisted dying for patients with psychiatric disorders – psychiatric euthanasia. You okay with it?

’A few days ago, a 30-year-old patient with very treatable mental illness asked me to end her life. Her distraught parents came to the appointment with her…’

Buckle up, we’re going to discuss a gut-wrenching and controversial topic that will continue to attract major attention.

Some of you may find it troubling, even triggering. If you’re one of them, please feel free to close the piece.

We laid a solid informational foundation in part one of our two-part series on assisted dying for patients with psychiatric disorders – psychiatric euthanasia. If you haven’t already, be sure to give it a read.

By the way, I shared the inspiration for writing about the contentious subject in that piece – the heartbreaking Shanti De Corte story.

Well, part two – ethics and opinions. Let’s get after it…

Assisted dying: Ethics and opinions

assisted dying

“…to do good or to do no harm.”  Hippocrates c. 400 BC

First, a quick heads-up. The terminology associated with assisted dying can be confusing – euthanasia, medical aid in dying, legal suicide, physician-assisted dying, physician-assisted suicide, and more.

Don’t lose the forest for the trees over semantics.

Okay, let’s take a look at how several healthcare professional organizations feel about assisted suicide…

American Medical Association

The AMA has a Code of Medical Ethics Opinion for physicians who oppose assisted suicide and for those who are neutral or support it.

Opinion 5.7 states that allowing physicians to engage in assisted suicide would ultimately cause more harm than good. Among other negative consequences, it’s incompatible with a physician’s role as a healer.

Opinion 1.1.7 declarers physicians need to have the opportunity to act (or not) in accordance with the dictates of their beliefs and conscience.

British Medical Association

In September of 2021, the BMA changed their policy from opposition to assisted dying to a position of neutrality.

American Psychological Association

The APA takes a position of neither endorsing or opposing assisted dying.

Assisted dying for patients with psychiatric disorders: A psychiatrist’s opinion

Dr. Mark S. Komrad is a practicing and teaching psychiatrist, as well as a medical ethicist. His commentary, “Oh, Canada! Your New Law Will Provide, Not Prevent, Suicide for Some Psychiatric Patients,” appeared on Psychiatric Times in June of 2021.

Dr. Komrad put a lot of thought and feeling – and, yes, opinion – into his piece. I’d like to run with some highlights.

Context is crucial. Dr. Komrad’s comments were motivated by the development and passage of a Canadian law, and its expansion, that permit what they refer to as medical aid in dying (MAID). We reviewed it in part one.

The door’s wide open

As he begins, Komrad untangles some of that terminology confusion we just talked about. He defines euthanasia as allowing suicidal patients to receive death by lethal injection. It’s assisted suicide when the lethal medication is self-administered.

Komrad points out that Belgium, the Netherlands, and Luxembourg legalized both in 2002. As he puts it, laws in those countries permit voluntary death for patients whose physical or psychological suffering is unbearable and can’t be effectively treated by means that are acceptable to them.

A terminal condition is not a necessary criterion.

Komrad believes these developments opened the door for some patients with psychiatric illness having suicide provided for them, rather than prevented.

He observes that these laws are now being passed around the world, which could profoundly change the practice of psychiatry.

The Canadian spark

Now to what lit Dr. Komrad’s fuse. Canada is the latest nation to legalize voluntary death for psychiatric conditions.

In 2016, Canada passed a law permitting medical euthanasia and physician-assisted suicide, together labeled medical aid in dying (MAID).

A key eligibility criterion was a prediction that a patient’s natural death is “reasonably foreseeable.” Since death from mental disorders wasn’t seen as strongly predictable, mental illnesses were not considered eligible conditions.

Superior Court intervenes

In 2019, a Quebec Superior Court ruling led to the introduction of a new federal bill extending euthanasia eligibility, without limiting it to the end of life. It also removed the prior exclusion of those who have non-terminal chronic illnesses.

And because of accusations of discrimination against those with mental illnesses, the Canadian Psychiatric Association being one of the accusers, euthanasia was permitted for those whose psychological or physical suffering is deemed “intolerable and untreatable.”

A vote was forced and on March 17, 2021 the expansion of euthanasia became the law of the land in Canada.

It’s interesting that the mental illness piece was put on a two-year hold. The idea was to give an expert panel time to establish standards for evaluating patients and procedures.

