re: 12 Year Old Girl with BPD

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She always has the nuclear option of threatening suicide, and she uses it very often.

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Suicide threats are one of the key means of manipulation these patients use. Even with a therapist they will go an entire session without saying anything bad, but right before the session ends they will start talking about suicide which forces the therapist to stay with them and address it. With BPD you typically get more self-injury and other parasuicidal behavior than actual suicide attempts. For example, cutting their wrist so they bleed, but not cutting so deep that there is an actual threat to their life from it.

Disorders like this are a key reason I stick to evaluation and diagnosis and don't do therapy.