Safety Plan for Borderline Personality Disorder

A safety plan is a critical part of treatment for borderline personality disorder (BPD). People with BPD are among the most at risk of attempting suicide or engaging in other high-risk activities. Without a safety plan, you may be in danger of harming yourself or someone else. A safety plan can reduce your risk and make it less likely that you will make a decision in the heat of the moment that will have serious consequences.

This article covers the steps in preparing a clear and comprehensive safety plan. This is not something that can be done when you are already in the midst of a mental health emergency but should be done ahead of time so you are ready.

Talk to Your Therapist About a Safety Plan

If you have BPD and have been going to therapy, talk to your therapist about developing a safety plan or emergency plan. Depending on your unique situation, she may recommend including specific things or skipping other areas so that it is tailored to you and your needs.

If you do not have someone to work with on a safety plan, find a therapist. If the stigma of seeing a therapist is keeping you from this important step, keep in mind that it's likely every person could benefit from seeing a therapist at times. Just as we see physicians (medical doctors) routinely to take care of our physical health, seeing a therapist can be an excellent investment in maintaining and maximizing your emotional health.

Evaluate Your Behaviors

Once you have enlisted your therapist, you can have her help you to evaluate your risk and potential dangers, including:

• Thoughts of suicide, even if infrequent and fleeting
• Urges to harm yourself
• Thoughts of harming others
• Issues with violence

These will be the targets of your safety plan, so it is important that you think carefully about what behaviors you may need to plan for.

Along with evaluating your risk, you should evaluate whether there are factors that may be increasing your risk of completing suicide or harming others, such as owning a weapon or access to potentially dangerous medications.

Depending on your situation, your healthcare provider may help you minimize your risk of harming yourself or others by handing your weapons over to police or prescribing medications in only small quantities.

Identify Triggers 

Once you have a list of the behaviors or symptoms that put you at risk of harm, identify the events, situations, people, thoughts or feelings that trigger those behaviors or symptoms (BPD triggers).

For example, many people with BPD have abandonment sensitivity, which makes experiences of real or perceived abandonment very painful. For those individuals who suffer from this symptom, abandonment experiences may trigger suicidal thoughts or thoughts of harming others.

Make a Safety Plan for Coping Resources

Now, identify how you can respond to your triggers in ways that will keep you safe. These will be coping resources that you will use before your symptoms become so intense that you are having a mental health crisis.

Make a list of healthy coping skills for BPD that you are familiar with and that work for you, as well as sources of social support and people or places that can help you if you need it. These can include:

• Coping techniques like mindfulness meditation
• Your therapist's emergency number
• List of emergency mental health clinics and emergency rooms
• The National Suicide Hotline (1-800-273-8255)

Document Your Safety Plan

Now it is time to put it all together. You have a list of your risk behaviors, your triggers, ways you can cope before symptoms become too intense and ways you will respond in the case of an emergency. Put these all together to give yourself a step-by-step plan of action.

For each risk behavior, write out the triggers for that behavior, the coping responses you could engage in if you experience a trigger and what you will do if the coping responses do not work and you begin to experience an emergency situation. Continue until you have a safety plan for all of the risk behaviors you identified.

Make a Safety Plan Commitment

The last step is to make a commitment to your safety plan. This means committing to yourself that you will follow this plan when the need arises and then committing out loud to someone else that you will follow this plan.