Without a protocol, there would be no way to determine if suicide for someone with a psychiatric disorder should be prevented or allowed.

A psychiatrist’s bottom-line

Komrad provides this statement by Canadian psychiatrist, Dr. John Maher…

A few days ago, a 30-year-old patient with very treatable mental illness asked me to end her life. Her distraught parents came to the appointment with her because they were afraid that I might support her request and that they would be helpless to do anything about it. It’s horrific they have to worry that by going to a psychiatrist, their daughter might be killed by that very psychiatrist.

What are your feelings?

Objections to physician-assisted dying

psychiatric euthanasia

Pentobarbital is typically the choice for physician-assisted dying. It’s usually secobarbital capsules for self-administered.

According to Dr. Komrad, countries that have allowed physician-assisted dying have quickly found themselves descending a slippery slope.

He quotes attorney Wesley J. Smith, a prominent critic of such policies…

Once a society embraces doctor prescribed death as an acceptable answer to human suffering or as some kind of fundamental liberty right, there are no brakes.

Indeed, Komrad points out that in Belgium and the Netherlands, policy makers and legislators are debating extending euthanasia beyond medical conditions to include those who feel they have a completed life and are tired of living.

There’s even discussion of demedicalizing euthanasia by providing lethal pills over-the-counter.

And then there’s Pegasos Swiss Association, which will take an application for voluntary assisted death (VAD) at their clinic in Basel. You have to be a “Pegasos Supporter” to apply.

Primary objections

Using the Canadian law as reference, Dr. Komrad shared his primary objections to physician-assisted dying…

  • There’s no requirement that additional, evidenced-based treatments be implemented, although patients are urged to give all treatments serious consideration.
  • Physicians are allowed to end the life of people with disabilities or chronic illnesses at their request and will require the system to ensure it happens – even when physicians are convinced, based on their expert knowledge, that medicine offers options and even when the patient may have years or decades to live.
  • Assisted dying laws would represent a terrible shift in the deep ethos of psychiatry. Psychiatrists would have to decide which suicides should be prevented and which should be abetted.

Do you think his objections are legit?

Assisted dying – psychiatric euthanasia: You okay with it?

If I’m going to ask, “You okay with it?” regarding assisted dying – psychiatric euthanasia, It’s only fair that I respond first.

As a former clinician and 50-year mood and anxiety disorder warrior, I’m not okay with it – as a matter of law for the masses.

My concern is the potentially lethal impact of a tired and hopeless mind, a lack of resources and alternatives, cognitive distortions, impulsivity – and rubber-stamped approvals.

What if I did it?

I know what it’s like to endure life-interrupting symptoms day after dreaded day. And I have no doubt my circumstances would qualify for assisted dying wherever it’s legal.

Thing is though, what if I did it? And don’t think checking out hasn’t crossed my mind a time or two over the decades.

What’s my family supposed to do with it? What about my readers? How do I account for it with my maker?

But you know what? Maybe most important of all is my belief there’s a living purpose for my suffering. And I sure can’t fulfill it if I’m dead.

So now it’s your turn. You okay with it?

If you or someone you care about are in immediate danger call 988 in the U.S. And here’s a list of international suicide hotlines.

Again, if you haven’t already, give part one a look-see. You’ll find lots of interesting details.

And dig into Dr. Komrad’s commentary. There’s a ton of information I couldn’t include, as well as an accompanying video: “Oh, Canada! Your New Law Will Provide, Not Prevent, Suicide for Some Psychiatric Patients

Be sure to scan the hundreds of Chipur mood and anxiety info and inspiration titles.

Assisted dying – psychiatric euthanasia: You okay with it? Part 2

Assisted dying – psychiatric euthanasia: You okay with it?

Have you ever wanted to die when your symptoms were at their worst? I have. So how do you feel about assisted dying for patients with psychiatric disorders – psychiatric euthanasia? You okay with it?

Shanti made a decision and requested to be euthanized because of ‘unbearable psychiatric suffering.’

This won’t be the first, or last, time I open by saying we don’t back away from controversy here on Chipur.

And it doesn’t get more controversial than discussing assisted dying for patients with psychiatric disorders – psychiatric euthanasia.

In fact, some may find the topic troubling, even triggering. If you’re one of them, please feel free to close the piece.

We have tons to cover, and to ensure we get to it all we’ll roll with two parts.

