hardborderline personality disorderchronic suicidalityDBTbenzodiazepine tapercrisis planningmeans restriction
A 27-year-old woman with borderline personality disorder has been hospitalized four times in the past year for suicidal ideation and self-harm including superficial cutting and two overdoses on over-the-counter medications. Between hospitalizations, she describes chronic passive suicidal ideation that she rates as 4 out of 10 at baseline. She is currently prescribed fluoxetine 40 mg, quetiapine 200 mg, and clonazepam 1 mg three times daily. She was recently discharged after a five-day hospitalization and presents for outpatient follow-up. She reports her typical baseline suicidal ideation without acute escalation, plan, or intent. When developing the outpatient treatment plan, which approach is most appropriate?