The borderline patient in the emergency department: an approach to evaluation and management

Emergency visits of borderline and chronically self-destructive patients remains a frequent and difficult problem. The author relates examples and clinical observations from these visits with emphasis on the meanings of suicide attempts, observations of families, patterns of visits, and psychodynamic issues. Suggestions for an approach to these patients are offered. The approach aims to preserve viable psychotherapeutic relationships through repeated crises and to decrease long-term risks of suicide. Theoretical consideration of the emergency room as an available object is suggested.