Information will lay the foundation in this piece. And we’ll come back with an ethics and opinions chat in part two.

Let’s get busy…

The Shanti De Corte story

It was March 22, 2016. Waiting for a flight to Italy with classmates, 17-year-old Shanti De Corte was strolling through Brussels Airport.

medical assistance in dying

It was more than she could absorb.

Suddenly, all hell broke loose as a terrorist-placed bomb exploded.

Mortally wounded

Shanti came through physically unscathed; however, what she saw, heard, and felt left her mortally wounded – emotionally and mentally.

It was more than she could absorb.

She was already troubled by depression and anxiety. But after the cataclysm, episodes of dark depression and non-stop panic attacks dominated her life.

Shanti was admitted to a psychiatric hospital where she was administered a variety of antidepressants. She claimed up to 11 a day.

Her decision to die

There was no response to the meds and she went on to attempt suicide in 2018 and 2020.

Shanti made a decision and requested to be euthanized because of “unbearable psychiatric suffering.”

After two of three physicians approved her request, surrounded by family, Shanti De Corte died in Brussels, Belgium on May 7, 2022 at the age of 23.

Her final social media post…

I was laughing and crying. Until the last day. I loved and was allowed to feel what true love is. Now I will go away in peace. Know that I miss you already.

Hits hard, doesn’t it.

The dissenting opinion

Though Shanti’s earthly life was over, legalities weren’t.

A neurologist at the CHU Brugmann academic clinical hospital was the physician who denied Shanti’s request.

After she died, he made it known that he believed the decision “was made prematurely,” as other care proposals had been made.

In response to his objection, Antwerp prosecutors opened an investigation. But it was closed in fairly short order.

Assisted dying protocol

A quick note before we continue. The terminology associated with assisted dying is varied and can be confusing – euthanasia, medical assistance in dying, legal suicide, physician-assisted suicide, and more.

To simplify matters, I go with “assisted dying”: voluntary active euthanasia and physician-assisted dying when a patient’s life is ended at their request.

Okay, in discussing protocol we’re not going to get into by-country or state lists of where assisted dying is legal. The information is easily found.

We’ll stick with what procedure protocol looks like, referencing Shanti’s home country, Belgium, and Canada.

(Alright, sort of a list: assisted dying is legal in some form in 10 U.S states and the District of Columbia, as well as seven countries.)

The Belgian protocol

psychiatric euthanasia

Within the context of our discussion, what do you feel when you look at the image?

Belgium has by far the most permissive assisted dying laws. Adults, minors, psychiatric patients – all can make a request.

A physician is required to consult with the patient for a period of time to establish that they’re aware of the decision and process.

No diagnosis is required for adults. However, a terminal diagnosis from a physician with agreement from a guardian or legal representative is mandated for minors.

In some cases, if death isn’t imminent, a pathologist or psychiatrist may be asked to assess a patient’s condition.

If a physician is responding to a patient’s medical directive (e.g., a living will), the patient must be permanently unconscious and suffering from an incurable condition.

Finally, the life-ending drug can be self-administered orally or by infusion or injection by a physician.

The two most common drugs used are the barbiturates, secobarbital (Seconal), which comes in a capsule, and pentobarbital (Nembutal), a liquid.

By the way, it’s free.

Medical assistance in dying: Canada

Canada passed a law in 2016 that permitted what they called medical assistance in dying (MAID).

The primary criterion of the law was a patient’s natural death is predicted to be “reasonably foreseeable.” Psychiatric illnesses were excluded.

Some four years later, in excess of 19,000 individuals had been voluntarily euthanized.

A new law

As a result of a Superior Court ruling, a new federal bill was introduced that extended assistance in dying by removing the prior exclusion of those who have non-terminal chronic illnesses.

It also permitted euthanasia for those whose psychological or physical suffering is deemed “intolerable and untreatable.”

On March 17, 2021, the euthanasia expansion became the law of the land.

The criteria: 18 years of age, mentally competent, a grievous and irredeemable medical condition,” assessed by two independent practitioners, if a psychiatric illness is the only medical condition the patient must wait until March 17, 2023.

On to part two

I have to ask. How are you feeling about all this? My mind has been somewhat unsettled and troubled since I began working on the piece. Hmm.

Well, we’ve laid a solid foundation. Now it’s on to our ethics and opinions chat in part two.

