Special Considerations “The Chronically Suicidal” Patient

(Lambert, Psychiatric Serv. 53:92-94, 2002)

• Often Cluster B Personality Disorder
• Often brief situational/interpersonal crisis
• The dilemma of “compassion fatigue”
• Potential abuse/over-utilization of resources

Special Considerations
The “Chronically Suicidal” Patient

Contingent Threats
• Leverage is applied
• Secondary gain
• Often presented in dramatic manner
• Risk contingent on meeting demands
• “Unless you , I will ”

Non-Contingent Threats
• Escape from severe emotional pain
• Passive, silent, hopeless, withdrawn
• Less demanding
• Requires knowing the patient’s history and baseline level of functioning

Special Considerations
The “Chronically Suicidal” Patient

• Severity and lethality are more important factors than frequency of ideations
• Avoid:
– “How bad is this situation compared to others?”
• Instead:
– “How is this situation different from your most severe time?”

• Set Limits & Offer Choices
• Go back to established crisis plan
• Ask about pets