The management of self-inflicted burn injuries and disruptive behavior forpatients with borderline personality disorder

One of the greatest behavioral and ethical challenges faced by a burn team is the treatment of a patient whose burn injury is the result of parasuicid al behavior. Parasuicidal behavior is defined as intentional self-injurious behavior that, although not fatal, may result in tissue damage or risk of death. There are a number of reasons, usually psychiatric, that patients en gage in parasuicidal behavior; however, our contention is that the majority of these patients have a Diagnostic and Statistical Manual of Mental Disor ders, Fourth Edition Axis II diagnosis of borderline personality disorder. We describe the nature of borderline personality disorder and how it leads to disruptive behavior, including self-harm behavior, on the burn unit. We also argue that if staff members fail to recognize the borderline personali ty disorder diagnosis, it will lead to responses from staff that can height en disruptive behavior. We present a series of recommendations for treating such patients with burns and an illustrative case report.