Don’t miss it.

If you or someone you care about are in immediate danger call 988 in the U.S. And here’s a list of international suicide hotlines.

Many more Chipur mood and anxiety disorder info and inspiration articles await. And all you have to do is scan the titles.

The truth about social media and teenage suicide: The Molly Russell story

The truth about social media and teenage suicide: The Molly Russell story

The coroner ruled it was “…an act of self-harm while suffering from depression and the negative effects of online content.” The truth about social media and teenage suicide – the heartbreaking, yet hopeful, Molly Russell story…

’If you’re struggling, please speak to someone you trust or one of the many support organizations, rather than engage with online content that may be harmful.’  Molly’s father, Ian Russell

Molly Rose Russell was 14-years-old when she died on November 21, 2017.

The inquest – judicial inquiry – at North London Coroner’s Court ended this past Friday.

Coroner Andrew Walker attributed Molly’s death to…

…an act of self-harm while suffering from depression and the negative effects of online content.

He went on to say the online material Molly viewed on platforms, including Pinterest and Instagram, “was not safe” and “should not have been available for a child to see.”

The Molly Russell story

Molly Russell lived in Harrow, a northwest suburb of London. According to her father, she showed no obvious signs of severe emotional or mental illness until a year before her death.

It was then that the family noticed major changes, including feelings of worthlessness, a deepened sense of helplessness, and social withdrawal.

Still, to her family, Molly’s life appeared to be normal.

Her mother’s statement

During the inquiry, a statement was read to the court on behalf of Molly’s mother, detailing the discovery of her daughter’s body.

Mrs. Russell said she was doing household chores on the morning of Molly’s death. After sending one of her other daughters off to school, she began searching the house for Molly – but couldn’t find her.

Then the shock and heartbreak…

I knew then something wasn’t right. I saw a load of her clothes on the floor (of her bedroom). For some reason I thought Molly had run away.

As I looked in her room, I found her…I had no doubt it was her.

I can’t even imagine.

Social media and teenage suicide

molly russell story

Molly Russell

Mr. Walker’s ruling – “…an act of self-harm while suffering from depression and the negative effects of online content.” – was unprecedented.

It was the first of its kind to directly and officially blame a child’s death on social media.

Also unprecedented was requiring the in person, under oath testimony of representatives of the two platforms involved.

Jud Hoffman, Global Head of Community Operations, stood for Pinterest. Meta, owner of Instagram, sent Head of Health & Well-Being Policy, Elizabeth Lagone.

We’ll get into some telling cross-examination details in just a bit.

Molly’s online activity

In her father’s words, Molly’s online environment was “the bleakest of worlds.”

During the inquiry he stated a lot of the content Molly was viewing seemed to “normalise” self-harm and suicide, while discouraging people from pursuing mental health care.

When Mr. Russell looked at Molly’s YouTube account he saw numerous normal teenage “likes” and “follows.” And there were a similar high number of disturbing posts pertaining to anxiety, depression, self-harm, and suicide.

Molly had accounts with Instagram, Pinterest, YouTube, and two with Twitter (one secret).

She used her Instagram account up to 120 times a day.

Of the 16,300 posts she saved, shared, or liked on Instagram in the six-month period before her death, 2,100 were depression, self-harm, or suicide-related.

Mr. Russell expressed shock when he saw the subject lines of the emails were clearly promoting depression-related content.

Trapped by algorithms

Perhaps most exasperating of all, some of the emails were selected and provided without a request from Molly.

How horrific was the material? A testifying child psychiatrist said even he found it disturbing and distressing. After the inquiry, he said there were times over several weeks that he was unable to sleep well.

And given that a depressed 14-year-old viewed the material over a period of months, there could be no doubt Molly was affected.

Even after her death, the disturbing content continued to be delivered.

John Naughton of The Guardian nailed it when he wrote, “Molly Russell was trapped by the cruel algorithms of Pinterest and Instagram.”

Pinterest and Meta respond

During the inquiry, cross-examination of the two company representatives spoke volumes.

The Russell family’s lawyer, Oliver Sanders KC, walked Mr. Hoffman of Pinterest through the last 100 posts Molly had seen before she died.

Hoffman expressed deep regret that she was able to access some of the content.

