Is Hospitalization Useful for Suicidal Patients with Borderline Personality Disorder?

Paris’ 2004 paper, “Is Hospitalization Useful for Suicidal Patients with Borderline Personality Disorder?” (Journal of Personality Disorders, 18[3]:240–247), argues that prolonged inpatient care for borderline personality disorder (BPD) is not only of unproven benefit but may, in fact, be counterproductive. Paris notes that while up to 10% of individuals with BPD may ultimately die by suicide, most suicide attempts are nonlethal, impulsive, and communicative acts that occur in the context of distress or relational rupture rather than a fixed wish to die. Long-term follow-up studies show that the majority of patients improve over time, suggesting that chronic suicidality can remit without prolonged hospitalization (Paris & Zweig-Frank, 2001; Paris, 2002a).

Hospitalization, Paris contends, rarely prevents suicide and can worsen dependency. When admissions become repetitive, patients may learn to “work the system,” seeking admission whenever distressed. This reinforces maladaptive behaviors and fosters regression rather than resilience. Moreover, hospital wards—designed for acute psychiatric illness—do not provide effective treatments for the interpersonal instability and affective dysregulation characteristic of BPD. As one patient insightfully reflected, every hospitalization “rewarded” her suicidality with increased nursing attention, prolonging the cycle (Williams, 1998).

Instead of prolonged inpatient care, Paris advocates for structured outpatient and partial hospitalization programs—such as day treatment, dialectical behavior therapy (Linehan, 1993), and mentalization-based treatment (Bateman & Fonagy, 1999)—which provide containment without fostering dependency. He concludes that clinicians must learn to tolerate chronic suicidality, using it as a therapeutic signal rather than an emergency requiring admission. Hospitalization should be brief, goal-directed, and reserved for acute crises, while recovery for most patients lies in learning to live, not in learning to be hospitalized.

Reference:Paris, J. (2004). Is Hospitalization Useful for Suicidal Patients with Borderline Personality Disorder? Journal of Personality Disorders, 18(3), 240–247. https://www.researchgate.net/publication/8472036