The Use of Dialectical Behavior Therapy in Patients with Suicidal Ideation

Abstract

Background: Dialectical behavior therapy (DBT) is a psychotherapeutic approach that aims to reduce incidences of self-harm and suicidal ideations through use of skills-based training and individualized psychotherapy. While DBT has been applied to patients with borderline personality disorder (BPD), it can potentially be used in anyone with a history of self-harm or attempted suicide. We investigated whether DBT is an effective therapy in the treatment of patients with repeat suicidal ideation regardless of a BPD diagnosis. Case Description: A 31-year-old female veteran with a history of substance use disorders, post-traumatic stress disorder, BPD, and multiple suicide attempts presented to the emergency department (ED) for suicidal ideation (SI). She has had at least 7 hospitalizations in the past year for SI. While inpatient, the patient had daily therapy, motivational interview, and pharmacological management. She denied SI upon discharge and was sent home on her previous medication regimen and follow-up with substance use recovery and DBT. Conclusion: Few studies have looked at the effectiveness of DBT in treating SI or self-harm without exclusively looking at BPD. However, the studies that have evaluated DBT for suicidal ideation, it was seen to be effective in reducing incidence of self-harm and suicidal attempts including a meta-analysis of 18 clinical trials found DBT reduced self-directed violence and frequency of psychiatric crisis. One point found during our literature search worth exploring further is whether DBT is offered more to female patients compared to male patients due to the association of BPD as every study reviewed had a female majority. Clinical significance: Per CDC, suicide is the 12th leading cause of death. In 2020, there were an estimated 1.20M suicide attempts and 45,979 Americans died by suicide. DBT therapy should be considered as a standard of care in patients with suicidal ideation as current literature suggests it can be beneficial in reducing suicidal attempts and incidence of self-harm.