He even admitted that recommendation emails sent by Pinterest to Molly, such as “10 depression pins you might like,” contained disturbing content and images he wouldn’t show his children.

Meta’s turn

It was a little different with Ms. Lagone of Meta. Evidence was presented showing that, as said earlier, of the 16,300 posts Molly saved, shared, or liked on Instagram in the six-month period before her death, 2,100 were depression, self-harm, or suicide-related.

Sanders then asked if she believed the material is safe for children.

Lagone’s first reply was it’s safe for people to be able to express themselves. Not satisfied, he asked again. Lagone said she didn’t find it a binary question.

Sanders was relentless. He asked, “So you are saying yes, it is safe or no, it isn’t safe?”

Lagone replied, “Yes, it is safe.”

The aftermath

molly russell story

Advocate for health and peace for our young people.

Instagram already announced in 2019 that it will ban all graphic self-harm images and drawings as part of a series of changes made in response to Molly’s death.

Mr. Hoffman admitted Pinterest was “not safe” in 2017, when Molly died. And they have since introduced measures to limit access to dangerous content.

However, when the co-founder of Pinterest, Ben Silbermann – a father of two, was asked at his home if he believed his platform is dangerous for kids, he replied, “I don’t have any comment.”

Her father’s grace and vision

In response to the coroner’s ruling, Molly’s father had the grace and vision to say “there is always hope” no matter how “dark it seems.”

More of his wisdom and love…

If you’re struggling, please speak to someone you trust or one of the many support organizations, rather than engage with online content that may be harmful.

Thank you, Molly, for being my daughter. Thank you.

We should not be sitting here. This should not happen because it does not need to happen. We told this story in the hope that change would come about.

During the inquiry Mr. Russell emphasized “It’s OK not to be OK.”

International attention

The coroner’s ruling received well-deserved international attention. Here’s what Prince William tweeted from the official Prince and Princess of Wales account…

No parent should ever have to endure what Ian Russell and his family have been through. They have been so incredibly brave. Online safety for our children and young people needs to be a prerequisite, not an afterthought.

Well said.

No more denial and ignorance

The coroner ruled “…an act of self-harm while suffering from depression and the negative effects of online content” killed Molly Russell.

And we all know she isn’t the only one.

Molly’s story is heartbreaking, but now hopeful. Social media’s deadly impact upon our youth can no longer be denied – ignored.

Let’s advocate for health and peace for our young people – and continue to monitor the work of Silicon Valley.

Be sure to connect with the Molly Rose Foundation. Established in Molly’s memory by family members and friends, its mission is to reach out to those under the age of 25 who are at risk of suicide. The foundation provides a ton of help, support, and practical advice.

If you or someone you care about needs help or are in immediate danger, the Foundation has incredible resources. Go to their Find Help page and tap on the green box: “To use the Find a Helpline service click here.” There are other resources available as well.

Let’s fast-forward a bit. Take a look at Social media and youth mental health: An advisory.

Sources: The Guardian, Daily Mail, BBC, The SunNew York Post

Image of Molly with permission: Molly Rose Foundation. That is not Molly in the featured image.

More Chipur mood and anxiety disorder info and inspiration articles? The titles are waiting for you.

988 Suicide & Crisis Lifeline: July 16

988 Suicide & Crisis Lifeline: July 16

When we’re experiencing an emotional or mental crisis, we need to be able to access the help we deserve quickly and easily. And the crisis counselor and resources have to be spot-on. 988 is a go on July 16.

First and foremost, it’s time to make a 988 call if you’re to any degree thinking about suicide or concerned about someone else.

I’ve provided contact information for the National Suicide Prevention Lifeline numerous times. In fact, here it is again…

800.273.TALK (8255) and for live chat and information:

Perhaps you’ve used it or provided the contact information to someone in need.

988 Suicide & Crisis Lifeline

The Substance Abuse and Mental Health Services Administration (SAMHSA) is introducing a new – quicker, easier, more effecient – way to connect calls and texts to the Lifeline.

988 will be ready for use on July 16, 2022.

The old Lifeline number and website with chat option will continue to be available, as will 24/7 access and excellent translation services.

Just like before, when you use 988 a trained crisis counselor will offer emotional and mental support and connect you with indicated resources.

And keep in mind, the Lifeline is comprised of more than 200 crisis centers. That means there’s an emphasis on locally available help.

When should you call 988?

i don't want to kill myself

July 16, 2022

First and foremost, it’s time to make a 988 call if you’re to any degree thinking about suicide or concerned about someone else.

Beyond that absolute necessity, there are no specific requirements for calling.

Reasons to call

It isn’t all inclusive, but here’s a list of reasons people call the Lifeline…

  • Active thoughts or plans of suicide
  • Suicidal ideation – having thoughts you’d like to die
  • Self-harm or wanting to hurt yourself
  • Struggles with substance use
  • Financial stress
  • Relationship problems
  • Dealing with abuse or domestic violence
  • LGBTQIA+ support
  • Emotional/mental and physical health struggles
  • Loneliness and isolation
  • Concern about a friend, family member, client, or others

Got it?

988 FAQs

Let’s take a look at some answers to a handful of FAQs. I’ll line you up with a link at the end so you can go through the full list…

  • You’re not required to share any personal details to use the Lifeline. But even if you do the call is confidential. That changes, however, under certain circumstances. For instance, if you’re in immediate danger of harming yourself or others, staff may request a wellness check by public safety officials.
  • The 988 and 911 systems will be closely coordinated. However, 911 only becomes involved when there’s imminent risk to someone’s life that can’t be reduced during a call.
  • The Lifeline works. Numerous studies have shown that most Lifeline callers are significantly more likely to feel less depressed, less suicidal, less overwhelmed, and more hopeful after speaking to a Lifeline crisis counselor.
  • The Lifeline currently serves TTY users through their preferred relay service or by dialing 711 then 1.800.273.TALK (8255). Services are also available through chat and text. Lifeline is in the process of expanding to video phone service to better serve deaf or hard of hearing individuals.
  • The Lifeline will be available in all 50 states and 5 territories. Of course, the caller has to have access to cellular or internet service.

Perhaps that gives you a bit more insight into the workings of 988 and the Lifeline.

The help we deserve

We’re human, so emotional and mental crises happen. We can handle some of them on our own; however, others exceed our ability to cope.

988 makes accessing the help we deserve quicker and easier. We’ll look forward to July 16.

Much more 988 information from SAMHSA. And those FAQs.

Here are some suicide-related Chipur articles you may find interesting and helpful…

Suicide Prevention: Guidance for family and friends

Saving People from Suicide: An occasional letter?

“I’m so tired of it all.”

And if you’re still in the mood for some reading, there are hundreds of Chipur mood and anxiety disorder info and inspiration articles waiting for you.

Borderline personality disorder: Let’s get it right

Borderline personality disorder: Let’s get it right

Borderline personality disorder is grossly misunderstood. And the stigmatic consequences wreak havoc on the lives of the diagnosed and those who won’t risk being labeled. It’s wrong, so let’s get it right.

BPD has traditionally been viewed as difficult to treat. However, with newer, evidence-based treatments, hopeful prognoses are common.

We have tons to cover, so I’ll make a brief opening statement.

I have personal reasons for setting the record straight on borderline personality disorder.

‘Nuff said. Let’s get busy…

What is borderline personality disorder?

Borderline personality disorder (BPD) is an emotional/mental illness characterized by an ongoing pattern of shifting mood, fluctuating self-image, and dicey behavior.

Those with BPD may experience intense episodes of anger, depression, and anxiety that can last from a few hours to many days.

Other common BPD characteristics include quickly changing interests and values, impulsivity, uncertainty about one’s role in the world, viewing things in extremes, seesawing opinions of others, and intense and unstable relationships.

BPD is a cluster B personality disorder.

DSM-5 diagnostic criteria

To help us better understand BPD, here are edited portions of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria.

According to the manual, meeting five or more qualifies for a diagnosis…

  1. Frantic efforts to avoid real or imagined abandonment
  2. A pattern of unstable and intense interpersonal relationships
  3. Identity disturbance
  4. Self-damaging impulsivity
  5. Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior
  6. Affective instability
  7. Chronic feelings of emptiness
  8. Inappropriate, intense anger or difficulty controlling anger
  9. Transient stress-related paranoid ideation or severe dissociative symptoms

An individual is most often “officially” diagnosed with BPD at or above the age of 18. Now, there’s no rule saying it can’t be diagnosed before; however, practitioners typically avoid it.

The issue is, many of the presenting “BPD” symptoms come with the adolescent mind. And in the majority of cases, they don’t stick around. But if a pattern of symptoms lasts for at least a year, a diagnosis is justified.

Finally, as many as 6% of adults are believed to have been affected by BPD at some time in their lives.

It was believed that women were three times more likely to be diagnosed with BPD than men. More recent studies indicate that number is decreasing.


BPD co-occurs with other emotional/mental disorders in 85% of cases. And that means a BPD diagnosis is frequently missed, bipolar disorder often being the wrongly chosen diagnosis.

By the way, check out Borderpolar: I’m thinking I know what it is. Do I?

Here are the numbers on BPD comorbidity (co-occurrence)…

  • Persistent depressive disorder (dysthymia): 70%
  • Major depressive disorder: 60%
  • Self-injury: 55%-85%
  • Substance abuse: 35%
  • Eating disorders: 25%
  • Narcissistic personality disorder: 25%
  • Antisocial personality disorder: 25%
  • Bipolar disorder: 15%

What causes borderline personality disorder?

what causes borderline personality disorder

“I can’t handle the abuse anymore. I’m outta’ here.”

Not near enough is known about the cause and risk factors of BPD. Sadly, research is in its infancy.

As long as we’re talking about cause, let’s quickly review something known as the diathesis-stress model (DSM).

The DSM suggests that predispositional vulnerabilities (diatheses) combine with stress from life experiences to generate, in our case, mood and anxiety symptoms and disorders.

So it’s this grand convergence of what was already in place and what was acquired.

The cause of BPD is no exception…


Environmentally, childhood events play a significant role in the development of BPD. Included are emotional, physical, and sexual abuse, loss, neglect, abandonment, adversity, bullying, and being exposed to unstable and invalidating relationships, as well as hostile conflicts.


Genetics (predispositional) appears to be involved, as having a close family member, such as a parent or sibling, with a BPD diagnosis points to higher risk.


Studies have shown that people with BPD may have structural and functional changes in the brain, especially in areas that control impulses and emotional regulation (predispositional). But, of course, are they contributors or caused by the wear and tear of BPD?

How is borderline personality disorder treated?

BPD has traditionally been viewed as difficult to treat. However, with newer, evidence-based treatments, hopeful prognoses are common.

One of the keys to a successful outcome is receiving specialized treatment from a qualified therapist. Getting along with, and trusting, that therapist is crucial. If there isn’t the right feel, the individual won’t be motivated to fully engage in treatment.


Yes, psychotherapy is the first-line treatment for BPD. The most frequently used is a form of cognitive behavioral therapy (CBT) known as dialectical behavior therapy (DBT), which was developed specifically for BPD.

DBT incorporates concepts of mindfulness and acceptance – being aware of and attentive to the current situation and one’s emotional state.

It also teaches skills that can aid in controlling intense emotions, reducing self-destructive behaviors, and improving relationships.

Also used in the treatment of BPD is cognitive behavioral therapy. CBT can assist with identifying and changing core beliefs and behaviors that underlie inaccurate perceptions of self and others, which helps with social interactions.

CBT may also help reduce a number of mood and anxiety symptoms, and reduce the quantity of suicidal or self-harming behaviors.

As long as we’re talking about therapy, significant others may benefit from it. In fact, some BPD therapies include them.


Medications aren’t used specifically for BPD; however, they may be prescribed to address mood swings, depression, anxiety, and other comorbid conditions.

BPD treatment is most often conducted on an outpatient basis. However, inpatient treatment may be indicated.

Self-harm and suicide

Given BPDs higher incidence of self-harming and suicidal behaviors, it’s important for those diagnosed to seek immediate help if either make the scene. Those close to them need to be prepared to intervene.

988 is the number for the Suicide & Crisis Lifeline. And here’s some international help.

Let’s get it right

Again, misunderstanding borderline personality disorder has stigmatic consequences. And that’s incredibly harmful to diagnosed individuals and those who won’t risk a diagnosis.

I couldn’t possibly include all there is to know about BPD, so do all you can to learn…

Let’s get it right.

If you’re looking for a great BPD read: Borderline Personality Disorder Demystified by Robert O. Friedel, MD.

Thanks to the National Institute of Mental Health and the National Education Alliance for Borderline Personality Disorder for the resource material.

Hey, Chipur mood and anxiety info and information articles are waiting for you. Peruse the titles.